Protracted pneumonia is one of the types of inflammation in the lung tissue, in which, according to clinical and radiological data, the pneumonic infiltrate resolves for a long time, in an extended period (more than 4-6 weeks). Unlike the chronic form, the disease, as a rule, ends with the recovery of the patient. Approximately 30% of acute pneumonias develop a protracted course.
Reasons
Main causes:
- 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.
- Permanent poisoning of the body, such as alcohol abuse, smoking.
- Older age (if the patient is older than 50-60 years, resolution of pneumonia takes longer even if there are no other diseases).
- Complication of acute pneumonia.
Other factors
As mentioned above, the long course of a protractedpneumonia mainly occurs due to reduced immunity, protective factors change: the activity of lymphocytes decreases, the synthesis of interferon decreases, 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 immune defense of a person, there are other factors contributing to the development of prolonged pneumonia. This is the wrong treatment, irrational selection of the drug, the possibility of immunity in the causative agent of inflammation to the antibiotics used. And also untimely treatment makes it possible to develop not only this pathology, but also all existing diseases.
Symptoms of lingering pneumonia
The monosegmental form has a relatively "smooth" course of the disease in comparison with the polysegmental form, which is characterized by relapses, severe manifestations, and a long regression of the source of inflammation. When inflammatory sources merge, the patient's condition becomes more complicated already 2-3 weeks after the initial manifestations of the disease. The temperature rises again, hyperhidrosis, asthenia, general impotence, drowsiness, coughing occur. A special sign of prolonged pneumonia in adults is the lack of signs with clearly pronounced radiological changes in the lungs.
When conducting a study with a bronchoscope, the presence of local lesions of parts of the affected organ is detected. In the area of the affected segment, moist rales are heard, a reduction in percussion sound is determined. On x-rayspecific manifestations of lesions of the vascular and pulmonary pattern are noticeable. In a laboratory study, signs of an increase in fibrin and sialic acids can be detected.
Classification
The development of prolonged pneumonia occurs with inflammation of the lungs, both with its mild focal form, and with fairly acute inflammation. Due to the fact that people's opinions 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 compared to all the others. The timing of prolonged pneumonia depends on the focus of inflammation. It can form in the following places:
- Only in one segment of the lung, otherwise this type of disease is called segmental pneumonia.
- Can spread to several segments at once in one lobe of the lung, this type is called polysegmental pneumonia. This type of disease can affect segments in different parts of the same lung, or it can affect both lungs at the same time, in different parts of the lung.
- Lobar pneumonia - spreads to the entire lung or both lungs completely.
Often the disease develops in the middle or below on the right lung and in the lower part of the left lung. In addition, a good place for its development is the reed segments of the upper lung.
Premature babies
Premature babies get sickmanifested by morphological immaturity and multifunctional weakness of the respiratory center and respiratory organs (in newly born with intracranial birth trauma and a defect in the central nervous system). Shallow, non-rhythmic breathing, occasional prolonged apnea, asphyxia attacks, and an insufficient amount of surfactant lead to uneven ventilation of the lungs, the occurrence of hypopneumatosis, major and minor atelectasis. In addition, the acute inflammatory process in the lungs is complicated by numerous hemorrhages, confirming the violation of vascular permeability, most often associated with hypoxia.
For preschoolers
Protracted pneumonia in children may be caused by a difficult and worsened course of acute pneumonia, especially with localization of the process in the middle lobe, where drainage and ventilation are difficult due to anatomical differences. A significant role is played by the premorbid climate and concomitant diseases, beriberi, malnutrition, exudative diathesis, intracranial birth trauma. Acidosis with "blooming" rickets helps to reduce the tone of the vessels of the lungs, their plethora 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 muscular hypotension, especially of the respiratory muscles and diaphragm. Reduced chest excursion, uneven lung ventilation, 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;
- too early termination of therapy, premature discharge from the hospital;
- immunodeficiency condition;
- fungal infection;
- age of the patient (children and the elderly are more likely to suffer from prolonged pneumonia).
Given the above factors, before prescribing therapy, it is necessary to conduct a bacteriological culture of sputum, check bronchial patency, and establish the presence of mycoplasma.
Drug therapy
Complex treatment of protracted pneumonia includes medication and physiotherapy. Medical therapy includes:
- Antibacterial drugs. They are prescribed after bacteriological culture of the patient's sputum. Prior therapy and its effectiveness are taken into account. The most commonly prescribed are cephalosporins, macrolides, and fluoroquinolones.
- Mucolytic drugs. In the presence of a cough with sputum difficult to separate, drugs such as Ambroxol, Acetylcysteine, Fenspiride are prescribed. Well help to cope with a long unproductive cough inhalation with the above drugs.
- It is possible to prescribe inhalations 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. They are prescribed to eliminate tissue swelling. For this, drugs such as Loratadine, Chloropyramine, Cetirizine are used. Medicines in this group help improve bronchial ventilation.
- Broncholytics. Used in the presence of bronchospasm. For this purpose, Berodual, Eufillin, Ephedrine are used.
Physiotherapy treatment for prolonged pneumonia has a positive effect and promotes a speedy recovery. For this purpose:
- Magnetotherapy.
- UHF.
- EVT.
In addition to physiotherapy, breathing exercises are shown to alleviate the condition and improve sputum discharge, chest and back massage, physical therapy, acupuncture may be prescribed in the absence of contraindications. For the entire period of treatment, the patient is assigned strict bed rest, a complete balanced diet, rich in vitamins and minerals.
Complications
The main problem with chronic pneumonia is the high risk of complications. This is especially true for a child's fragile organism, weakened by the disease. It is quite difficult to predict what the outcome of the disease will be in such cases. Pneumonia is characterized by both pulmonary complications and non-specificside of other organs and systems.
Most often, problems arise from the cardiovascular system, since it is most closely related to the respiratory system, which includes the lungs - the organ in which the focus of the disease is located. Complications that have arisen due to the detrimental effect of the disease on the cardiovascular system are manifested in the form of endocarditis and myocarditis. Children may develop meningitis or meningoencephalitis. 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 strong antibiotics, the liver suffers. Because of this, patients develop toxic hepatitis. The following pulmonary complications may occur:
- lung abscess;
- pneumosclerosis;
- respiratory failure;
- obstruction.
Rehab
Rehabilitation is a set of inpatient and outpatient activities aimed at accelerating recovery and necessary in order to restore the optimal condition and performance of a person.
The first stage of assistance should be deployed already on the third day of illness, and it lasts up to two weeks, but only if the patient's condition improves and the temperature drops to subfebrile values.
The second period consists of prescribing and following a special diet, adjusting the electrolyte and microbiological balance,physiotherapeutic procedures, medical and respiratory gymnastics. All this the patient can undergo in a rehabilitation center, sanatorium or at home. This stage is necessary to eliminate the consequences of the disease and cure with potent medicines (antibiotics).
