community-acquired pneumonia in adults

Community-acquired pneumonia accounts for approximately 4-5th place in terms of mortality from infectious and inflammatory processes. Among young people, mortality is up to 2 – 4%, reaching 15 – 20% by old age.

What is Community Acquired Pneumonia

Community-acquired pneumonia is called if the infection developed outside the walls of medical institutions, a person became infected with certain bacteria, viruses or fungal pathogens at work, at home or while traveling. This is important because completely different types of pathogens circulate in medical institutions and outside them, which provoke different forms of pneumonia and they need to be treated in a special way.

Causes of Community Acquired Pneumonia in Adults

Bacteria are considered the key provocateurs of community-acquired pneumonia. Among them, the leaders in the development of pneumonia can be called:

• Pneumococcus;
• hemophilic bacillus;
• streptococcus;
• Legionella;
• mycoplasma.

In recent years, pneumonia caused by chlamydia and pneumocystis has become more common. The number of pneumonias that provoke viruses (including coronavirus, influenza and other types) has also risen sharply.

If the patient is young and middle-aged, one type of pathogens is usually determined in him. If these are elderly people over 60 years old, they may have mixtures of several bacteria, which greatly complicates the course of the disease, can lead to dangerous complications.

Symptoms of Community Acquired Pneumonia in Adults

The most basic and frequent symptoms that occur with pneumonia can be considered:

• elevated temperature, which lasts for a long time and is poorly knocked down by antipyretics;
• a cough that may be dry at first but quickly becomes wet, with purulent or blood-streaked sputum;
• pain in the chest when breathing, especially in the lower sections;
• sharp chills, severe sweating;
• wheezing, breath sounds and shortness of breath.

Symptoms will vary depending on which area of ​​the lung is affected. If this is a lesion of one lobe, the doctor can determine signs of respiratory failure, wheezing in the lungs, changes in breathing.

In severe pneumonia, if a large volume of lung tissue is affected, there may be problems with the work of the heart, digestive disorders, and impaired consciousness due to oxygen deficiency in the tissues.

The right lung is affected more often than the left. Doctors explain this by the peculiarities of the structure of the bronchi, which bring gases to the lungs.

The course of community-acquired pneumonia in adults

Community-acquired pneumonia can proceed according to different scenarios. It depends on how aggressive the bacteria or viruses are, how much inflammation affects the lungs, and how much lung tissue is affected. Acute pneumonia usually occurs, which can be:

• one or two sided (one or both lungs suffer);
• segmental, polysegmental or lobar (a different amount of tissue is affected).

If these are dangerous microbes or aggressive viruses (for example, a coronavirus that provokes COVID-19), inflammation can literally affect up to 2% of the lungs or more in just 3 to 50 days, which leads to respiratory failure, hypoxia (lack of oxygen in the blood), due to for which the brain, kidneys, heart, liver suffer.

Severe pneumonia can lead to the development of DIC (when blood clotting is impaired), respiratory failure, or toxic shock (poisoning of the body by metabolic products and bacterial decay). All of these conditions can lead to death.

Treatment of Community Acquired Pneumonia in Adults

Any types of community-acquired pneumonia, if they are not detected in time and treatment is not started, can be dangerous with severe complications, up to the death of the patient. Uncomplicated forms of pneumonia in relatively healthy young patients can be treated at home, under the supervision of a doctor. Elderly or at-risk patients should be admitted to the hospital.

Diagnostics

If you suspect pneumonia, you should see a doctor as soon as possible, and if the condition is serious, call a therapist or an ambulance at home. The first thing the doctor will evaluate is all complaints and the general condition: skin color, especially the presence of pallor, cyanosis of the fingertips and nasolabial triangle. The doctor will measure the pressure and pulse, evaluate the blood oxygen saturation (the norm is from 95%), carefully listen to the lungs from the chest and back, noting wheezing and changes in breathing.

Help to confirm pneumonia:

• X-ray of the lungs or in difficult cases CT;
• urine and blood tests (general, biochemical, clotting, sugar, etc.);
• sputum cultures for flora, PCR test or other methods for identifying a specific pathogen.

If bacteria are found, their sensitivity to antibiotics is determined so that the doctor can select the most effective drug for treatment.

Modern treatments

If it is a bacterial infection, as soon as the patient is admitted to the hospital, the doctor will prescribe antibiotics, focusing on the most likely causative agent of community-acquired pneumonia. After 3 – 4 days, when the results of sowing on the flora are ready, it is possible to change the antibiotic.

With viral pneumonia, therapy is carried out, which is aimed at improving the general condition and combating symptoms. Rarely, antiviral drugs (Ingavirin, Arbidol, Relenza, Tamiflu, Amiksin) can be used.

Usually the patient is prescribed:

• intravenous infusions of glucose and saline solutions to support the body, replenish energy reserves;
• antipyretic and anti-inflammatory drugs (Ibuklin, Nurofen, Paracetamol, Rinza, Nimesulide);

• in severe cases – hormonal drugs (in tablets, in injections);
• preparations for thinning and removing sputum (Fluimucil, ACC, Bromhexine, Ascoril, Ambrobene, etc.);

• vitamin preparations;
• oxygen therapy – with hypoxia.

As the condition improves, respiratory gymnastics, exercise therapy, drainage massage are shown to remove sputum.

The regime, adherence to nutritional recommendations and plenty of fluids are important in order to activate the body’s defenses.

Prevention of community-acquired pneumonia in adults at home

Community-acquired pneumonia is most often caused by bacteria – pneumococci, Haemophilus influenzae, from which there are vaccinations. They are shown to people at risk. If these are viral infections, vaccination against influenza and coronavirus infection will help reduce the risk of complications.

In addition, simple safety rules are effective and simple:

• wearing a protective mask during epidemics;
• washing hands with soap, avoiding touching the face with hands;
• use of hand sanitizers;
• avoid contact with sick people.

Popular questions and answers

Community-acquired pneumonia is a very large group of diseases. Each type is dangerous in its own way. What threatens pneumonia, especially if it is not treated from practicing self-medication, she told us pulmonologist Natalya Neeshpapa.