Clinical picture, treatment and prevention of pneumococcal pneumonia. Pneumococcal Pneumonia Treatment: Medical Blog of an Emergency Physician Pneumococcal Pneumonia Symptoms

Pneumococcal pneumonia refers to a type of bronchial pneumonia provoked by pneumococci, which affects a significant part of the pulmonary lobe. Up to 70% of pneumonia is provoked precisely by pneumococci, since they are present in the microflora of the upper respiratory tract, activating only when weakening immune defense... In most cases, pneumococcal pneumonia appears in the winter, after complications of influenza and acute respiratory viral infections.

Causes and risk factors for the disease

Sources of pneumococcus are carriers or patients who are already ill. Most often outbreaks of pneumococcal pneumonia are observed in collectives and in medical institutions where nosocomial infections are possible.

The main route of transmission of pneumococcus is airborne. In addition, a contact transmission path is possible (through household items).

Factors that significantly worsen the prognosis of pneumococcal pneumonia include:

• alcohol abuse and smoking;
• the presence of bacteria in the blood and the spread of the inflammatory process in a large part of the lung;
• negative influence of production factors (toxins, pesticides, etc.);
• pathology of the heart and blood vessels, accompanied by stagnant processes;
• the presence of chronic diseases of the nasal and oral cavity, as well as obstruction of the respiratory system;
• disorders of the liver, kidneys and heart;
• underweight and decreased immunity;
• the risk group includes children under 2 years of age and patients over 65 years of age.

Susceptibility to pneumococci is quite high, therefore, it is possible to involve lymphatic vessels, interstitial tissues, alveoli and regional lymph nodes in the inflammatory process.

Clinical stages and symptoms of pneumococcal pneumonia

The disease can occur in 4 stages:

Initial

At this stage, there is an acute onset of pneumonia. The duration of this stage is from 12 to 36 hours. During this time, pneumococcus provokes reactive filling of the pulmonary vessels with blood, which leads to increased formation of leukocytes in the alveolar lumens. This process activates the production of serous exudate, in which a large amount of the pathogen is present, in the alveoli.

The initial signs of pneumococcal pneumonia are hyperthermia (up to 40 degrees), which is preceded by chills. In addition, the patient complains of a dry, unproductive cough and the appearance of sharp chest pains on the side of the inflammation when inhaling.

Red seal stage

The duration of this stage can be from 12 to 72 hours. The stage of compaction is characterized by the penetration of erythrocytes into the lumens of the alveoli of the affected lung. Further, the exudate is compacted.

In addition, the patient complains of severe shortness of breath due to the exclusion of a part of the lung from the respiratory activity, rapid breathing and a wet cough. Intoxication symptoms are increasing (weakness, muscle pain, body aches). Blood streaks may be present in purulent sputum.

At this stage, in addition to the alveoli, interstitial tissues, as well as the pleura and lymph nodes of the mediastinum, can be involved in the pathological process.

Stage of brown compaction (gray hepatization)

This stage lasts from 2 to 7 days and is characterized by the penetration of leukocytes into the exudate. Erythrocyte breakdown is observed, which in turn changes the color of the sputum. The symptomatology of the gray hepatic stage is similar to the previous stage.

Resolution

The incubation period of the final stage of pneumococcal pneumonia is no more than 3 days. At this stage, there is a subsiding of the pathological process, resorption of exudate in the pulmonary lobes, due to the action of macrophages. The stage of resolution of pneumonia can be indicated by a decrease in the amount of sputum, hypothermia, relief of pain symptoms and a decrease in shortness of breath.

Important! Symptoms of the development of pneumococcal pneumonia in childhood proceeds with more pronounced intoxication symptoms and requires mandatory hospitalization.

Diagnostics

In order to confirm pneumococcal pneumonia, diagnostic measuresincluding:

Physical examination

At the first stage of pneumonia, a dull sound above the inflammatory focus, crepitus (a characteristic creak when breathing), long exhalation and hard breathing are determined.

