Symptoms of different types of bronchopneumonia

There are several forms of inflammation, each of which has its own symptoms, pathogen and course; let's look at the main types of bronchopneumonia.

Morphological:

• Pneumococcal is the most common form, characterized by the formation of foci associated with the bronchioles. The inflammatory foci contain fibrinous exudate.
• Staphylococcal - occurs in 5-10% of cases. Develops after flu, pharyngitis. Tends to necrosis and suppuration of the alveolar septa. Often leads to the development of purulent pleurisy, acute abscesses, cysts, pneumatocele.
• Streptococcal – this type accounts for 11-13% of cases of the disease. It occurs due to hemolytic streptococcus groups A and B. It affects the lower lobes of the lungs. The foci of inflammation contain serous-leukocyte exudate with a pronounced interstitial component.
• E. coli - the pathogen enters the respiratory system by hematogenous route. This occurs with urinary tract infections, gastrointestinal tract, after surgical interventions. The lesion is bilateral, accompanied by foci of necrosis and hemorrhagic exudate.
• Pseudomonas aeruginosa - with aspiration infection, inflammation with pleurisy and abscess formation develops. The mortality rate of patients with this form is 50%.
• Fungal infection (most often Candida fungi) – inflammation foci vary in size with accumulation of eosinophils and polymorphonuclear leukocytes. Formation of decay cavities is possible, in which fungal threads can be easily detected. Inflammation is accompanied by fibrosis.

Depending on the degree of damage and the nature of the course, the following forms of bronchopneumonia are distinguished:

• One and two-sided.
• Focal – affects a small area of the lung.
• Confluent - the fusion of small foci of inflammation into large ones.
• Lobar or croupous - affects an entire segment.
• Segmental – captures one or more segments.
• Total – the inflammatory process affects the entire organ.

According to the severity, the inflammatory process can be: mild, moderate, severe and extremely severe.

Right-sided bronchopneumonia

High concentration of bacteria in the projection of the lung field on the right causes inflammation. Right-sided bronchopneumonia is localized on the left side of the lungs. This is due to the fact that the main bronchus goes obliquely from top to bottom, which provokes the throwing of harmful microorganisms into the lower parts of the lung and the accumulation of a large amount of infection in one place. Treatment is difficult, since microbes multiply much faster than they die, and there is weak blood circulation in the bronchial tree.

The causes of the lesion may be viruses, fungi, bacteria and physical factors. They provoke painful symptoms: cough, weakness, increased fatigue and sweating, shortness of breath, sputum production and an increase in leukocytes in the blood. Most often, the disease occurs as a result of streptococcal infection. Pneumococcal infection can cause death, as with bilateral lesions.

X-rays in lateral and direct projections are used for diagnostics. This makes it possible to identify the infiltrative focus, assess its localization, size and track the dynamics of pathological changes during therapy. Treatment is carried out with antibiotics. The lesion must be eliminated as early as possible. Since the anatomical structure of the bronchial tree causes rapid proliferation of bacteria and a high frequency of relapses due to poor or late treatment.

Left-sided bronchopneumonia

Inflammation of the left side of the chest is a common disease that can occur as a result of a cold. Left-sided bronchopneumonia is rightfully considered one of the most dangerous and serious illnesses, as the mortality rate is 5%.

Signs of malaise:

• Pain in the chest area on the left side (of a nagging nature, intensifies with deep inhalation and weakens with compression of the chest)
• Cough with sputum containing streaks of pus and blood
• Fever and chills
• Intoxication of the body
• Dyspnea
• Increased weakness
• Headaches and dizziness

In some cases, the disease is asymptomatic, i.e. it takes an atypical form. This has a negative impact on the prognosis of recovery, since without timely diagnosis and treatment, many life-threatening complications arise. To identify the pathology, X-ray, bronchoscopy, laboratory analysis of sputum and blood are used.

Second and third generation antibiotics (levofloxacin, cephalosporin, amoxicillin) are used as therapy. Inflammatory processes are eliminated by strengthening the immune system. Vitamin therapy, exercise therapy, and a complete balanced diet are used for these purposes.

Bilateral bronchopneumonia

Harmful microorganisms that affect the respiratory system affect the functioning of the entire body, causing failures and disruptions in its functioning. Bilateral bronchopneumonia is a serious and dangerous disease that can be fatal without proper treatment.

