Health is the most valuable thing a person has. Everyone hopes to live long and not suffer from this or that ailment. The disease changes people beyond recognition - they become depressed, their appearance leaves much to be desired, indifference to everything that happens around, and in some cases, people who are once kind and responsive to other people's troubles turn into embittered and cynical.
The disease does not spare anyone. Even newborns are not immune to the risk of contracting an infection. In addition, suffering is experienced not only by the patients themselves, but also by their loved ones. It is especially difficult for parents whose children found this or that pathology to cope with their emotions and feelings. Because of their young age, babies still cannot explain what exactly bothers them, in which part of the body they experience pain and how it manifests itself.
An insidious disease is pneumocystis pneumonia. You can get infected anywhere and, paradoxically, even in medical institutions. The situation is complicated by the fact that it is very difficult to identify an infection at the initial stage of its development. Often people understand that they need medical help when valuable time is already lost. That is why mortality from pneumocystosis is very high. Doctors are not always able to save a person’s life.
Diagnosed with pneumocystosis
People who have nothing to do with medicine, for the most part, have little knowledge of medical terminology. Therefore, having heard the diagnosis of "pneumocystosis", or "pneumocystic pneumonia", they are at a loss and even fall into a stupor. In fact, you should not panic. First of all, you need to calm down, pull yourself together and ask the attending physician in detail, in simple words to explain what it is.
Pneumocystosis is often called pneumocystic pneumonia, which is a protozoal disease that affects the lungs. Pathogens are considered microorganisms known as Pneumocystis carinii. Until the recent past, scientists believed that they belong to the species of protozoa. However, relatively recently, on the basis of numerous studies, it was concluded that these microorganisms possess some features characteristic of fungi. Pneumocystis carinii is a parasite that infects only humans. At least in animals it has not yet been detected to this day.
What happens in the patient’s body with pneumocystis pneumonia?
Changes in the body due to pneumocystosis depend on two factors: on the biological properties of the causative agents of pneumonia, and on the state of the human immune system. Pneumocysts, once in the body, begin their advancement through the respiratory tract, bypass them and enter the alveoli. This is where their life cycle begins. Their proliferation occurs, they come in contact with a surfactant and release toxic metabolites. Fight Pneumocystis carinii T-lymphocytes, as well as the so-called alveolar macrophages. However, a weakened immune system is not only unable to protect its owner from infection, but even vice versa - it has the opposite effect: it stimulates and contributes to an increase in the number of pneumocysts.
A fully healthy person does not face rapid reproduction of Pneumocystis carinii. But the situation is fundamentally changing if the state of the immune system leaves much to be desired. In this case, the disease is activated at lightning speed, and over a relatively short period of time the number of pneumocysts that have entered the lungs reaches one billion. Gradually, the space of the alveoli is completely filled, which leads to the appearance of foamy exudate, a violation of the integrity of the membrane of the alveolar leukocytes and, ultimately, damage and, consequently, subsequent destruction of the alveolocytes. Due to the fact that pneumocysts are tightly attached to the alveolocytes, the respiratory surface of the lungs is reduced. As a result of damage to lung tissue, the process of development of alveolar-capillary blockade begins.
To build its own cell wall, Pneumocystis carinii requires human surfactant phospholipids. As a result of this, a violation of surfactant metabolism occurs and hypoxia of the lung tissue is significantly exacerbated.
Who is most at risk of the disease?
The types of pneumonia known to date differ from each other, including the fact that different categories of people are at risk of getting sick. Pneumocystosis in this sense is no exception. It most often develops in:
- prematurely born children;
- infants and children who, being susceptible to severe acute bronchopulmonary diseases, were forced to stay in the hospital for a long time and undergo complex and lengthy therapy;
- people suffering from cancer and hemorrhage diseases and receiving cytostatics and corticosteroids, as well as struggling with various pathologies of the kidneys and connective tissues resulting from transplantation of one or another internal organ;
- tuberculosis patients who have been receiving potent antibacterial drugs for a long time;
- HIV infected.
As a rule, the infection is transmitted by airborne droplets, and its source is healthy people, most often workers in hospitals. Based on this, the vast majority of scientists argue that pneumocystis pneumonia is an exclusively stationary infection. Despite this, it is necessary to clarify that some doctors support the point of view according to which the development of pneumocystosis in the neonatal period is the result of infection of the fetus in the womb.
What are the symptoms of pneumocystis pneumonia in children?
