Pneumonia

Introduction to pneumonia Pneumonia refers to inflammation of the terminal airway, alveolar and interstitial lungs, which can be caused by disease microorganisms, physical and chemical factors, immune damage, allergies and drugs. Bacterial pneumonia is the most common form of pneumonia and one of the most common infectious diseases. Pneumonia is mainly referred to as pneumonia caused by bacterial infection. This pneumonia is also the most common type. Before the application of antibiotics, bacterial pneumonia is a great threat to the health of children and the elderly. The emergence and development of antibiotics was once The pneumonia mortality rate has dropped significantly, but in recent years, despite the use of strong antibiotics and effective vaccines, the overall mortality rate of pneumonia has not decreased or even increased. basic knowledge The proportion of illness: 0.06% Susceptible people: no special people Mode of infection: non-infectious Complications: lung abscess bronchopneumonia

Cause of pneumonia

Reduced immunity (20%):

Pneumococcal bacteria generally reside in the nasopharynx of normal people, and generally do not develop disease. When the body's immunity declines, such as cold, fatigue, chronic bronchitis, chronic heart disease, long-term smoking, etc., pneumococci can invade the human body, causing Pneumonia, otitis media, sinusitis, meningitis, endocarditis, sepsis, etc.

Bacteria (15%):

Pneumonia can be caused by pneumococcal, hemolytic streptococcus, staphylococcus aureus, Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, and Pseudomonas aeruginosa.

Virus (15%):

Coronavirus, adenovirus, influenza virus, cytomegalovirus, herpes simplex virus and other viruses can cause pneumonia.

Fungus (10%):

Fungi such as Candida albicans, Aspergillus, and Actinomycetes can cause pneumonia.

Atypical pathogens (10%):

Pneumonia can be caused by atypical pathogens such as Legionella, Mycoplasma, Chlamydia, Rickettsia, Toxoplasma, and Protozoa.

Physical and chemical factors (10%):

Physical and chemical factors such as radioactivity, gastric acid inhalation, and drugs can cause pneumonia.

Pneumonia prevention

Daily prevention of pneumonia:

1, usually keep cold and warm, in case of climate change, change clothing at any time, physically susceptible, can often wear drugs like Yupingfeng scattered to prevent external sensation.

2, quit smoking, avoid inhaling dust and all toxic or irritating gases.

3. Strengthen physical exercise and enhance physical fitness.

4, when eating or feeding, attention should be concentrated, requiring patients to chew slowly, avoid eating and speaking, handing food into the lungs.

health education:

1, diet guidance

High-protein, high-calorie, high-vitamin digestible semi-liquid food. Patients with pneumonia with fever should pay attention to drinking more water, which not only can make the body's water loss be supplemented, but also facilitate the excretion of bacterial toxins and lower body temperature. Eat more fruits, don't eat a lot of spicy and greasy food. For pneumonia patients with chronic lung disease, pay attention to eating high-protein foods.

2, rest and activity guidance

Those who are fever should stay in bed, keep warm, keep indoor air fresh, and encourage patients to take deep breaths and effectively cough every 1 hour. Patients in bed should pay attention to turning over, and the patient should be drained once every 4 hours. Appropriate activities during the recovery period should increase rest time, adhere to deep breathing exercise for at least 4-6 weeks, which can reduce the incidence of atelectasis; also avoid respiratory irritation, such as smoking, dust, chemical droplets, etc.; Go to crowded places or people with existing respiratory infections.

Pneumonia complications Complications lung abscess bronchopneumonia

Active treatment of pneumonia is completely curable, but improper treatment or delay in treatment, severe cases of dyspnea, bronchial pneumonia, lung abscess and so on.

Symptoms of pneumonia Common symptoms Bronchial purulent secretion increased wet rales immune damage cough chest pain multi-cough foam mucus sputum sputum fever with chills heart function sudden decompensation

Clinical manifestation

Most of the onset is rapid, often caused by cold rain, fatigue, viral infections, etc., about 1/3 of the upper respiratory tract infection before the disease. The course of disease is 7 to 10 days.

1, chills and high fever

Typical cases start with a sudden chill, followed by high fever, body temperature can be as high as 39 ° C ~ 40 ° C, showing a heat retention pattern, often accompanied by headache, body muscle soreness, reduced food intake. The heat type after antibiotic use can be atypical, and the elderly and the weak can only have low fever or no fever.

2, cough and cough

The initial stage is irritating dry cough, and then cough up white mucus or bloody sputum. After 1~2 days, it can cough up bloody sputum or rust sputum, or it can be purulent sputum. And thin.

3, chest pain

Most of them have severe lateral chest pain, often acupuncture-like, exacerbated by coughing or deep breathing, and can be radiated to the shoulder or abdomen. Such as lower lobe pneumonia can stimulate severe abdominal pain caused by the pleura, easy to be misdiagnosed as acute abdomen.

4, difficulty breathing

Difficulty and shallow breathing due to insufficient lung ventilation, chest pain and toxemia. When the condition is severe, the gas exchange is affected, and the arterial oxygen saturation is lowered to cause purpura.

5, other symptoms

A few have gastrointestinal symptoms such as nausea, vomiting, bloating or diarrhea. Seriously infected people may have confusion, irritability, lethargy, coma and so on.