At the final stage, the state is normalized, finely bubbling sonorous rales appear, and bronchial breathing changes to hard, and then vesicular. It should be borne in mind that the regularity typical for the stages of pneumococcal pneumonia can be violated, therefore, physiological data can simultaneously diagnose various signs.

X-ray

At the beginning of the development of pneumococcal pneumonia, radiographic signs are poorly expressed. Diffuse darkening in the image does not define clear boundaries, the pulmonary pattern is enhanced. There is a non-focal homogeneous infiltration in the affected part of the lung with expansion of its root.

At the stage of regression, a decrease in the intensity of the shadows due to the resorption of the infiltrate is radiologically diagnosed. Pleural induration and strengthening of the lung pattern are preserved.

To exclude the presence of malignant neoplasms, as well as pulmonary tuberculosis, a computed tomogram is recommended. An estimated improvement in the general condition occurs no earlier than after 30 days.

Diagnostic criteria for pneumococcal pneumonia

The diagnosis of the disease corresponds to the stages of pneumonia.

At stage 1, there are dry wheezing, dull percussion sound, breathing is difficult. At the 3rd and 2nd stages, bronchophonia joins. The final stage of the disease is accompanied by the appearance of wet wheezing and hard breathing.

Pneumococcal pneumonia is accompanied by blood changes. Laboratory diagnostics reveals a shift (to the left) of the leukocyte formula, increased ESR and neutrophilic leukocytosis. The positive C-reactive protein, increased indicators of fibrinogen, haptoglobin and sialic acid are determined.

The causative agent of pneumonia is determined by examining sputum (there is an accumulation of pneumococci with a Gram reaction). In addition, a sputum culture is prescribed for bacteriological examination and serological reaction.

Treatment of pneumococcal pneumonia

After clarifying the diagnosis, the doctor prescribes therapeutic measures that correspond to the stage of development of pneumonia.

Comprehensive treatment includes:

Power and mode

Particular attention should be paid to the water regime (at least 3 liters of liquid during the day), since general intoxication contributes to dehydration of the body. The diet should contain a sufficient amount of fresh fruits and vegetables, proteins and easily digestible fats.

Antibiotic therapy

Drugs that are part of the antibiotic group are prescribed empirically (in the absence of a response to bacterial susceptibility to certain antibiotics).

This approach is due to the fact that in a bacteriological study, the analysis results are ready after 5 days, which leads to a loss of time.

Most often, antibiotics of the penicillin series (Ampicillin, Amoxiclav), the macrolide group (Azithromycin and Erythromycin), as well as cephalosporins (Ceftriaxone and Cefazolin) are used in treatment.

The dose, method of administration and duration of antibiotic use depends on the patient's condition. For adults, treatment is predominantly given with injectable antibiotics, while for children, oral medication is preferred.

Pathogenetic therapy

Treatment of pneumonia is due to the severity of pulmonary and systemic factors.

Pathogenetic therapy includes:

• taking immunomodulators (Decaris, Timalin, etc.) to enhance the body's defenses;
• for better sputum discharge, expectorants are prescribed (Bromhexin, Lazolvan);
• the use of inhalations with bronchodilators (Berodual, Atrovent);
• mucolytics are prescribed (Potassium iodide, Acetylcysteine, Mukaltin) and bronchodilators, for example, Euphyllin;
• as an antioxidant treatment, a complex of vitamins is prescribed, mainly of groups C and E, Rutin and multivitamins.

The main role of pathogenetic therapy is to restore the drainage function, since only in this case the patient can recover.

Detoxification

Detoxification (elimination of toxins from the body) necessarily includes the infusion of drugs (saline, Ringer's, hemodez, glucose, lipoic acid, Lidase, etc.) with the obligatory control of diuresis. With pronounced intoxication, plasmapheresis and hemosorption are prescribed (purification of the patient's blood from toxins with sorbents).

Symptomatic treatment

Based on the symptoms, the doctor may prescribe non-steroidal drugs (Diclofenac, Paracetamol, Ortofen), which relieve pain and reduce the swelling of the intermediate lung tissues.

