Septic pneumonia is a very severe form of pneumonia that develops against sepsis. The main predisposing factor to the emergence of a dangerous pathology is the presence in a patient of serious violations in the body's immune system. The risk group includes the elderly, newborns with intrauterine infection and HIV-infected. It is worth noting that infectious pneumonia is often fatal. The article describes this disease. Readers will also learn about the symptoms and treatment of septic pneumonia.
What it is
By sepsis is meant an inflammatory reaction of the body in response to an infection. This condition appears when toxins or pathogens enter the bloodstream. In this case, the spread of infection and damage to various systems and organs, including the lungs, which provokes infectious pneumonia.
In addition to pathogenic microorganisms, the causes of sepsis can be:
- pathogenic fungi;
- various bacteria (streptococci, staphylococci, protea, pneumococci, enterococci, Klebsiella and others);
- viruses.
Patients with infectious pneumonia are urgently sent to the intensive care unit upon admission to the hospital.
Causes
The following factors contribute to the development of septic pneumonia:
- Hypothermia. It is worth noting that this reason is relevant not only in the cold season. Often, it is dangerous in the warm season. Examples are: body hypothermia due to cold water, room conditioning, and so on.
- ARVI is one of the most common causes of septic pneumonia in the form of a complication of a viral disease. This may occur due to incomplete or inadequate treatment, as well as the attachment of other pathogens.
- Active and passive smoking. This bad habit leads to weakening of lung tissue, as well as immunity in general.
- Negative manifestation of the external environment, including air pollution by toxic substances.
In addition to these factors, each person has a threshold for individual resistance, and there are also chronic or concomitant diseases that exacerbate the condition of the body. These reasons can contribute to the development of pneumonia, and the course of the disease becomes more severe. In childhood and old age, septic pneumonia often causes complications.
Individual factors
This group of causes contributing to the appearance of infectious pneumonia includes:
- Chronic lung diseases.
- Pathologies of the heart and blood vessels associated with circulatory disorders in the pulmonary circle.
- Congenital malformations of the chest, as well as its trauma.
- Recovery period after surgery.
- Bad habits (alcohol, drugs, smoking).
- Reduced immunity.
- Age.
Symptoms of the disease
In most people, septic pneumonia (ICD-10 - code - from J12 to J18) is accompanied by purulent decay of the lung tissue. Sepsis significantly worsens the already serious condition of the patient.
The main clinical signs that may indicate infectious inflammation are:
- fever, fever, chills;
- severe cough, often causing chest pain;
- labored breathing;
- dyspnea;
- respiratory failure, which progresses with improper treatment;
- the skin turns pale and becomes covered with a cyanotic shade;
- rapid pulse;
- a sharp drop in pressure;
- a breakthrough of the abscess in the bronchi can cause a strong cough, while the patient will cough up a lot of purulent sputum.
Complications of septic pneumonia include pyopneumothorax, pulmonary hemorrhage, pleural empyema, and bacteremic shock. All this with untimely treatment can be fatal.
Bilateral septic pneumonia
In medical practice, bilateral pneumonia is classified according to several criteria. The main criterion is the location of the foci of inflammation. Based on this, several types of such pneumonia are distinguished:
The latter is less common than focal, and is characterized by the rapid development of the inflammatory process, as well as a pronounced clinical picture. This form of the disease involves the defeat of both lungs in full, so respiratory failure and patient death occur quite quickly.
Focal bilateral septic pneumonia is much more common. With it, there is a lesion of some segments of the lung on both sides. This form of inflammation can be the result of mechanical ventilation for an extended period, therefore it is common among people in intensive care. Unfortunately, the prognosis for recovery with focal pneumonia in the lungs on both sides is extremely unfavorable. Since in the respiratory organ numerous areas are affected.
If we classify pneumonia taking into account which area is affected, then the following forms of the disease can be distinguished:
- upper lobe bilateral;
- lower lobe bilateral;
- polysegmented.
The most dangerous course has a polysegmental type of inflammatory process in both lungs. The disease is severe, with signs of severe intoxication, and therefore therapy should begin as soon as possible. It should be borne in mind that polysegmental inflammation quickly leads to respiratory failure and death of the patient.
The most formidable complication of bilateral septic pneumonia is considered to be GNT (immediate hypersensitivity). It often leads to pulmonary edema with impaired respiratory processes.
Diagnosis of the disease
The main method for diagnosing pneumonia is x-ray. Signs of septic pneumonia in this case look like multiple foci of dimming. As a rule, they are interconnected and form abscesses. X-ray studies are used not only for diagnostic purposes, but also to assess the dynamics of the disease.
During the initial examination, the doctor can determine the participation in the breathing of auxiliary muscles and an increase in the frequency of the respiratory process. In addition, the specialist distinguishes wheezing: dry, wet or crepitating. An x-ray does not always help to see the foci of inflammation. After all, they can have a deep location and small size. That is why in some cases additional diagnostic methods are needed. For this, angiography, scintigraphy and computed tomography are used. On CT, septic pneumonia can be considered best.
