Lingering pneumonia is one of the types of inflammation in the lung tissue, in which, according to clinical and radiological information, pneumonic infiltrate is resolved for a long time, in long periods (more than 4-6 weeks). Unlike the chronic form, the disease, as a rule, ends with the recovery of the patient. About 30% of acute pneumonia get a protracted course.
Causes
The main causes of occurrence:
- Weakening of the immune system caused by chronic diseases of the internal organs, bronchopulmonary diseases, as well as HIV infection, tumors of various types, heart and kidney failure.
- Metabolic abnormalities.
- Constant poisoning of the body, for example, alcohol abuse, smoking.
- Elderly age (if the patient is older than 50-60 years, resolving pneumonia requires more time, even if there are no other diseases).
- Complication of acute pneumonia.
Other factors
As mentioned above, a long course of protracted pneumonia mainly occurs due to reduced immunity, protection factors change: the activity of lymphocytes decreases, the synthesis of interferon decreases, and the intensity of macrophages decreases. As a result, the protective function of the body weakens, which contributes to the long course of the inflammatory process. In addition to reducing the human immune defense, there are other factors contributing to the development of protracted pneumonia. This is an incorrect treatment, irrational selection of the drug, the possibility of the appearance of immunity in the pathogen of inflammation to the antibiotics used. And also untimely treatment allows not only this pathology to develop, but also all existing diseases.
Symptoms of protracted pneumonia
The monosegmental form has a relatively "smooth" course of the disease in comparison with the polysegmental one, which is characterized by relapses, severe manifestations, and a long regression of the source of inflammation. When fusion of inflammatory sources, the patient's condition becomes complicated after 2-3 weeks after the initial manifestations of the disease. The temperature rises again, hyperhidrosis, asthenicity, general weakness, drowsiness, and coughing occur. A special sign of prolonged pneumonia in adults is the lack of signs with clearly expressed radiological modifications in the lungs.
When conducting a bronchoscope study, the presence of local lesions of parts of the affected organ is detected. In the area of the affected segment, wet rales are heard, due to a reduction in percussion sound. On the x-ray, specific manifestations of lesions of the vascular and pulmonary pattern are noticeable. In a laboratory study, you can detect signs of increased fibrin and sialic acids.
Classification
The development of protracted pneumonia occurs with pneumonia, both with its mild focal form, and with fairly acute inflammation. Due to the fact that the opinions of people quite often differ, there is no single classification of the disease, but there are the most popular classification options. Below is one of them, it is considered the most simple and understandable in comparison with all the others. The timing of prolonged pneumonia depends on the site of inflammation. It can form in the following places:
- Only in one segment of the lung, in another way, this type of disease is called segmental pneumonia.
- It can be spread immediately to several segments in one lobe of the lung, this type is called polysegmental pneumonia. This kind of disease can have a negative effect on individual segments in different parts of one lung, or it can affect both lungs at once, in its different parts.
- Lobar pneumonia - extends to the entire lung or both lungs completely.
Often the disease develops in the middle or lower part of the right lung and in the lower part of the left lung. In addition, the reed segments of the upper part of the lung are a good place for its development.
In premature infants
In premature infants, the disease is manifested by morphological immaturity and multifunctional weakness of the respiratory center and respiratory organs (in newly born infants with intracranial birth injury and a defect in the central nervous system). Shallow, irregular breathing, occasional prolonged apnea, seizures of asphyxia, and an insufficient amount of surfactant lead to uneven ventilation of the lungs, the occurrence of hypopneumatoses, primary and secondary atelectasis. In addition, the island-inflammatory process in the lungs is complicated by numerous hemorrhages, confirming a violation of vascular permeability, most often associated with hypoxia.