With the development of a dry cough, Libexin, Codterpine and Tusuprex tablets can be prescribed. To improve myocardial contraction, cardiac glycosides (Strofantin or Cardiamine) are used.

Physiotherapy

In the recovery stage, an effective effect is exerted by:

• physiotherapy - electrophoresis with the addition of magnesium sulfate, potassium iodide and calcium chloride, inhalation with Bioparox and Acetylcysteine, UHF, UHF, acupuncture, applications with ozokerite and paraffin;
• Exercise therapy - physical education is prescribed after the temperature has dropped and antibiotics are withdrawn. The exercise is aimed at improving pulmonary ventilation, normalizing tissue microcirculation and bronchial drainage;
• massage - performing classical and reflex massage is possible at any stage of the disease, but massage techniques for each stage are selected individually.

In addition, oxygen therapy is recommended to normalize the supply of oxygen to the brain.

Prediction and prevention of pneumococcal pneumonia

With early diagnosis and adequate treatment, the prognosis of pneumococcal pneumonia is favorable. The patient's recovery is possible after 4 weeks. Only in 5% of cases (if the symptoms are ignored), severe complications and death of the patient are possible in the first 5 days of the development of the disease

To reduce the likelihood of developing pneumococcal pneumonia, it is recommended to adhere to preventive measures, for example, quitting smoking and alcohol, normalizing nutrition, healthy way life. In addition, timely treatment of ARVI and chronic diseases is necessary.

Specific prophylaxis consists in vaccination, especially of patients at risk, against pneumococcal infections with Prevenar and Synflorix vaccines, which can significantly reduce the level of pneumococcal carriage. The vaccine is administered once, positive results such prevention has been proven by numerous observations of specialists.

It should be remembered that pneumococcal pneumonia requires mandatory treatment and observation by the attending physician. Therefore, at the first manifestations of the disease, it is necessary to contact medical institution, which will allow you to start timely therapeutic measures, thereby preventing serious complications.

Pneumococcal pneumonia - the etiological type of bacterial pneumonia caused by Streptococcus pneumoniae (pneumococcus). In the clinic of pneumococcal pneumonia, febrile-intoxication (severe weakness, anorexia, febrile temperature, chills) and bronchopulmonary (cough with sputum, shortness of breath, pain in the side) syndromes dominate. The diagnosis is facilitated by a comprehensive assessment of physical, radiological, laboratory data. First-line antibiotics for the treatment of pneumococcal pneumonia are penicillins, cephalosporins, macrolides; additionally, detoxification, oxygen therapy, immunocorrection, physiotherapy are carried out.

Pneumococcal pneumonia

Pneumococcal pneumonia is a form of pneumococcal infection that occurs in the form of focal bronchopneumonia or croupous pleuropneumonia. Pneumonia of pneumococcal etiology is the leader in the structure of bacterial pneumonia. S. Pneumoniae is believed to cause about 30% of the community and 5% of nosocomial pneumonia... The highest incidence is observed among children under 5 years old and adults over 60 years old. In about a quarter of cases, pneumococcal pneumonia occurs with severe pulmonary (pleurisy, lung abscess, pleural empyema) and extrapulmonary (pericarditis, arthritis, sepsis) complications.

Before the era of penicillin, the mortality rate from pneumococcal pneumonia exceeded 80%; now, thanks to vaccination and antibiotic therapy, this figure has significantly decreased. Nevertheless, the levels of morbidity, morbidity and mortality remain high, which leads to an increased alertness of specialists in the field of pediatrics and pulmonology in relation to pneumococcal pneumonia.

Causes of pneumococcal pneumonia

Streptococcus pneumoniae, the causative agent of pneumococcal pneumonia, belongs to gram-positive diplococci. The bacterium is surrounded by a polysaccharide capsule, which serves as a factor determining the virulence and pathogenicity of pneumococcus, its ability to form antibiotic resistance. Considering the structure and antigenic properties of the polysaccharide capsule, over 90 serotypes of S. pneumoniae are isolated, 20 of which cause the most severe, invasive forms of pneumococcal infection (meningitis, pneumonia, septicemia).