Moms and dads are always very reverent about the health of their children. Therefore, it is not surprising that they want to know how to determine pneumonia on time. Of course, only a doctor can make a final diagnosis, but any conscious parent should be able to identify the first signs of the disease. Each lost day can lead to the fact that a child may experience bilateral pneumonia, pneumocystosis and other complications.
Pneumocystis pneumonia in children usually develops starting at the age of two months. Most often, the disease affects those children who have previously been diagnosed with a cytomegalovirus infection. This disease occurs in them in the form of classic interstitial pneumonia. Unfortunately, doctors recognize that at the initial stage it is almost impossible to detect a disease such as pneumocystis pneumonia. Symptoms come later. The main signs indicating the rapid development of infection include:
- very strong whooping cough;
- periodic outbreaks of suffocation (mainly at night);
- in some children, there is a discharge of vitreous, foamy, gray and viscous sputum.
The incubation period of the disease is 28 days. In the absence of adequate and timely treatment, the mortality rate of children with pneumocystosis reaches 60%. In addition, in newborns in whom pneumocystis pneumonia proceeds without visible signs, there is a great chance that obstructive syndrome will appear in the near future. This is mainly due to swelling of the mucous membranes. If the baby does not immediately receive qualified medical care, obstructive syndrome can transform into laryngitis, and in older children, into asthmatic syndrome.
Symptoms of the disease manifested in adults
Pneumonia in the elderly, as well as in youth, proceeds in a more complex form than in newborns and young children. The disease attacks mainly people born with immunodeficiency, or those with whom it has developed throughout life. However, this is not a rule that does not tolerate the slightest deviation. In some cases, pneumocystis pneumonia develops in patients with a completely healthy immune system.
The incubation period of the disease ranges from 2 to 5 days. The patient has the following symptoms:
- fever,
- migraine,
- weakness in the whole body,
- excessive sweating
- chest pain
- severe respiratory failure, accompanied by dry or wet cough and tachypnea.
In addition to the main symptoms of the above, sometimes signs such as acrocyanosis, retraction of the spaces between the ribs, cyanosis (blueness) of the nasolabial triangle are sometimes noted .
Even after completing the full course of treatment, some patients experience a number of complications specific to pneumocystis pneumonia. Some patients relapse. Doctors say that if a relapse occurs no later than 6 months from the first case of the disease, then this indicates that the infection resumes in the body. And if it occurs after more than 6 months, then we are talking about a new infection or reinfection.
Without appropriate treatment, mortality in adults with pneumocystosis is from 90 and up to 100%.
Symptoms of the disease in HIV-infected
Pneumocystis pneumonia in HIV-infected people, unlike people without this virus, develops very slowly. From the moment when the prodromal phenomena begin, and before the pronounced pulmonary symptoms occur, it can take from 4 to 8-12 weeks. Therefore, doctors, at the slightest suspicion of the presence of an infection in the body, among other tests, recommend such patients to undergo fluorography.
The main symptoms of pneumocystosis in AIDS patients include:
- high temperature (from 38 to 40 ° C), which does not subside for 2-3 months;
- sharp loss of body weight;
- dry cough;
- dyspnea;
- increasing respiratory failure.
Most scientists adhere to the point of view that other types of pneumonia in HIV-infected people have the same symptoms as with pneumocystosis. Therefore, in the early stages of the development of the disease, it is almost impossible to determine which type of pneumonia in a patient. Unfortunately, when pneumocystis pneumonia is detected in HIV-infected people, too much time is already lost and it is very difficult for an exhausted body to fight infection.
How is pneumocystosis diagnosed?
Surely everyone knows how a person’s lungs look. Each organ’s photo was singled out either in the textbook on anatomy, or on the stands in the clinic, or in any other sources. There is no shortage of information today. In addition, doctors annually remind all of their patients that they should undergo fluorography. Contrary to the opinion of many, this is not a whim of "picky" doctors, but an urgent need. Due to this, it is possible to timely detect a blackout of the lung on an X-ray and, without wasting time, start treatment. The sooner it becomes known about the disease, the more likely it will be to recover.
However, it is unlikely that any of us knows how pneumocystic pneumonia manifests itself in x-rays. Photos of this kind cannot be found in school textbooks, and medical manuals and encyclopedias are not of interest to most ordinary people. Moreover, we even have no idea how this disease is diagnosed, although it would not hurt to know.
First, a preliminary diagnosis is made. The doctor is interested in the patient about his contacts with people at risk (HIV-infected and AIDS patients).
