Fever and cough may be signs of pneumonia

Pneumonia – This is an acute disease characterized by an infectious lesion of the lung tissue.
In the clinical picture of pneumonia, the leading manifestations are intoxication and respiratory syndromes.

For the diagnosis of pneumonia, a mandatory method of research – radiography of the organs of the chest cavity, which allows to determine focal-infiltrative changes in the lungs.

In this article on estet-portal.com, we will consider the modern classification, severity criteria and indications for hospitalization of patients with pneumonia, as well as the principles of drug therapy for this disease.

Modern classification of the disease: community-acquired and hospital-acquired pneumonia

According to the modern classification, pneumonia is divided into hospital and community-acquired.

Hospital pneumonia – a disease characterized by the development of infiltrative-focal changes in the lung tissue after 48 hours or more from the moment of hospitalization.

X-ray changes in nosocomial pneumonia are accompanied by symptoms confirming their infectious nature: fever, cough with purulent sputum, characteristic changes in the blood test.

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Nosocomial pneumonia subdivided into:

1.    Early nosocomial pneumonia: develops during the first 5 days of hospital stay, but not earlier than 48 hours after hospitalization. At the same time, the etiological pathogen, as a rule, – representative of the opportunistic microflora of the human body;

2.    Late nosocomial pneumonia: develops 6 days later and later after hospitalization, while the etiological pathogen – representative of hospital microflora;

3.    Ventilator-associated pneumonia – develops after 48 hours or later in mechanically ventilated patients;

4.    Pneumonia in immunocompromised patients;

5.    Aspiration pneumonia.
For more information on the diagnostic criteria for hospital-acquired pneumonia, read later in the article.

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Aspects of clinical diagnosis of pneumonia: criteria for diagnosis

There are certain diagnostic criteria for nosocomial pneumonia. These include:

1.    The level of axillary body temperature is over 38 degrees, rectal – over 38.5 degrees;

2.    Bronchial hypersecretion;

3.    Ratio of PaO2 (partial pressure of oxygen in arterial blood, mmHg) and FiO2 (fraction of oxygen in the inhaled air) – less than 300;

4.    Cough with purulent sputum, tachypnea, local crepitus, moist rales, bronchial breathing;

5.    Leukocytosis or leukopenia, shift of the leukocyte formula to the left.

Unlike hospital-acquired pneumonia, community-acquired pneumonia is much more common in the practice of a doctor, is associated with fewer therapeutic failures and has a more favorable prognosis for the patient.

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Clinical features of community-acquired pneumonia: diagnostic criteria

CAP – This is an acute disease that has arisen outside the hospital, characterized by the development of radiologically detectable focal-infiltrative changes in the lungs, in combination with clinical manifestations of a respiratory infection.

For the diagnosis of community-acquired pneumonia, the presence of characteristic radiographic changes, combined with at least two of the following clinical symptoms:

1.     Acute onset of the disease with body temperature above 38 degrees;

2.    Wet cough;

3.    Focus of crepitus and/or small bubbling rales, harsh breathing, shortening of the percussion tone;

4.    Leukocytosis or shift of the leukocyte formula to the left.

To determine the severity of pneumonia, the CRB-65 scale is used, which consists in assessing four indicators: consciousness, respiration, blood pressure and the patient's age.

On the CRB-65 scale, the presence of each of the following symptoms is estimated at 1 point:

1.    Respiratory rate over 30 per minute;

2.    Systolic blood pressure below 90 mm Hg. or diastolic blood pressure less than 60 mmHg;

3.    Impairment of consciousness;

4.    Over 65 years of age.

Thus, the course of pneumonia in patients whose condition is estimated at 0 points is mild and requires outpatient treatment, 1-2 points – moderate, requires treatment in the therapeutic department. Patients with more than 3 points are severe and should be treated in intensive care.

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Empirical treatment of pneumonia according to the severity of the disease

In most cases, pneumonia has a bacterial etiology, and treatment is prescribed empirically, depending on the characteristics of the clinical picture, the age of the patient, and the history of the disease.

Treatment of patients with mild pneumonia, who do not have indications for hospitalization and concomitant diseases, is to prescribe amoxicillin or an antibacterial drug of the macrolide group. If the patient also has a comorbidity, then the antibiotic of choice is amoxicillin/clavulanic acid or cefuroxime.

For moderate pneumonia, it is necessary to prescribe parenteral antibiotic therapy: aminopenicillins in combination with macrolides or third-generation cephalosporins, as well as oral macrolides.

For the treatment of severe pneumonia, the following combination of drugs should be used: intravenously protected aminopenicillin, a macrolide or third-generation cephalosporin, ertapenem, and an oral macrolide. If P.aeruginosa is suspected in the etiology of pneumonia, it is necessary to use an intravenous cephalosporin III-IV generation, active against the pathogen, in combination with an aminoglycoside or levofloxacin.

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