Pneumococcus is a representative of the conditionally pathogenic nasopharyngeal microflora of humans. S.pneumoniae bacteria are found in 10-25% of healthy people. The reservoir and distributor of the pathogen is a bacterial carrier or a patient with pneumococcal infection. Infection can occur in several ways:

• airborne - by inhalation of mucus particles sprayed in the air containing the pathogen
• aspiration - when the secretion of the nasopharynx enters the lower respiratory tract
• hematogenous - from extrapulmonary foci of pneumococcal infection.

The risk category most susceptible to pneumococcal pneumonia is children under 2 years of age, elderly people over the age of 65, immunocompromised patients, persons with asplenia, alcoholism and tobacco dependence. The factors that increase the likelihood of morbidity are hypothermia, nutritional deficiency, hypovitaminosis, frequent ARVI, stay and close contacts in the team (in a kindergarten, hospital, nursing home, etc.). Up to 50% of pneumococcal pneumonias occur during an influenza pandemic, as the influenza virus facilitates pneumococcal adhesion and colonization of the bronchial mucosa.

The development of pneumococcal pneumonia occurs with the change of four pathomorphological phases. In the first (phase of microbial edema) lasting 12-72 hours, there is an increase in the blood filling of the vessels with the release of exudate into the lumen of the alveoli. Pneumococci are determined in the serous fluid. The second phase of pneumonia (red curing) is characterized by the appearance of fibrinogen and erythrocytes in the exudate. The affected lung tissue becomes dense, airless, resembling liver tissue in consistency and color. This period lasts 1-3 days. The next phase (gray hepatization), lasting 2-6 days, proceeds with a predominance of leukocytes in the exudate, due to which the lung acquires a grayish-yellow color. In the last period (resolution phase), the reverse development of changes begins: resorption of exudate, dissolution of fibrin, restoration of lung airiness. The duration of this period is determined by the severity of the inflammatory process, the reactivity of the macroorganism, and the correctness of therapy.

Pneumococcal pneumonia symptoms

The clinical picture of pneumococcal pneumonia consists of a number of syndromes inherent in acute pneumonia in general: intoxication, general inflammatory, bronchopulmonary and pleural. Inflammation of the lungs caused by pneumococcal infection usually occurs in one of two variants: in the form of lobar pneumonia (lobar pneumonia, pleuropneumonia) or focal pneumonia (lobular pneumonia, bronchopneumonia).

Croupous pneumonia manifests itself acutely, with a sudden rise in temperature to 38-40 ° C, tremendous chills, feverish blush on the cheeks. Signs of intoxication are significantly expressed: weakness, headache, myalgia, loss of appetite. Shortness of breath and tachycardia appear. Patients notice chest pain on the affected side when breathing and coughing. Dry, painful at first, cough soon becomes moist, with brownish ("rusty") sputum. The course of lobar pneumococcal pneumonia is severe. There are often complications in the form of acute respiratory failure, pleurisy, lung abscess, pleural empyema. Less often, extrapulmonary and generalized complications develop: meningitis, endocarditis, nephritis, sepsis.

The onset of focal pneumococcal pneumonia is usually preceded by an episode of ARVI. General weakness, high fatigue, and severe sweating persist. Symptoms are generally similar to those of croupous pleuropneumonia, but less pronounced. The fever is less high and prolonged, the cough is moderate and less painful. The course of focal pneumonia is usually moderate, complications are relatively rare. However, bronchopneumonia is more prone to a protracted course - often infiltrative changes in the lungs persist for more than one month.

Diagnosis of pneumococcal pneumonia

Pneumococcal pneumonia is characterized by certain physical data that change in accordance with the pathological phase of the disease. At the stage of exudation, the dullness of percussion sound, hard breathing, dry wheezing, initial crepitus are determined. In the stage of hepatization, bronchophonia appears, the noise of pleural friction is heard. For the stage of resolution, various-sized moist rales, sonorous crepitus, hard breathing, turning into vesicular are typical.