In preschoolers
The cause of prolonged pneumonia in children may be the difficult and aggravated course of acute pneumonia, especially with the localization of the process in the middle lobe, where the drainage system and ventilation are difficult due to anatomical features. A significant role is played by the premorbid climate and associated diseases, vitamin deficiency, malnutrition, exudative diathesis, intracranial birth injury. Acidosis with "blooming" rickets helps reduce the tone of the vessels of the lungs, their fullness and other pathological phenomena, which leads to swelling of the interstitium of the lungs, thickening of the interalveolar septa, and a reduction in the airiness of the lungs. All this is complicated by muscle hypotension, especially respiratory muscles and diaphragm. Decreased excursion of the chest, uneven ventilation of the lungs, the appearance of micro- and macroatelectasis leads to a long course of pneumonia.
Treatment
Before treating prolonged pneumonia, it is necessary to take into account the factors of its long course. These include:
- incorrect previous antibiotic therapy;
- cessation of therapy too early, premature discharge from the hospital;
- immunodeficiency state;
- fungal infection;
- patient age (children and elderly people are more likely to suffer from protracted pneumonia).
Given the above factors, before prescribing therapy, it is necessary to conduct bacteriological culture of sputum, check the patency of the bronchi, establish the presence of mycoplasma.
Drug therapy
The complex treatment of protracted pneumonia includes medication and physiotherapy. Drug therapy includes:
- Antibacterial drugs. Appointed after bacteriological culture of the sputum of the patient. Prior therapy and its effectiveness are considered. Most often, cephalosporins, macrolides and fluoroquinolones are prescribed.
- Mucolytic drugs. In the presence of a cough with sputum that is difficult to separate, such drugs as Ambroxol, Acetylcysteine, and Fenspiride are prescribed. They help to cope with a long unproductive cough of inhalation with the above drugs.
- Perhaps the appointment of inhalation with mineral water.
- Immunostimulating drugs. In order to increase the activity of immunity, preparations containing immunoglobulin are used. For example, Cycloferon, Anaferon, Ergoferon, Arbidol.
- Antihistamines. Appointed to eliminate swelling of the tissues. To do this, use drugs such as Loratadine, Chloropyramine, Cetirizine. Medicines in this group help improve bronchial ventilation.
- Bronchodilator drugs. They are used in the presence of bronchospasm. For this purpose, use Berodual, Eufillin, Ephedrine.
Physiotherapeutic treatment for prolonged pneumonia has a positive effect and contributes to a speedy recovery. For this purpose:
In addition to physiotherapy, respiratory gymnastics is indicated to alleviate the condition and improve sputum discharge, massage the chest and back organs, exercise with physiotherapy, it is possible to prescribe acupuncture in the absence of contraindications. For the entire period of treatment, the patient is attributed to a strict bed rest, a full balanced diet, rich in vitamins and minerals.
Complications
The main problem of protracted pneumonia is the high level of risk of complications. This is especially true for a child's fragile body, weakened by the disease. Predicting what the outcome of the disease will be is quite difficult in such cases. Pneumonia is characterized by both pulmonary forms of complications and non-specific ones from other organs and systems.
Most often, problems arise from the cardiovascular system, since it is most closely associated with the respiratory system, to which the lungs belong - the organ in which the focus of the disease is located. Complications arising from the harmful effects of the disease on the cardiovascular system are manifested in the form of endocarditis and myocarditis. In children, meningitis or meningoencephalitis may begin. Against the background of a general decrease in hemoglobin, which is observed in patients during therapy against pneumonia, anemia is a frequent complication.
Since there is a constant need to take potent antibiotics, the liver suffers. Because of this, patients develop toxic hepatitis. The following pulmonary complications may occur:
- lung abscess
- pneumosclerosis;
- respiratory failure ;
- obstruction.
Rehabilitation
Rehabilitation is a set of inpatient and outpatient activities aimed at accelerating healing and necessary in order to return the person’s optimal condition and performance.
The first stage of care must be deployed on the third day of the disease, and it lasts up to two weeks, but only if the patient's condition improves and the temperature decreases to subfebrile values.
The second period consists of the appointment and observance of a special diet, adjustment of electrolyte and microbiological balance, physiotherapy procedures, medical and respiratory gymnastics. All this, the patient can go to a rehabilitation center, sanatorium or at home. This stage is necessary to eliminate the consequences of the disease and cure with potent medicines (antibiotics).