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Bilateral pneumonia is a serious disease with a relatively high mortality rate. Of particular danger to human life is bilateral lung damage. The pathological process can be primary when infection occurs simultaneously in both lungs. The secondary development of bilateral pneumonia is possible when inflammation in one lung becomes chronic and spreads to the other side. Often, bilateral pneumonia is a complication of immunodeficiency states, heart attacks, congestive processes in the chest.
Early medical studies showed that the most common causative agents of bilateral pneumonia were coccal bacteria. Recently, more and more often there are confirmed data on the damage to the lung tissue by atypical infectious agents – viruses, fungi, non-specific bacteria.
How does it arise?
The occurrence of bilateral pneumonia develops with the introduction of an infectious agent against the background of reduced general immunity.
There can be several ways of infection:
Airborne – the pathogen is inhaled with air, which contains microparticles of the secretions of a sick person.
Aspiration through oro-, nasopharynx – after settling on the mucous membrane of the upper respiratory tract, after a few days, the infection descends into the bronchi, and then into the lungs.
Hematogenous – descending or ascending route of infection from the main focus.
Lymphogenic – the infectious agent is transported to the lung tissue with a current of lymphatic fluid during thoracic injuries.
Most often, the disease develops precisely with airborne infection.
Under the influence of bacterial or viral flora, there is a violation of cellular immunity, a disorder of local metabolism and innervation of the bronchial tree, lungs.
The development and further progression of the disease occurs in several stages:
Inflows – proceeds from 12 to 72 hours, during which the vessels of the lungs are intensively filled with blood, signs of fibrinous exudation appear in the alveoli.
red hepatization – lasts 24-72 hours. During this time, seals form in the lung tissue, the texture of which is similar to the liver. Exudate, sweating from the alveoli, contains a lot of red blood cells.
gray hepatization – can take from 48 hours to a week. During this period, the breakdown of red blood cells occurs. At the same time, large numbers of leukocytes enter the alveoli.
Permissions – characterized by gradual restoration of lung tissue. It may take quite a long time.
The development of bilateral pneumonia is facilitated by various diseases, conditions that cause a decrease in the immune functions of the body:
Bad habits.
Frequent psycho-emotional stress.
Chronic physical stress.
Prolonged use of the air conditioner.
Periodic disorders of consciousness of any origin.
Frequent epileptic seizures.
Stay on artificial lung ventilation.
Types of pathogens
Bilateral pneumonia flares up when a certain group of microorganisms enters the respiratory tract – viruses, bacteria, rods. The clinical symptoms and features of the therapeutic approach depend on the type of infectious agent.
Pneumococcus
The causative agent is well preserved in an anaerobic environment with a high content of carbon dioxide. For quite a long time, pneumococci were the most common cause of bilateral pneumonia.
The situation changed in 1983, when a polyvalent vaccine appeared, which is currently recommended for certain categories of the population:
All people over 65.
Patients with chronic pulmonary pathologies – emphysema, bronchiectasis, bronchial asthma.
Patients receiving treatment for chronic cardiovascular diseases.
Neurological patients with an unexpressed cough reflex, circulatory disorders, prone to convulsive attacks.
Patients with diagnosed liver cirrhosis.
Persons suffering from diabetes.
Patients with reduced immunological status.
Particular attention is paid to people who stay in numerous groups for a long time, regardless of age – children in orphanages and children’s homes, older patients in institutions where they receive specialized care and treatment.
Streptococcus
An infectious agent in an inactive state can stay for quite a long time in the oral cavity, on the nasal mucosa, on the inner membranes of the digestive organs, and the large intestine. Under certain conditions, the spread of pathogenic flora with blood flow occurs, leading to inflammatory processes in the lungs and bronchi. (Read also: Causes, symptoms and treatment of streptococcus)
staphylococcus
The causative agent causes severe pulmonary pathologies, in which the destruction of alveolar cells occurs. In this case, pulmonary abscesses are formed, air cavities with a thin membrane.
Staphylococcus leads to the formation of multiple foci of inflammation in both lungs. Very often, these processes end in severe toxic shock, cardiovascular failure, and impaired brain activity.
Klebsiella
Klebsiella contributes to the development of severe pulmonary lesions, which lead to the death of half of the patients. Most often, the pathogen attacks the body, weakened by alcohol, as well as patients with immune pathologies.
Legionella
The pathogen persists and develops in air conditioning systems, ventilators, and sometimes in the water supply system. Legionella can be contracted while working on the ground. Symptoms of the disease appear unexpectedly and progress quite rapidly. The course of bilateral pneumonia is difficult with the risk of serious complications.
