He alth is the most valuable thing a person has. Everyone hopes to live long and at the same time 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 appears, and in some cases people who were once kind and sympathetic to other people's troubles turn into embittered and cynical.
Disease spares no one. Even newborns are not immune from the risk of contracting any infection. In addition, suffering is experienced not only by the patients themselves, but also by their loved ones. It is especially difficult for parents to cope with their emotions and feelings, in whose children this or that pathology was found. Toddlers, due to their early age, cannot yet explain what exactly worries them, in which part of the body they experience pain and how it manifests itself.
Pneumocystis pneumonia is an insidious disease. You can get infected anywhere and, paradoxically, even in medical institutions. The situation is complicated by the fact that to identify the infection at the initial stage of its developmentvery difficult. Often people realize that they need medical help when precious time has already been lost. That is why the death rate 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 understanding of medical terminology. Therefore, having heard the diagnosis "pneumocystosis", or "pneumocystis pneumonia", they are somewhat confused, and even fall into a stupor. Actually, there is no need to panic. First of all, you need to calm down, pull yourself together and ask the attending physician to explain in detail, in simple words, what it is.
Pneumocystosis is often referred to as pneumocystis pneumonia, which is a protozoan disease that affects the lungs. The causative agents of pathology are microorganisms known as Pneumocystis carinii. Until recently, scientists believed that they belonged to the protozoan species. However, relatively recently, on the basis of numerous studies, it was concluded that these microorganisms have some features characteristic of fungi. Pneumocystis carinii is a parasite that only infects humans. At least it has never been detected in animals until today.
What happens in the body of a patient with Pneumocystis pneumonia?
Changes in the body due to pneumocystosis depend on two factors: on what biological properties the causative agents of pneumonia have, and on the state of the human immune system. Pneumocysts, once in the body, begintheir progress through the respiratory tract, bypass them and enter the alveoli. This is where their life cycle begins. They proliferate, come into contact with the 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 host from infection, but on the contrary, it has the opposite effect: it stimulates and contributes to an increase in the number of pneumocysts.
A completely he althy person is not threatened by the rapid reproduction of Pneumocystis carinii. But the situation changes radically if the state of the immune system leaves much to be desired. In this case, the disease is activated at lightning speed, and in 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 a foamy exudate, a violation of the integrity of the membrane of the alveolar leukocytes and, ultimately, to damage and, accordingly, the subsequent destruction of the alveolocytes. Due to the fact that the pneumocysts are tightly attached to the alveolocytes, the respiratory surface of the lungs is reduced. As a result of lung tissue damage, the process of development of alveolar-capillary blockade begins.
To build its own cell wall, Pneumocystis carinii needs human surfactant phospholipids. As a result, there is a violation of surfactant metabolism and hypoxia of lung tissues is significantly aggravated.
Who is most at risk for the disease?
The currently known types of pneumonia 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:
- premature babies;
- infants and children who, being susceptible to acute bronchopulmonary diseases of severe forms, were forced to stay in the hospital for a long time and undergo complex and lengthy therapy;
- people suffering from oncological and hemo-diseases and treated with cytostatics and corticosteroids, as well as struggling with various pathologies of the kidneys and connective tissues resulting from the transplantation of one or another internal organ;
- tuberculosis patients who received strong antibacterial drugs for a long time;
- HIV infected.
As a rule, the infection is transmitted by airborne droplets, and its source is he althy people, most often workers in medical institutions. Based on this, the vast majority of scientists argue that pneumocystis pneumonia is an exclusively stationary infection. Despite this, it should be clarified that some doctors support the view that 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 sensitive to the he alth of their children. Sono wonder they want to know how to detect pneumonia in 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. Every lost day can lead to the fact that the child may develop bilateral pneumonia, pneumocystosis and other complications.