Sign

Pneumococcal pneumonia patients often have acute face, cheeks red, dry skin, simple herpes on the mouth and nose. In patients with sepsis, the skin mucosa may have bleeding spots, yellow staining of the sclera, increased heart rate or irregular heart rhythm. Gram-negative bacilli have a wide range of lesions, and may have signs of lung consolidation, and both sides of the lungs and the back can smell wet voices. The signs of patients with mycoplasma pneumoniae pneumonia are not obvious, there may be moderate congestion of the pharynx, dry and wet sputum of the lungs, tympanic membrane congestion and even bleeding in the otoscope, showing inflammatory changes. The signs of viral pneumonia are not prominent, and occasionally the wet lungs can be heard in the lower lungs.

Pneumonia check

1, blood routine examination

This is the most commonly used test, including the total number of white blood cells, the percentage of various white blood cells in the total white blood cell count. The total number of white blood cells in normal people is 4~10×10 ⁹ / L, and the percentage of neutrophils is less than 70%. If the total number of white blood cells exceeds 10×10 ⁹ / L and the percentage of neutrophils exceeds 70%, we say the blood of this patient. High, this is a common blood picture change in bacterial pneumonia.

2, arterial blood gas analysis

There may be a decrease in arterial oxygen partial pressure and a decrease in carbon dioxide partial pressure, but the combined chronic obstructive pulmonary disease is due to an increase in carbon dioxide partial pressure due to a poor alveolar ventilation disorder.

3, X-ray chest examination

By X-ray examination of the patient, you can directly understand the changes in the lungs. This is an important means of diagnosing pneumonia. Although pneumonia can be diagnosed by blood and chest X-ray, what pathogen is caused by pneumonia is caused by bacteria. It is still caused by viruses, mycoplasma, fungi, etc. What are the types of bacteria? The above two tests can't tell us. It is only possible to take the patient's sputum and blood for culture and possibly find the pathogen. Doctors can be targeted to treat pathogen-sensitive drugs. Blood routine, chest X-ray examination and sputum examination are the most basic examinations for patients with pneumonia, in addition to chest CT examination (medically known as computed tomography). However, if the patient has pneumonia repeatedly in the same site or other suspicious lesions on the chest X-ray, and the general examination is difficult to confirm the diagnosis, chest CT or other further examination is needed.

Diagnosis of pneumonia

diagnosis method

For the diagnosis of pneumonia, infiltration of the lungs by X-rays is the gold standard for the diagnosis of pneumonia. Supportive diagnostic methods are the cultivation of microorganisms by the patient's sputum or blood. When pneumonia is suspected, a blood test is usually performed: a complete blood count can show hyperplasia of the neutrophil (except for some patients with hypoplasia or neutropenia). If the condition progresses to sepsis, the patient's renal function may decline. In the determination of ions, the release of anti-urinary hormones is usually caused by the release of anti-urinary hormones from the lung tissue of pneumonia.

If it is a nosocomial infection or pneumonia caused by immunodeficiency, the diagnosis may be difficult, and even a lung scan may be needed to distinguish the cause of pneumonia (such as pulmonary embolism). Tomography also has applicability if the patient has other symptoms or discomfort (such as vasculitis, sarcoidosis or lung cancer).

Differential diagnosis

Pneumonia needs to be differentiated from the following diseases: tuberculosis, lung cancer, acute lung abscess, pulmonary embolism.

Non-infectious lung diseases such as pulmonary interstitial fibrosis, pulmonary edema, atelectasis, pulmonary eosinophilic infiltration, and pulmonary vasculitis are also excluded.

With severe chest pain, it should be differentiated from exudative pleurisy and pulmonary infarction. Relevant signs and X-ray images are helpful for identification. Pulmonary infarction often has the basis of venous thrombosis, hemoptysis is more common, and there is rarely a herpes zoster. Abdominal symptoms may occur in the lower lobe pneumonia, and should be differentiated from acute cholecystitis, underarm abscess, appendicitis by X-ray, B-ultrasound, etc.

1. Tuberculosis

Many symptoms of systemic poisoning, low fever, night sweats, fatigue, weakness, weight loss, insomnia, palpitations and other symptoms in the afternoon. X-ray chest radiographs can be seen in the lung tip or clavicle, uneven density, slow dissipation, and can form a cavity or spread in the lungs. Mycobacterium tuberculosis can be found in sputum. Conventional antibiotic treatment is ineffective.

2, lung cancer

There is often a history of smoking. There are symptoms of cough, cough, and blood in the sputum. The white blood cell count is not high, and if cancer cells are found in the sputum, the diagnosis can be confirmed. Can be associated with obstructive pneumonia, inflammation is not easy to dissipate after antibiotic treatment, or visible hilar lymphadenopathy, sometimes atelectasis. If necessary, do CT, MRI, fiberoptic bronchoscopy, and exfoliated cells.

3, acute lung abscess

Early clinical manifestations were similar. As the disease progresses, a large amount of pus sputum is coughed up as a characteristic of lung abscess. X-ray films show the abscess and the fluid level.

4, pulmonary thromboembolism

Pulmonary thromboembolism has many risk factors for venous thrombosis, hemoptysis, syncope, dyspnea, and jugular vein filling. X-ray chest radiograph showed local lung texture reduction, visible wedge-shaped shadow of the tip pointing to the hilum, common hypoxemia and hypocapnia. Examinations such as D-dimer, CT pulmonary angiography, radionuclide lung ventilation/perfusion scan, and MRI can help with identification.

5, non-infectious lung infiltration

Non-infectious lung diseases such as pulmonary interstitial fibrosis, pulmonary edema, atelectasis, pulmonary eosinophilic infiltration, and pulmonary vasculitis should be excluded.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.