Its main cause is viruses and other pathogenic microorganisms. Factors such as frequent colds, hypothermia, disrupted rhythm of life, chronic diseases, hypovitaminosis and allergies significantly weaken the protective properties of the immune system, provoking the development of the disease.

Symptoms:

• Fever is a sharp jump in body temperature that is difficult to reduce with antipyretic drugs.
• Severe headaches and migraines.
• Pain in the chest area that intensifies with deep breathing.
• Increased sweating and shortness of breath.
• Cough with the separation of sputum with an unpleasant odor, pus and blood.
• Pale or bluish skin tone, rashes on the face.

The treatment is long and complicated. The patient is prescribed a drug complex, the composition of which depends on the severity of the pathological process and the age of the patient. As a rule, antibiotics, antihistamines and anti-inflammatory drugs, vitamins are used. Physiotherapeutic procedures are used to achieve a lasting therapeutic effect.

Bronchopneumonia in children

In children's pathology, among various diseases, respiratory tract lesions occupy a special place. Bronchopneumonia in children under two years of age accounts for 85% of all respiratory diseases. In older age - from 2 to 10 years, it occurs less often, but has a longer course.

The main causative agents of bronchopneumonia:

• Newborns (up to 3 weeks of age) – group B streptococci, Listeria monocytogenes, cytomegalovirus, gram-negative bacilli.
• Up to three months – most often it is a viral infection (ARI, parainfluenza virus, influenza), Bordetella pertussis, Streptococcus pneumoniae, Staphylococcus aureus.
• Up to four years – patients in this age category are susceptible to group A streptococci, various viral infections, Streptococcus pneumoniae, Mycoplasma pneumoniae.
• From 5 to 15 years – Chlamydiapneumoniae, Streptococcuspneumoniae, Mycoplasmapneumoniae.

The main symptoms are: severe cough, intoxication, elevated body temperature, headaches, shortness of breath, wheezing, leukocytosis, pale skin, rapid heartbeat. In rare cases, the disease occurs without fever and cough.

If the disease is mild, then the treatment is carried out on an outpatient basis. The thing is that pneumonia foci in pediatric patients can easily resolve on their own. This is due to the good contractility of the lungs and the abundance of lymphatic vessels in this organ. If the disorder is severe or recurs, then the baby is prescribed drug therapy. The child's parents should ensure that the patient stays in bed and drinks plenty of fluids. Particular attention should be paid to a therapeutic diet and physiotherapy to strengthen the body.

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Acute bronchopneumonia

A disease affecting the walls of the bronchioles, accompanied by severe symptoms, indicates an acute pathological process. Acute bronchopneumonia develops quickly and is extremely rare. Most often, it occurs in young patients and occurs against the background of such ailments as: inflammation of the trachea and bronchi or bronchitis. It is difficult to diagnose, since in the secondary form, the symptoms are blurred and similar to the signs of the primary lesion.

At first, there is a very high temperature, increased weakness, headaches and cough. In addition, chest pain and rapid breathing are possible. The disease can be caused by streptococcal infection, E. coli and Staphylococcus aureus. Bacteria penetrate the parenchyma of the lungs, causing inflammation. This leads to the alveoli filling with exudates or pus. Part of the air space is lost, the patient has difficulty breathing. Isolation of one or more lobes of the organ is possible.

Treatment involves bed rest and plenty of fluids. The patient is prescribed a complex of antibiotics and drugs to strengthen the immune system. Expectorants are taken to restore normal functioning of the bronchi. Auxiliary methods are also used in therapy: exercise therapy, mustard plasters, ozokerite and other means.

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Chronic bronchopneumonia

Without proper or timely treatment, almost all diseases recur and cause a number of complications. Chronic bronchopneumonia occurs as a result of complications of its acute form. The etiology of the disease is similar to the primary one, that is, the causative agent is pathogenic microflora: streptococci, pneumococci, staphylococci, decreased immune system, chronic bronchitis and much more.

Chronic course is characterized by bronchiectasis, which can appear due to previous bronchitis. Due to the inflammatory process in the bronchi, the muscle tissue of the walls is replaced by connective tissue, which makes the organ thin. The bronchi stretch, gradually expand, and pus and mucus accumulate in them.