Mycoplasma
Quite often, outbreaks of mycoplasma pneumonia occur during the autumn-winter season among young people who closely interact in numerous teams in an enclosed space. Most often they are students, schoolchildren.
Viruses
Recently, cases of atypical bilateral pneumonia of a viral nature are often recorded. The primary manifestations of the disease are similar to the clinic of a common cold. Over time, the manifestations of the pathology are aggravated. Viral pneumonia often causes severe complications, sometimes irreversible.
Features of the clinical picture
Bilateral pneumonia is an insidious disease that at the very beginning of its development does not have specific symptoms. A person, unaware of the impending danger, perceives the malaise as a common cold. And at this time, the pathological mechanism that destroys lung cells has already been launched.
The incubation period can last from 4 to 14 days, depending on the pathogen. During this time, the infectious agent moves from the upper respiratory tract to the lungs, aggressive symptoms appear.
The first symptom is an increase in temperature to 38-40°C. The patient complains of “tremendous” chills. This is followed by a cough, which may be dry at first. Over time, the cough becomes persistent, sputum appears. It can be mucous, mucopurulent or bloody type. Blood impurities in the sputum are explained by the fact that in the stage of red hepatization, intracellular hemorrhages occur in the lung tissue.
Over time, shortness of breath appears. The more severe the damage to the lungs, the more pronounced the signs of respiratory failure. Difficulty breathing increases with physical activity, performing habitual movements. The patient begins to complain of severe pain in both parts of the chest. Even sparing, forced postures do not bring much relief.
Nausea, vomiting, bouts of sweating, muscle and headache lead to physical exhaustion of the patient. There is a pronounced general weakness, fatigue, loss of consciousness is possible.
The aggravation of symptoms leads to the fact that a peculiar protein, fibrin, is deposited along the periphery of the lungs. It is the cause of the progression of severe respiratory failure, which leads to the death of the patient.
Diagnostics
The fundamental research method that can establish the fact of bilateral pneumonia is a chest x-ray. Recently, computed tomography has been actively used. The resulting images allow you to establish the exact localization and boundaries of the focus of inflammation.
Sputum examination makes it possible not only to verify the pathogen, but also to determine its resistance to a particular antibiotic. The selection of a suitable antibacterial drug can be very difficult – not always the first appointments bring the desired therapeutic effect.
A laboratory blood test establishes the level of ESR, erythrocytes, a shift in the leukocyte formula. These parameters make it possible to preliminarily judge the bacterial or viral etiology of inflammation in the lung tissue.
Of the additional hardware diagnostic methods, ultrasound is mandatory. The examination allows you to establish the fact of involvement in the process of the pleural cavity, the presence of effusion in it. If fluid is found, thoracocentesis may be needed to establish its nature and isolate the pathogen.
X-ray examination and verification of the type of pathogen play a decisive role in the diagnosis. Only on the basis of these data it is possible to establish the fact and nature of bilateral pneumonia, to prescribe adequate treatment.
Treatment
Almost all patients with bilateral pneumonia are hospitalized in a specialized department. In severe cases, the patient can be immediately admitted to the intensive care unit to be connected to a ventilator.
Treatment of bilateral pneumonia is always complex. Tactics consists of the following measures:
The appointment of antibiotic therapy. At the first suspicion of the development of pneumonia, a broad-spectrum drug is prescribed. If no positive dynamics is observed in the next 2-3 days, an antibiotic with another active substance is prescribed. There may be several such selections until the result of a bacterial sputum analysis with a verified type of pathogen and its sensitivity to antibiotics appears. It is advisable to prescribe cephalosporins, amoxicillin, macrolides.
Symptomatic treatment aimed at alleviating, stopping the accompanying manifestations of pneumonia. Patients receive antipyretic drugs, immunostimulants, agents for thinning and removing sputum. Be sure to conduct detoxification therapy, taking antiallergic drugs.
Physiotherapy methods begin to apply after stabilization of the patient’s condition, when the body temperature drops to normal parameters, all symptoms of intoxication are eliminated. To normalize the respiratory function, restore the vital capacity of the lungs, a course of electrophoresis, inhalations, massage and physiotherapy exercises is recommended. A full recovery of the patient may take a month of systematic rehabilitation measures.
Possible complications
Bilateral pneumonia is an aggressive disease that requires serious treatment and responsibility on the part of the patient. Neglect of medical requirements, non-compliance with bed rest, irregular intake of pharmaceuticals can provoke a number of complications:
Sepsis.
Inflammation of the pleural cavity.
Cardiovascular insufficiency.
Lung abscess.
Pulmonary edema.
The death of the patient.