In addition to the methods described above, for the diagnosis of the disease using:
- biochemical and clinical blood analysis;
- general urine analysis;
- sputum examination to determine the resistance of bacteria to antibiotics.
In case of urgent need, additional studies are carried out:
- serological examination;
- histo- and cytological studies;
- bronchoscopy;
- angiopulmonography and isotopic scanning of the lungs;
- if surgical intervention is necessary, a test is taken for the proper functioning of the kidneys and liver to establish a range of loads on the heart and blood vessels.
Disease treatment
Patients even with suspected infectious pneumonia undergo treatment and further examination in the intensive care unit. A general approach to the treatment of the disease and the very cause that provoked it is to use all available surgical and therapeutic methods.
Intensive therapy begins at the time the patient enters the department. After determining the entrance gate of the infection, which led to the spread of the inflammatory process, the septic focus is eliminated. The main objective of intensive care is to eliminate septic shock with pneumonia, as well as complications that threaten the stabilization of the patient's condition and life.
During the treatment process, doctors from different fields of medicine take part: therapists, resuscitators, surgeons and others.
Antibiotic therapy
The use of antibacterial drugs for infectious pneumonia significantly reduces the risk of complications and deaths. As a rule, doctors do not wait for the results of bacteriological studies, they prescribe antibiotics with a wide spectrum of action immediately after the patient enters the department.
After identifying the causative agent of infection, antibiotic therapy is adjusted. In this case, the sensitivity of pathogenic microflora to drugs is taken into account. Most often, preference is given to medicines that have a bactericidal effect:
- Cephalosporins.
- Penicillins.
- Fluoroquinolones.
- Carbapenemam.
- Aminoglycosides and others.
In some cases, combination therapy with antibacterial drugs is used. But still experts prefer monotherapy. Since the simultaneous use of several antibiotics increases the risk of side effects and compatibility problems. Choosing the optimal medicine, it is necessary to consider contraindications, the presence of individual intolerance, toxic effects on the kidneys and liver, and so on.
Prescribing the maximum allowable dosages of antibiotics for septic pneumonia is considered clinically justified. To date, a scheme of empirical antibacterial therapy has been developed, which can be applied even without the availability of research results.
In the absence of data on the causative agents of the infectious process, it is considered normal to use a combination of different drugs. It is worth remembering that only a specialist can determine the correct combination of medicines.
Detoxification measures
A mandatory element of the treatment of septic pneumonia (ICD-10 - code - from J12 to J18) is the implementation of effective detoxification therapy. The introduction of intravenous electrolyte solutions helps to correct the water-salt balance. Protein disorders in the body effectively restore albumin, amino acid preparations, plasma. To eliminate toxins and pathogens, hemosorption, plasmapheresis and hemofiltration are used. In case of renal failure, hemodialysis is prescribed.
Surgical intervention
In some cases with septic pneumonia, it is necessary to use surgical methods of treatment. This is especially true when severe complications occur. Indications for the operation are:
- Pneumothorax (accumulation of air in the pleural cavity).
- The development of bleeding in the lungs.
- Pus in the pleural cavity.
- Preservation of signs of septic pneumonia (hemoptysis, cough with purulent sputum, etc.) after eliminating the infection for several months.
Proper treatment of septic pneumonia using modern methods of therapy can count on a positive outcome even in the most severe cases.
AIDS virus
Septic pneumonia in HIV develops in 80% of patients. Such a high percentage is due to the following factors:
- The main function of the lungs is breathing. Together with air, viruses, bacteria, and tiny particles of dust get into them, so the concentration of pathogens of various diseases in the lungs is much higher than in other organs.
- In addition, the lungs themselves do not have local immunity. Only the general immunity of the body is responsible for their protection, and it is weakened by the human immunodeficiency virus and cannot resist infections.
- The lungs have their own microflora, which is not dangerous for a healthy person. But due to a weakened immune system, these harmless fungi and bacteria can trigger the development of pneumonia.
The main objective of the treatment of pneumonia in HIV patients is the restoration of immunity. In addition, antiretroviral therapy is performed.
Prevention of septic pneumonia in HIV should be lifelong. When lowering the level of CD4-lymphocytes, patients are prescribed Biseptolum (once every three days). If the patient has already suffered an infectious pneumonia, then Biseptolum is taken daily.
In addition to drug prevention, it is recommended that a special regimen, diet, refusal from bad habits and regular visits to the attending physician be recommended.
Forecast
Septic pneumonia is characterized by a long course and a tendency to reappear. Unfortunately, the prognosis for this disease is often unfavorable. In half the cases, it is fatal. With timely access to a doctor and competent treatment, the chance of recovery increases.