Main symptoms:

• Pulmonary heart failure
• Elevated temperature
• Cough with foul-smelling, green sputum with streaks of blood
• Pulmonary hemorrhages
• Shortness of breath
• Excessive sweating
• Sudden weight loss
• Loss of appetite
• Wet rales

X-rays are used to detect the disorder. They help to identify peribronchial or infiltrative changes. Bronchography can detect bronchiectasis, which resembles a tree with foliage due to the expanded segments of the bronchi. The blood shows pronounced leukocytosis, with a band shift and an increase in ESR.

Catarrhal bronchopneumonia

Bronchitis causes not only pathological damage to the respiratory system, but also many complications. Catarrhal bronchopneumonia is one of such complications. The disease is an inflammation of individual lobes of the lung, which passes from the mucous membrane of the bronchi to the pulmonary alveoli.

It can occur under the influence of factors that reduce the body's immune system. That is, colds, bronchitis, vitamin deficiency, poor nutrition and negative environmental influences can provoke the disorder.

• At first, there is a high temperature, decreased appetite, a runny nose with mucopurulent discharge and cough. Breathing becomes difficult, shortness of breath and wheezing appear. In addition, minor heart failure and problems with the gastrointestinal tract are possible.
• The disease lasts for 2-3 weeks and with proper and timely treatment has a favorable prognosis and does not recur. Without proper therapy, it can cause serious complications: purulent pneumonia, abscess and gangrene of the lungs.

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Focal bronchopneumonia

One of the most dangerous forms of inflammation is considered to be the one in which the pathological process moves to the lung tissue. Focal bronchopneumonia is characterized by the appearance of inflammation foci of different sizes and different localizations. In the affected areas, the alveoli are filled with serous or purulent exudate with a high level of leukocytes. If it occurs as a result of flu or a cold, then ruptures of small vessels are observed.

Most often, the focal form is secondary, that is, it appears against the background of another disease. The cause may be: flu, purulent otitis, dysentery, scarlet fever, measles, peritonitis, scarlet fever, furunculosis and others. If the disorder is primary, then the microbes enter the lungs through the bronchi, that is, by the bronchogenic route.

Symptoms:

• Elevated body temperature
• Sweating
• Chills
• Headaches
• Fever
• Chest pain (worsens with breathing and coughing)
• Cough (can be either dry or wet with expectoration)
• Tachycardia
• Shortness of breath
• Exudative pleurisy (if the causative agent of the disease is streptococcus)

In most cases, the causative agent is pneumococcal infection, so antibacterial drugs (penicillins, cephalosporins, fluoroquinolones) are used for treatment. Medicines can be combined and used both intravenously and intramuscularly. A mandatory condition for recovery is the use of general tonics, i.e. vitamins and anti-inflammatory drugs. After the acute symptoms have gone, various physiotherapeutic procedures are used (electrophoresis, UHF).

Despite the danger of the disease, the disease is not contagious, but the pathogens can enter another person's body, causing flu or some other disease. Without proper treatment, this leads to serious complications: heart failure, pulmonary edema, sepsis, pericarditis, septic shock, meningitis, anemia, gangrene of the lung.

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Purulent bronchopneumonia

The abscessing form of inflammation is characterized by the destruction of lung tissue under the influence of pathological processes, which can lead to abscesses, pneumosclerosis or bronchiectasis. Purulent bronchopneumonia is a destructive process characterized by the formation of multiple purulent foci in the tissues of the respiratory system.

The cause may be aspiration, when a foreign body closes the lumen in a small bronchus. An abscess forms in the airless area. Another variant of the development of pathology is the introduction of infection through the circulatory system from any external source. In this case, unaffected lung tissue is separated from the abscess by connective tissue.

Symptoms of illness depend on the pathogen:

• Classic symptoms include fever, severe intoxication, chills, cough with foul-smelling sputum, sudden weight loss and anorexia.
• The symptoms differ significantly before and after the abscess bursts. If before the rupture, the sputum caused severe intoxication and general weakness, then as soon as the abscess bursts, a large volume of sputum is released - about 1 liter.
• After the purulent contents have passed, the disease changes its course dramatically. The patient's condition improves, breathing becomes easier, and appetite appears. Sputum continues for a certain period of time, while the cough persists. After the purulent cavity has been completely emptied, it scars.

X-ray and computed tomography are used for diagnostics. Medications (antibiotics, immunotherapy, infusion therapy), physiotherapy and folk methods of influencing the source of infection help as treatment.