X-ray examination (radiography of the lungs in two projections) allows visualizing pneumonic infiltration of lung tissue (in the form of intense darkening of the lobe or focal shadow), to determine the presence of pleural effusion. With the aim of differential diagnosis with lung cancer, tuberculosis, atelectasis, linear and computed tomography (CT of the lungs) is used.

With pneumococcal pneumonia, changes in the analyzes are pronounced peripheral blood... Typical neutrophilic leukocytosis, a sharp shift of the formula to the left, increased ESR. In a biochemical blood test for activity inflammatory response indicates positive CRP, increased sialic acids, fibrinogen, haptoglobin, γ-globulins.

Etiological verification of pneumococcal pneumonia is carried out using microscopic examination of sputum: in preparations stained according to Gram, accumulations of pneumococci are determined. Also, bacteriological culture of sputum, serological reactions are carried out (titers of antipneumococcal antibodies in paired blood sera increase on days 10-14 of the disease).

Treatment of pneumococcal pneumonia

The modern approach to the treatment of pneumococcal pneumonia consists of basic, etiotropic, pathogenetic and symptomatic therapy. Hospitalization in a hospital is carried out according to clinical indications (children of the first year of life, elderly patients, persons with chronic concomitant diseases). For the period of fever, bed rest is prescribed, a full-fledged diet balanced in calories is recommended, and the use of a sufficient amount of liquid.

Etiotropic therapy of pneumococcal pneumonia consists in the use of antibacterial drugs that are most active against S.pneumoniae. First of all, these are inhibitor-protected penicillins (amoxicillin, ampicillin), second-third generation cephalosporins (ceftriaxone, cefotaxime), macrolides (josamycin, spiramycin), carbapenems (imipenem, meropenem). Vancomycin is used to target antibiotic-resistant pneumococcal strains.

The pathogenetic approach to the treatment of pneumococcal pneumonia is based on detoxification therapy, the use of bronchodilators, cardioprotectors, anti-inflammatory and diuretics. Symptomatic therapy involves taking antipyretic, antitussive, expectorant drugs, conducting distracting and local therapy (inhalation, irrigation of the throat with antiseptic solutions). In the resolution phase, rehabilitation measures are added to drug treatment: breathing exercises, physiotherapy, chest massage, vitamin therapy. The total duration of treatment for pneumococcal pneumonia should be at least 3 weeks with dynamic X-ray control.

Prediction and prevention of pneumococcal pneumonia

Pneumococcal pneumonia of moderate severity, as a rule, progresses favorably and resolves within two to four weeks. Severe infections occur in children younger age, persons with severe intercurrent diseases and can be fatal due to the addition of various pulmonary and extrapulmonary complications.

In order to reduce the incidence rate and adverse outcomes, mandatory vaccination against pneumococcal infection has been included in the national vaccination calendar since 2014. In addition to developing specific immunity, vaccination allows you to sanitize the upper respiratory tract from pneumococcal colonization and reduce the number of bacteria carriers. Non-specific prevention of pneumococcal pneumonia consists of the isolation of patients, an increase in the general resistance to infections, and timely treatment of ARVI.

Pneumococcal pneumonia;

Pneumococcal pneumonia is highly stereotyped compared to other infections such as typhoid fever and tuberculosis. The processes caused by various serotypes of pneumococci differ somewhat in severity or clinical manifestations. The prognosis for serotype 3 pneumococcal disease is generally considered poor, probably because the pathogen is a common cause of disease in older people and those with chronic wasting diseases such as diabetes and congestive heart failure. In adults, a segment or the entire lobe of the lung is involved in the process, however, focal bronchopneumonia often develops in children and the elderly.

