The respiratory system performs one of the most important functions in our body. It provides cells, organs and tissues with uninterrupted breathing and the removal of harmful carbon dioxide from them. Inflammatory lung disease greatly reduces respiratory function, and such a pathology as community-acquired pneumonia can lead to deep respiratory failure, oxygen starvation of the brain and severe complications.

Community-acquired pneumonia is pneumonia that affects a person outside a hospital or within 48 hours of being admitted to a hospital.

Typical symptoms

Inflammation of the pulmonary structures begins acutely. There are several criteria that should alert the environment of a sick person and facilitate his coming to the doctor:

• a state of fever;
• cough;
• dyspnea;
• chest pain.

This complex of symptoms should be a signal to go to the clinic to see a doctor.
Fever is manifested by chills, headache, temperature rise to high numbers. Possible nausea, vomiting after eating, dizziness. In severe cases, convulsive readiness, a state of confusion.

Cough, dry at first, excruciating. After a few days, sputum begins to drain. It can be of various consistencies: from mucous to purulent blood-streaked. Shortness of breath with pathologies of breathing of the expiratory (on exhalation) type. Pain sensations are of varying intensity.   

Very rarely, fever may not be present in old age. This happens after 60 years, in 25% of all pneumonia. The disease manifests itself in other symptoms. Chronic diseases come to the fore. Weakness and severe fatigue appear. Possible abdominal pain, nausea. Elderly people often lead a reclusive and sedentary lifestyle, which contributes to the development of congestion in the lungs and clinically atypical forms of pneumonia.  
 

Main reasons

A healthy body is protected from most pathogenic microbes and pneumonia is not dangerous for it. But when unfavorable conditions arise, the risk of the disease increases. The most common factors that can lead to pneumonia are:

• smoking tobacco;
• viral diseases of the upper respiratory tract;
• chronic pathologies of the heart, gastrointestinal tract, kidneys and liver;
• contact with wild animals, birds, rodents;
• frequent changes of residence (travel to other countries);
• systematic or one-time severe hypothermia;
• younger and old age (unlike adults, children and old people get sick more often).

Heart pathology

Predisposing factors often become the trigger for the disease, but community-acquired pneumonia occurs only if the pathogen has entered the lungs. 

Classification of types of pathogens in percentage

Causative agent	%	Characteristic
Pneumococcus	30-40	The main causative agent of pneumonia.
Mycoplasma	15–20	Causes atypical inflammation in the lung tissue.
Haemophilus influenzae	3-10	Pneumonia caused by this bacterium is most prone to purulent complications.
Staphylococcus	2-5	Lives on the mucous membranes of most people, affects weakened organisms.
Influenza viruses	7	They cause specific viral pneumonia.
Chlamydia	2-8	It mainly causes diseases of the genital organs in humans, but is also carried by rodents and birds, therefore it can sometimes cause pneumonia.
Legionella	2-10	It is the causative agent of Legionnaires’ disease and Pontiac fever, sometimes causing pneumonia. Can live and reproduce peacefully in many environments.
Other flora	2-10	Klebsiella, Pseudomonas aeruginosa and Escherichia coli, Proteus, other microorganisms.

Basically, the infection enters the body in three ways:

• Transbronchial, through the respiratory system, with air flow from the outside.
• Contact, that is, direct contact of the infected substrate with the lung tissue.
• Hematogenous, from the primary focus with blood flow through the vessels.

Diagnostics

When a patient is admitted with suspected pneumonia, the doctor begins the diagnosis by interviewing complaints and an initial examination with physical examination methods:

Palpation

• palpation;
• percussion;
• listening.

When tapping, the sound is shortened over the affected part of the lung, the more dullness, the higher the risk of detecting complications. Listening shows localized bronchial breathing, wheezing of various calibers, possibly crepitus. Palpation of the chest reveals increased bronchophonia and vocal tremors.

Further, the doctor prescribes:

• chest x-ray;
• general blood analysis.