Aspiration bronchopneumonia

Infectious toxic lesion of the lung parenchyma, develops due to irritants entering the lower respiratory tract. Aspiration bronchopneumonia occurs as a result of the penetration of stomach contents (food, liquid) or the nasopharynx into the respiratory organ. It manifests itself as tachycardia, severe cough, chest pain, sputum with a sharp unpleasant odor, cyanosis, fever.

There are a number of factors that contribute to the development of pathology. This category includes elderly patients with lung diseases or stroke, as well as those who have problems with teeth. Convulsions, loss of consciousness due to alcohol consumption, stroke, can cause aspiration. Another group of factors is: heartburn, lung damage of varying severity, swallowing disorders due to Parkinson's disease, Charcot's disease, bad teeth.

Symptoms:

• Frequent coughing after eating or drinking.
• Increased heart rate and shortness of breath.
• Pain in the chest when coughing and breathing.
• Problems with swallowing.
• Fever, chills.

To diagnose the disorder, the patient undergoes a chest X-ray, which helps to detect the presence of infiltrates. A sputum sample is taken to determine the resistance of the infection to various antibiotics. In addition, patients undergo bronchoscopy and X-ray contrast barium study.

The treatment consists of several stages. As a rule, the entire process takes place in a hospital setting. At the first stage, the patient is prescribed a course of antibiotics, which are administered through an intravenous catheter and taken orally. If there are breathing problems, the patient is connected to a respirator. Particular attention is paid to prevention methods - this is timely therapy of various diseases and elimination of dental problems.

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Community-acquired bronchopneumonia

Inflammatory lung disease that occurs outside of a hospital setting or in the first two days after hospitalization is considered one of the most common acute infectious diseases. Community-acquired pneumonia (outpatient, home) most often occurs due to pneumococcal infection and atypical microorganisms (Legionella, mycoplasma), in rare cases due to Haemophilus influenzae.

Main reasons:

• Aspiration, that is, the entry of contents from the oropharynx into the respiratory tract.
• Violation of the mechanism of cleansing the bronchi from pathogenic microorganisms that cause inflammation.
• Penetration of infection from neighboring organs.
• Inhalation of air containing a large number of microorganisms (one of the rare mechanisms for the development of pathology).
• Infection enters the bloodstream from various affected areas.

This type of disease most often occurs in the following forms:

1. Croupous inflammation is characterized by acute symptoms, i.e. a sharp increase in body temperature to 39° C, headaches, chills and chest pain. It occurs due to damage to the pleura. In the first day after infection, the patient develops a dry cough, which quickly transforms into a wet cough with sputum. Shortness of breath, a significant decrease in performance, muscle and joint pain, loss of appetite occur.
2. The focal form begins gradually and, as a rule, after a previously suffered viral infection. It all begins with symptoms of weakness, constant coughing. Later, a dry cough with the separation of purulent-mucous sputum and an increase in body temperature occurs.

In some cases, the disease is complicated by pleurisy, acute respiratory failure, gangrene and abscess. Most often, complications occur with the croupous form. To identify the disease, X-ray examination, percussion and auscultation, computed tomography and bronchoscopy are used. The patient must pass sputum, blood and urine tests.

Moderate and severe cases are treated in hospital. In mild cases, therapy can be carried out at home. The patient is prescribed a course of antibiotics, anti-inflammatory drugs, vitamins and other medications to strengthen the protective properties of the immune system. The patient is prescribed bed rest, plenty of fluids and a complete, balanced diet.

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Lower lobe bronchopneumonia

Acute inflammation of an infectious-allergic nature, affecting one or more lobes of the lung and the pleura, occurs in patients of all ages. Lower lobe bronchopneumonia can be left-sided and right-sided. It is characterized by a sharp deterioration in health, headaches, fever, shortness of breath, wet cough, sweating and general weakness.

Most often, right-sided lower lobe damage is diagnosed. This is due to the anatomical features of the location and structure of the respiratory system. The thing is that the right lower lobe of the bronchus has an oblique direction, where viruses and bacteria can accumulate. A long-term decrease in the protective properties of the immune system contributes to the development of malaise. Without timely and adequate treatment, the disease leads to acute inflammation of the alveoli and disruption of gas exchange between the circulatory system and the alveolocapillary barrier. As a result of blood deficiency, the work of other organs and systems is disrupted.