Pneumocystis pneumonia in children usually develops from the age of two months. Most often, the disease affects those children who have previously been diagnosed with cytomegalovirus infection. This disease occurs in them in the form of classic interstitial pneumonia. Unfortunately, doctors admit that at the initial stage it is almost impossible to identify a disease such as pneumocystis pneumonia. Symptoms appear later. The main signs indicating the rapid development of the infection include:
- very severe pertussis-like persistent cough;
- periodic outbreaks of suffocation (mainly at night);
- Some children produce glassy, frothy, gray and viscous sputum.
The incubation period of the disease is 28 days. In the absence of adequate and timely treatment, the mortality of children with pneumocystosis reaches 60%. In addition, in newborns in whom pneumocystis pneumonia proceeds without visible signs, there is a huge likelihood that an obstructive syndrome will manifest itself in the near future. This is mainly due to swelling of the mucous membranes. If the baby is not urgently providedqualified medical care, an obstructive syndrome can transform into laryngitis, and in older children - into an asthmatic syndrome.
Symptoms of the disease in adults
Pneumonia in the elderly, as well as in young people, is more complex than in newborns and young children. The disease attacks mainly people who were born with an immunodeficiency, or those who developed it throughout their lives. However, this is not a rule that does not tolerate the slightest deviation. In some cases, Pneumocystis pneumonia develops in patients with a perfectly he althy immune system.
The incubation period of the disease ranges from 2 to 5 days. The patient has the following symptoms:
- fever,
- migraine,
- weakness all over the body,
- excessive sweating,
- chest pain
- severe respiratory failure with dry or wet cough and tachypnea.
In addition to the main symptoms listed above, sometimes there are signs such as acrocyanosis, retraction of the spaces between the ribs, cyanosis (blue) of the nasolabial triangle.
Even after a full course of treatment, some patients experience a number of PCP-specific complications. 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 is resuming 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 ranges from 90 to 100%.
Symptoms of the disease in HIV-infected people
Pneumocystis pneumonia in HIV-infected people, unlike people who do not have this virus, develops very slowly. It can take from 4 to 8-12 weeks from the moment when the prodromal events begin to the onset of well-defined pulmonary symptoms. Therefore, doctors, at the slightest suspicion of the presence of an infection in the body, in addition to other tests, recommend such patients to do a fluorography.
The main symptoms of pneumocystosis in AIDS patients include:
- high temperature (between 38 and 40°C) that does not subside for 2-3 months;
- dramatic weight loss;
- dry cough;
- shortness of breath;
- growing respiratory failure.
Most scientists are of the 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 a patient has. Unfortunately, when Pneumocystis pneumonia is detected in HIV-infected people, too much time has already been lost, and it is very difficult for an exhausted body to fight the infection.
How is pneumocystosis diagnosed?
Surely everyone knows what the lungs look likeperson. Everyone singled out a photo of this organ either in an anatomy textbook, or on stands in a clinic, or in any other sources. There is no lack of information to date. In addition, every year doctors remind all their patients that they should do a fluorography. Contrary to the opinion of many, this is not a whim of "picky" doctors, but an urgent need. Thanks to this, it is possible to detect the darkening of the lung on an x-ray in time and, without wasting time, begin treatment. The sooner it becomes known about the disease, the more chances there will be for recovery.
However, hardly any of us know how pneumocystis pneumonia appears on x-rays. Photos of this kind cannot be found in school textbooks, and medical reference books and encyclopedias do not arouse any interest in 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 asks 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:
- Doctor writes a referral to a patient for a general blood test. Particular attention is drawn to the elevated levels of eosinophils, lymphocytes, leukocytes and monocytes. Patients with pneumocystosis may have moderate anemia and slightly reduced hemoglobin.
- Instrumental is assignedstudy. We are talking about X-ray, with the help of which determine the stage of development of the disease. An x-ray is taken, which clearly shows the lungs of a person. The photograph is attached to the patient's card. In the first stage, an increase in the pattern of the lung is noticeable on it. If the pneumocystosis has passed into the second stage, the darkening of the lung on the x-ray is clearly visible. Either only the left lung or only the right lung can be infected, or both can be affected.