After that, the final diagnosis is carried out. The following laboratory and instrumental studies are used:
- The doctor prescribes the patient a referral for a general blood test. Particular attention is paid to elevated levels of eosinophils, lymphocytes, white blood cells and monocytes. Patients with pneumocystosis may have moderate anemia and slightly reduced hemoglobin.
- Assigned instrumental research. We are talking about x-ray, with which determine the stage of development of the disease. An x-ray is taken, on which the human lungs are clearly visible. The photograph is attached to the patient's card. In the first stage, it enhances the pattern of the lung. If pneumocystosis has passed into the second stage, a blackout of the lung on the x-ray is clearly visible. Either only the left or only the right lung can be infected, and one and the other can be affected.
- In order to detect the presence of pneumocystosis, the doctor usually decides to conduct a parasitological study. What does it consist of? First of all, a mucus sample is taken from the patient for analysis. To do this, resort to the help of methods such as bronchoscopy, fibrobronchoscopy and biopsy. In addition, a sample can be obtained using the so-called cough induction method .
- In order to identify antibodies against pneumocysts, a serological test is carried out, consisting in the fact that with a difference of 2 weeks the patient is taken for analysis of 2 serums. If in each of them there is an excess of the normal titer value by at least 2 times, then this means that the person is sick. This study is conducted in order to exclude a conventional carrier, since antibodies are found in approximately 70% of people.
- To detect parasite antigens in sputum, as well as in a biopsy sample and broncho-alveolar lavage, PCR diagnostics is performed.
Stages of pneumocystosis
There are three successive stages of pneumocystis pneumonia:
- swollen (1-7 weeks);
- atelectatic (on average 4 weeks);
- emphysematous (of varying durations).
The edematous stage of pneumocystosis is characterized first by the appearance of weakness throughout the body, lethargy, and then a rare cough, gradually intensifying, and only at the end of the period - a strong dry cough and shortness of breath during physical exertion. Infants do not suckle well, do not put on weight, and sometimes refuse breast milk altogether. No significant changes in the x-ray of the lungs are not detected.
During the atelectatic stage, febrile fever is observed. The cough is greatly increased, and foamy sputum appears. Shortness of breath manifests itself even with minor physical exertion. Atelectatic changes are visible on the x-ray.
In patients who survived the first 2 periods, the emphysematous stage of pneumocystosis develops, during which functional respiratory rates decrease and signs of pulmonary emphysema are noted .
Degrees of pneumonia
In medicine, it is customary to distinguish the following degrees of disease severity:
- lung, which is characterized by weak intoxication (temperature not exceeding 38 ° C, and an unclouded consciousness), at rest there is no shortness of breath, a slight eclipse of the lung is detected on an X-ray;
- medium, characterized by moderate intoxication (temperature exceeds 38 ° C, heartbeat reaches 100 beats per minute, the patient complains of excessive sweating , etc.), dyspnea is observed at rest, pulmonary infiltration is clearly visible on the x-ray;
- severe, with severe intoxication (temperature exceeds 39 ° C, palpitations exceeding 100 beats per minute, delusional state is observed), respiratory failure progresses, and extensive lung infiltration is visible on the x-ray, and various complications are highly likely to develop.
What treatment is prescribed for patients with pneumocystis pneumonia?
There is no doubt that knowing how to determine pneumonia is a huge plus for every person. However, this is not enough. We are not doctors and cannot make an accurate diagnosis. There is more than one type of pneumonia, and a layman cannot afford to determine unilateral or bilateral pneumonia, pneumocystosis and other forms of the disease. Therefore, self-medication is out of the question. The main thing is not to delay and trust doctors. After carrying out all the necessary studies, the doctor will definitely be able to conclude whether pneumocystic pneumonia is the cause of the patient's well-being. Treatment is prescribed only after confirmation of the diagnosis and consists in conducting organizational and regimen activities and drug therapy.
Organizational and regime measures include the indispensable hospitalization of the patient. In the hospital, the patient receives medication and follows a diet recommended by the doctor.
Drug therapy consists of etiotropic, pathogenetic and symptomatic treatment. "", "", "", "", , , , .
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Prevention
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- Drug prophylaxis of people at risk. This prevention is of two types: primary (before the disease begins to develop) and secondary (prevention after full recovery in order to prevent relapse).
- Timely detection of pneumocystis pneumonia and immediate isolation of the patient.
- Regular disinfection in places where outbreaks of pneumocystosis were recorded. To do this, do wet cleaning using a 5% solution of chloramine.