Signs of the disease:

• High temperature
• Excessive sweating
• Chills
• Cough with viscous sputum
• Blood streaks in sputum
• Pain in the right or left half of the chest

All the above symptoms are classic for lower lobe lesions. Treatment is carried out in a hospital setting, where the patient undergoes a course of drug therapy, that is, taking antibiotics, anti-inflammatory drugs and other means to combat the disease. Recovery takes a long time, so after the hospital, the patient is prescribed prevention, which includes physiotherapy, vitamin therapy and a balanced diet.

Hilar bronchopneumonia

Inflammation of the lung tissue located at the roots of the organ is rightfully considered one of the most complex forms of the disease. Root bronchopneumonia occurs as a result of infection. Getting into the body, harmful microorganisms begin to actively multiply at the level of large bronchi. Against this background, a periprocess develops, which spreads along the paramediastinal space, but does not affect peripheral tissues.

Most often, patients are diagnosed with right-sided lesions. The pathology can take two forms - tumor-like and inflammatory. Let's consider each of them:

• Inflammatory - it is characterized by a protracted course, and remissions are quickly replaced by exacerbations. The body quickly weakens, and it becomes increasingly difficult to treat the disease.
• Tumor-like – has a torpid course. Small tubercles form on the root of the lung, and as a result of pressure – lobar and segmental atelectasis.

Regardless of the form of the illness, the patient experiences symptoms such as fever, chills, severe cough, weakness, headaches, leukocytosis. At the same time, such a classic symptom as pain in the hypochondrium may be absent.

The treatment process depends on the results of diagnostics, which is significantly complicated. The whole point is that the radiological signs are similar to the symptoms of tuberculosis or central lung cancer. Intensive therapy should begin immediately after the disease is detected. The patient is prescribed antibacterial agents and physiotherapy procedures to restore the immune system and the body's defenses.

Specific bronchopneumonia

Diseases of the lungs and bronchi, most often caused by pneumococcal and streptococcal infections. Specific bronchopneumonia can be caused by: tuberculosis mycobacteria, glanders bacillus and other microorganisms. That is, according to morphological features, specific inflammation does not differ from the nonspecific form.

Let's look at the main signs of malaise:

• The disease has a wave-like course and quickly becomes chronic. In this case, periods of remission are often replaced by exacerbations.
• During the inflammation process, granuloma development and productive tissue reaction occur.
• As the disease progresses, necrosis of exudate and proliferate is observed, which arise due to a specific tissue reaction.

The above-described signs unite all types of inflammation caused by various harmful microorganisms. The symptoms are classic, that is, a sharp increase in temperature, chills, fever, dry cough, which quickly transforms into a wet cough with sputum. Bronchoscopy, X-ray examination and tests (sputum, blood, urine) are used for diagnosis. Treatment depends on the resistance of the pathogen to various antibiotics. Vitamin therapy and prevention are mandatory.

Nonspecific bronchopneumonia

An inflammatory disease of the bronchi, characterized by periodic exacerbations, indicates a special form of the disease. We are talking about non-specific bronchopneumonia, which very often becomes chronic. It is accompanied by structural changes in the lung tissue.

Optional signs of non-specific inflammation are: bronchiectasis, pleurisy, emphysema, atelectasis (typical for mature patients), acute and chronic abscesses. In case of complications, pulmonary hemorrhage and hypertension, pleural empyema and amyloidosis are possible.

The disorder may arise due to previously suffered acute infectious and viral diseases. Chronic bronchitis plays a special role in the development of the non-specific form. The malaise causes disturbances in bronchial patency and drainage function of the bronchi.

Viral bronchopneumonia

Pathogenic microorganisms, in particular viruses, cause various diseases in all organs and systems of the body. Viral bronchopneumonia is a lesion of the respiratory tract, which in its pure form is extremely rare. This is due to the fact that during infection, the epithelial barrier is damaged, resulting in the development of a secondary bacterial infection. Pathogens can be influenza viruses A and B, parainfluenza, adenovirus, respiratory syncytial virus, and, less often, fungi and bacteria.

The incubation period lasts from three to five days and is similar in symptoms to flu and acute respiratory viral infections. Often, infection occurs against the background of these ailments, so the disease can be diagnosed only after the patient's health deteriorates, despite therapy.