- In order to identify the presence of pneumocystosis, the doctor usually decides to conduct a parasitological study. What is it? First of all, a mucus sample is taken from the patient for analysis. To do this, they 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 detect antibodies against pneumocysts, a serological study is carried out, which consists in taking 2 sera from the patient for analysis with a difference of 2 weeks. 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 being done to rule out a common carrier, as antibodies are found in approximately 70% of people.
- PCR diagnostics are performed to detect parasite antigens in sputum, as well as in a biopsy sample and bronchoalveolar lavage.
Stages of pneumocystosis
There are three successive stagesPneumocystis pneumonia:
- edematous (1-7 weeks);
- atelectatic (on average 4 weeks);
- emphysematous (of varying duration).
The edematous stage of pneumocystosis is characterized first by the appearance of weakness throughout the body, lethargy, and then a rare cough, gradually increasing, and only at the end of the period - a strong dry cough and shortness of breath during physical exertion. Babies suckle poorly at the breast, do not gain weight, and sometimes even refuse mother's milk. No significant changes in the X-ray of the lungs are detected.
During the atelectatic stage, there is a febrile fever. The cough is greatly increased, and frothy sputum appears. Shortness of breath is manifested even with minor physical exertion. X-ray shows atelectatic changes.
In patients who survived the first 2 periods, the emphysematous stage of pneumocystosis develops, during which the functional parameters of breathing decrease and signs of pulmonary emphysema are noted.
Degrees of pneumonia
In medicine, it is customary to distinguish between the following degrees of severity of the disease:
- lung, which is characterized by mild intoxication (temperature not exceeding 38 ° C, and clear consciousness), at rest there is no shortness of breath, a slight eclipse of the lung is detected on x-ray;
- medium, characterized by moderate intoxication (temperature exceeds 38 ° C, heart rate reaches 100 beats per minute, the patient complains of excessive sweating, etc.), at restshortness of breath is observed, lung infiltration is clearly visible on the x-ray;
- severe, proceeding with severe intoxication (temperature exceeds 39 ° C, heart rate exceeds 100 beats per minute, a delirium is observed), respiratory failure progresses, and extensive infiltration of the lungs is visible on the X-ray, there is a high probability of developing various complications.
What is the treatment for patients with Pneumocystis pneumonia?
It is undeniable that knowing how to identify 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 it is beyond the power of a non-specialist to determine unilateral or bilateral pneumonia, pneumocystosis and other forms of the disease. Therefore, self-treatment is out of the question. The main thing is not to delay and trust the doctors. After carrying out all the necessary studies, the doctor will definitely be able to conclude whether pneumocystis pneumonia is the cause of the patient's poor he alth. Treatment is prescribed only after confirmation of the diagnosis and consists in carrying out organizational and regimen measures 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. Patients are usually prescribed drugs "Pentamidin", "Furazolidone", "Trichopol", "Biseptol", as well as various anti-inflammatory drugs, drugs that promote sputum discharge and facilitate expectoration, mucolytics.
"Biseptol" is prescribed orally or intravenously. The drug is well tolerated and is preferable to "Pentamidine" when administered to patients who do not suffer from AIDS. "Pentamidine" is administered intramuscularly or intravenously.
HIV-infected patients, among other things, are on antiretroviral therapy because they develop Pneumocystis pneumonia as a result of a weakened immune system. Alpha-difluoromethylornithine (DFMO) has recently been increasingly used to treat pneumocystosis in AIDS patients.
Prevention
Prevention of pneumocystosis includes a number of activities, among which the following should be noted:
- To exclude infection in children's medical institutions, in hospitals where oncological and hematological patients are treated, all personnel, without exception, should be periodically examined for infection.
- Drug prevention for persons at risk. This prophylaxis is of two types: primary (before the disease begins to develop) and secondary (prophylaxis after complete recovery in order to prevent relapse).
- Early detection of Pneumocystis pneumonia and immediate isolationsick.
- Regular disinfection in places where outbreaks of pneumocystosis have been recorded. To do this, do a wet cleaning using a 5% solution of chloramine.