Clinical manifestations. Pneumonia is often preceded by a runny nose or other symptoms of common respiratory diseases for several days, and it often begins so abruptly that the patient can point to the exact hour of onset. In more than 80% of cases, the disease begins with tremendous chills and a rapid increase in body temperature with tachycardia and rapid breathing (tachypnea). In most patients with pneumococcal pneumonia, if they do not receive antipyretic drugs, they note one attack of chills, and if they are repeated, one should think about another possible cause of the disease.

Approximately 75% of patients develop severe pleural pain and cough with pinkish sputum, which becomes "rusty" after a few hours. The pains in the chest area are extremely severe, and breathing becomes rapid, shallow, and hoarse as the patient tries to spare the affected side. In many patients, at the first examination, moderate cyanosis is noted as a result of hypoxia caused by impaired ventilation of the lungs or blood shunting, and swelling of the wings of the nose. The general condition of the patient is severe, but the symptoms of intoxication (nausea, headache, feeling of weakness) are moderately expressed, and in most patients, consciousness is completely preserved. The main complaints include pleural pain and shortness of breath.

In an untreated patient, the body temperature is maintained at a level of 39.2-40.5 ° C, pleural pains, cough with phlegm persist, and abdominal distention is often added. Herpetic eruptions on the lips are not uncommon as a complication. After 7-10 days, a crisis occurs; profuse sweating, a sharp decrease in body temperature and a significant improvement in the patient's well-being.

In cases that end fatally, extensive lung damage is usually noted, the patient is particularly short of breath, cyanosis, and tachycardia, circulatory collapse or a pattern resembling acute respiratory failure syndrome in adults may occur. The cause of death is sometimes empyema or other suppurative complications such as meningitis or endocarditis.

On physical examination, attention is drawn to the limitation of the mobility of the affected half of the chest. On the first day of illness, the voice tremor may be weakened, but then it intensifies as the thickening of the inflammatory infiltrate is completed. Deviation of the trachea in the opposite direction indicates an effusion into the pleural cavity or empyema. The percussion sound is dull, and with the localization of the inflammatory process in the upper lobe, a unilateral limitation of the diaphragm mobility can be detected. In the early stages, weakened breathing is heard, however, as the pathological process develops, it takes on the character of bronchial, and then bronchophonia increases and the conductivity of whispering speech through the chest increases. Against the background of these signs, small crepitant rales are revealed.

Results of specific chemotherapy. When treated with appropriate antibacterial drugs, pneumococcal pneumonia usually resolves quickly. 12-36 hours after the start of treatment with penicillin, the body temperature decreases, the pulse and respiration begin to decrease and can normalize, pleural pain decreases, the further spread of the inflammatory process stops. However, in about half of patients, body temperature returns to normal within 4 days or more, therefore, if it does not return to normal after 24-48 hours, this should not serve as a basis for replacing the drug, unless there are other serious indications for this.

Complications. The typical course of pneumococcal pneumonia can be complicated by the development of a local or distant process.

Lung atelectasis. Atelectasis of the entire lobe or part of it can occur in the acute stage of pneumonia or during treatment. The patient begins to complain of a sudden relapse of pain in the chest, his breathing quickens. Often, small areas of atelectasis are found during X-ray examination in a patient who does not present complaints. They usually disappear with coughing and deep breathing, but in some cases aspiration bronchoscopy is required to eliminate them. In an untreated patient, the areas of atelectasis are fibrosed and do not participate in respiration.

Slow resolution of the process. Usually, 2-4 weeks after pneumococcal pneumonia, physical examination does not reveal pathology. However, on the roentgenogram for about 8 weeks, residual signs of compaction of the lung tissue are determined, while other radiological signs (decreased transparency, heaviness of the lung tissue, pleural changes) can be detected within about 18 weeks. The process of resolving pneumonia can be delayed for a long time in people over the age of 50 and in patients with chronic obstructive pulmonary disease or alcoholism.