In the hospital, a biochemical blood test is performed, and sputum is examined for the presence of microflora. A complete blood count shows signs of inflammation: 

• leukocytosis, with a shift of the formula to the left;
• increased ESR;
• sometimes toxic granularity of red blood cells and aneosinophilia.

X-ray

On the roentgenogram, a sign of pneumonia is infiltrative darkening of the lung tissue, which can be of different sizes, from focal to total (right / left-sided) and bilateral. In case of an unusual picture on the roentgenogram (incomprehensible changes or “nothing” in the lungs), computed tomography is prescribed for a more complete visualization of the lesions. 

Clinical guidelines for the diagnosis of community-acquired pneumonia indicate several clinical and laboratory signs for the detection of severe pneumonia, in which the patient is indicated for hospitalization not in a specialized (therapeutic, pulmonological) hospital, but in the intensive care unit.

Signs of severe pneumonia

Clinical	Laboratory
Acute respiratory failure (Respiratory rate more than 30 per minute).	Decrease in the blood count of leukocytes below 4.
Pressure less than 90/60 (in the absence of blood loss).	The defeat of several lobes of the lungs on the roentgenogram.
Decrease in oxygen saturation below 90%.	Hemoglobin below 100 g / l.
The partial pressure in arterial blood is below 60 mm. rt. Art.
Confused state of consciousness not associated with other medical conditions.
Symptoms of acute renal failure.

Any of these signs is a significant signal for the doctor’s decision to admit the patient to the emergency department and start a comprehensive therapy to restore the body.

Healing procedures

The general principles of inpatient treatment of community-acquired pneumonia are based on several important points:

Good nutrition

• Sparing treatment for the patient.
• Good nutrition.
• Complete drug therapy.

The mode is chosen by the doctor depending on the clinical manifestations. In a febrile period – bed mode, with a raised headboard and frequent turns in bed. The patient is then allowed to walk a little.

Complex nutrition includes easily digestible carbohydrates, natural vitamins. Consumption of large volumes of liquid is imperative.

Medical treatment consists of 3 main points:

• etiotropic therapy aimed at suppressing the pathogen (antibiotics, specific sera, immunoglobulins);
• detoxification therapy, which is aimed at reducing the level of fever, removing toxins from the body;
• symptomatic therapy.

Much attention is paid to the choice of antibiotic. Until microflora is clarified, patients with pneumonia are treated empirically with antibiotics based on the following data:

• conditions for the occurrence of pneumonia;
• the age of the patient;
• the presence of concomitant pathologies;
• the severity of the disease.

Antibiotics

The doctor chooses broad-spectrum antibiotics (penicillins, cephalosporins). If the effect of treatment is absent within 2-4 days, the antibiotic is replaced with another one or the dose is increased. And after identification of the pathogen, correction of etiotropic therapy is often carried out to increase efficiency.

The prognosis is favorable in the absence of severe pulmonary and other complications, concomitant chronic diseases. Timely referral to a specialist is important for effective recovery. In inpatient treatment, discharge home is usually given after 2 weeks in the hospital.

An early consultation visit to a medical facility will allow the patient to be on outpatient treatment and take medication in a more comfortable home environment. However, when treating at home, it is necessary to observe a special regimen for the patient (separate dishes, mask regimen).

Prophylaxis

Preventive measures aimed at reducing the risk of out-of-hospital pneumonia in the home should be carried out at different levels.

Prevention at the household level

Long-term living in damp rooms with poor air access and lack of sunlight is not recommended. It is necessary to carry out constant wet cleaning.

Sanitary vigilance in large teams

The management of enterprises should take care of labor protection, improve work technology and industrial sanitation.
 

Community prevention

Mass sports campaigning for a healthy lifestyle and giving up bad habits.

Prevention in medicine

Systematic timely vaccination of the population against influenza. The vaccine must match the virus strain that progresses during the vaccine season.

Personal prevention

Rational hardening, reducing the amount of hypothermia (especially in the cold season), eliminating bad habits, daily sports.

Any disease is easier to prevent than to cure.