Signs of malaise:

• Severe intoxication of the body
• Pain and aches throughout the body
• Muscle weakness
• Dry cough and runny nose
• Pain in the eye area, lacrimation

Some viruses can cause severe headaches, nausea, vomiting, gastrointestinal discomfort, and other symptoms. If a high temperature appears, this indicates a normal reaction of the body, which is trying to fight the infection. If the temperature does not decrease within 1-2 days, this indicates an inflammatory process.

Antiviral drugs and antibiotics are used for therapy, which are symptomatic. The thing is that antiviral drugs are effective if they are taken no later than 48 hours after infection. Therefore, they can be prescribed to prevent the first symptoms. The patient is required to be prescribed expectorants to remove sputum and drainage massage. Antibiotics are taken for 5-7 days, depending on the severity of symptoms and the sensitivity of the virus.

Since the viral form is transmitted by airborne droplets, the patient is quarantined and on bed rest. This is necessary to prevent the spread of infection. Without timely treatment, advanced forms lead to serious complications, most often pneumosclerosis, obstructive bronchitis, chronic respiratory failure.

Drain bronchopneumonia

Influenza infection causes many complications that have a pathological effect on the entire body, in particular on the respiratory system. Confluent bronchopneumonia is one of such complications. With this ailment, many areas of inflammatory infiltrate are formed in the lung tissue, forming a large affected area, which can reach 5-10 cm in diameter. In 7% of cases, the disease is complicated by abscess formation.

The lesions touch each other, each lesion goes through all stages of inflammation, which significantly prolongs the course of the disease. Most often, the pathology occurs in the lower lobes of the lungs, affecting several segments at the same time. In this case, the development of a cross form is possible, that is, bilateral inflammation. Very often, the confluent form of bronchopneumonia develops against the background of ARVI, especially influenza. In this case, the symptoms are disguised as a primary disease, complicating the diagnostic process.

Based on X-ray morphological changes, two variants of the disease are distinguished:

• A single infiltrate, round in shape, with a diameter of 5 to 10 cm.
• The infiltrate increases in size, fester and forms an abscess. The inflammatory process affects several segments of the lung and is polysegmental in nature.

In 80% of patients, the confluent form of lung damage causes a pleural reaction, and in 20% - atelectatic syndrome.

Symptoms:

• Fever and chills
• A sharp increase in body temperature
• Growing cough with mucopurulent sputum
• Chest pain when breathing and coughing
• Intoxication of the body
• Shortness of breath
• Tachycardia
• Cyanotic skin tone
• Persistent hypoxemia
• Cardiopulmonary failure

To identify the disorder, the same diagnostic methods are used as for other forms of respiratory system damage. First of all, this is an X-ray examination, bronchoscopy, ultrasound, CT, sputum, blood and urine tests.

The risk group includes children of different ages, patients with chronic forms of respiratory diseases, elderly people who have suffered chest injuries, patients with congenital lung anomalies, immunodeficient states, people who abuse alcohol and smokers.

Treatment is carried out using antibiotics, pathogenetic therapy (mucolytics, expectorants, bronchodilators), corticosteroids. Patients are prescribed vitamins, agents to improve metabolism and physiotherapy. Particular attention is paid to prevention, which involves vaccination against pneumococcal infections, treatment of chronic diseases and maintaining a healthy lifestyle.

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Hypostatic bronchopneumonia

Many respiratory diseases that occur against the background of other ailments are significantly complicated. For example, hypostatic bronchopneumonia develops with circulatory failure. Pathogenetic factors include failures in the pulmonary circulation, decreased protective properties of the immune system, and poor ventilation of the lungs.

The disease is characterized by a sluggish, i.e. slow progression. Patients have a slight increase in temperature, may have a cough with a small amount of sputum, slight weakness and muscle pain. The main pathogens are: staphylococcus, pneumococcus, bacteroids and E. coli. Most often, the inflammation is localized in the posterior lower parts of the lung.

As a rule, this form occurs against the background of congestion in the respiratory organs, chronic heart failure or prolonged bed rest. It often occurs against the background of a stroke. In this case, the disease can be early, that is, occur in the first days of a stroke, or late - in the 3rd-6th week of the pathology. The symptoms are blurred, against the background of heart failure, impaired consciousness and breathing, subfebrile temperature, chills are possible.