Lung abscess. Pneumococcal infection is rarely complicated by an abscess, although pneumococcal pneumonia often complicates abscesses of other etiology. Clinically, an abscess is manifested by a constant febrile state and profuse discharge of purulent sputum. X-ray in the lungs determine one cavity or several. This complication is extremely rare in patients treated with penicillin and is most likely associated with type 3 pneumococcal infection.

Pleural effusion. When X-ray examination of the patient in the supine position on his side, in about half of cases of pneumococcal pneumonia, effusion into the pleural cavity is revealed, which is associated with delayed initiation of treatment and bacteremia. The effusion is usually sterile and resolves spontaneously within 1–2 weeks. However, sometimes it is quite abundant and requires suction or drainage to remove it. pleural cavity.

Empyema. Before the introduction of effective chemotherapeutic agents into practice, empyema was recorded in 5-8% of patients with pneumococcal pneumonia. Currently, it occurs in less than 1% of treated patients and manifests itself as a persistent febrile state or pleural pain with signs of effusion into the pleural cavity. Early infected effusion may not be microscopically different from sterile pleural fluid. Then a large number of segmented leukocytes and fibrin migrates into it, which is accompanied by the formation of a thick greenish purulent fluid, which contains large flakes of fibrin. Exudate can accumulate in fairly large quantities and cause mediastinal displacement. In advanced cases, extensive cicatricial changes are formed in the pleura and the mobility of the chest during breathing is limited. Sometimes pus can spontaneously break out through the chest wall with the formation of a fistula. In rare cases, chronic empyema can be complicated by metastatic brain abscess.

Pericarditis. Especially severe complications the spread of infection to the pericardial sac. In this case, pain appears in the region of the heart, synchronized with the contractions of the heart, pericardial friction murmur, swelling of the cervical veins, although sometimes all these signs (or one of them) may be absent. In all cases of complications with empyema, one should think about the possibility of the simultaneous development of purulent pericarditis.

Arthritis. This type of complication is more common in children than in adults. In the area of \u200b\u200bthe joint involved in the process, swelling, redness, soreness are determined, a purulent effusion appears in the joint capsule. Systemic penicillin treatment is usually effective, although an adult patient may require removal of fluid from the joint and intra-articular penicillin.

Acute bacterial endocarditis. This complication of pneumococcal pneumonia occurs in less than 0.5% of cases. For information on its clinical manifestations and treatment, see below. Other complications of pneumococcal pneumonia include meningitis.

Paralytic ileus. A patient with pneumococcal pneumonia often has a swollen abdomen, and in a seriously ill patient it can be so pronounced that it is sometimes regarded as paralytic intestinal obstruction. This complication makes breathing even more difficult due to the high standing of the diaphragm and is rather difficult to treat. Rarer and more serious complications include acute enlargement of the stomach.

Liver dysfunction. Pneumococcal pneumonia is often complicated by impaired liver function, often with mild jaundice. The pathogenesis of jaundice is not entirely clear, although in some patients, it appears to be associated with a deficiency of glucose-6-phosphate dehydrogenase.

Laboratory research data. Before starting treatment with antibacterial drugs, sputum should be collected from the patient for analysis under the supervision of a doctor. In some cases, this requires resorting to puncture of the trachea or lungs in order to establish the etiology of pneumonia, but the routine use of these invasive methods is not recommended due to the accompanying (albeit rare) complications. In a sputum smear, stained according to Gram, segmented leukocytes and a different number of gram-positive cocci are found, lying separately or in pairs. The causative agents can be. identified directly using the Neufeld crush method (this method should be used to speed up the diagnosis). In the first days of the disease, pneumococci are found in 20-30% of untreated patients during blood culture. A clinical blood test reveals neutrophilic leukocytosis (12-25 \\ 0 9 / l). With a severe infection and bacteremia in a patient, the number of leukocytes may be within the normal range, and sometimes leukopenia is noted. In rare cases, in patients with bacteremia, pneumococci can be seen directly in the granulocytes when examining a Wright-stained preparation of a light layer of a blood clot. Asplenia is often determined in these patients. X-ray examination usually reveals homogeneously compacted lung tissue. In the midst of an illness, the induration may extend to the entire lobe or to several lobes. Patients with chronic underlying lung diseases may have atypical forms of seals.

Pneumococcal pneumonia

It remains the most common in children 6 months - 4 years old, occupying a significant place among pneumonia and in older children. Of the 83 serotypes of pneumococcus, 20-25 account for more than 95% of all cases of pneumonia. Children lose a high level of maternal immunity to pneumococcus by the end of the first year of life, the increase in antibody titers (carriage, infection) accelerates after 3 years. A number of serotypes (3, 5, 9) are characterized by increased virulence; they, like other serotypes new to the patient, often cause complicated forms. According to the culture of pulmonary punctates, pneumococcus is often accompanied by a non-capsular hemophilic bacillus.

Clinical picture... Pneumococcal pneumonia occurs in different forms... "Classical" are croupous (lobar) and similar large focal, in which a homogeneous shadow occupies 1-2 segments or has a spherical appearance. The onset is acute, with a temperature of up to 40-41 ° C, dry cough, sometimes with brown sputum, leukocytosis with a shift to the left, increased ESR... Herpes, redness of the cheeks on the affected side, pain (grunting) when breathing (dry pleurisy), often radiating to the abdomen, are often observed, which can divert the doctor's attention from changes in the lungs.

In less reactive forms, the onset is not so violent, the physical picture corresponds to that in bronchopneumonia, on the roentgenogram there are inhomogeneous shadows in the zone of 1-2 segments with indistinct boundaries. Blood changes are insignificant or absent.

Bilateral localization of the process is rarely observed; it is usually a serious illness with complications.

Complications... Pneumococcus is the most common causative agent of pleurisy, pulmonary suppuration and pyopneumothorax. The presence of exudate in the pleura at the onset of the disease (synpneumonic pleurisy) increases the likelihood of destruction. Pleurisy responds well to therapy without drainage, as evidenced by a decrease in cytosis and other signs of suppuration with repeated puncture. In many cases, however, it is "replaced" by the formation of metapneumonic effusion with a cytosis below 1000 in 1 μl and an abundance of fibrin. Clinically, this is manifested by a rise in body temperature after 1-2 days of its decrease and the accumulation of exudate; ESR sharply increases, although the number of leukocytes in the absence of destruction decreases. Fever of a persistent type or hectic, its duration is on average 7 days, but in the next 2-3 weeks, rises in body temperature may be observed, inferior to treatment with anti-inflammatory drugs (steroids, indomethacin); in adolescents, they can be a symptom of a tuberculosis outbreak. Echographic analysis often reveals pericardial effusion that does not require special treatment.

In the presence of a focus of destruction, fever also persists against the background of effective therapy, leukocytosis (often against the background of metapneumonic pleurisy) until the abscess is emptied through the bronchus or into the pleural cavity. The cavity formed in the lung, most often thin-walled (bulla), in the first days with a fluid level, often tense due to the valve mechanism in the bronchus, gradually decreases and disappears after 2-4 weeks. An abscess with a dense wall is rare, usually with superinfection (pseudomonas, anaerobes).

A small, unstrained pyopneumothorax can be healed without drainage; in many cases, however, drainage is unavoidable and often lasts 3 weeks.

Treatment... The drugs of choice are penicillin, ampicillin, levomycetin, lincomycin, first generation cephalosporins (the last 3 drugs are used for intravenous therapy and penicillin intolerance), biseptol, macrolides; with metapneumonic pleurisy - non-steroidal anti-inflammatory drugs. Drainage of the pleural cavity with pleurisy does not accelerate recovery and does not reduce the frequency of destruction. Repeated puncture of the pleura is indicated when the volume of effusion increases. Puncture of the lung cavities or their bronchoscopic drainage is indicated only in rare cases after unsuccessful conservative treatment (antibiotics, mucolytics, drainage position).

Signs, diagnosis and treatment of pneumococcal pneumonia

Pneumococcal pneumonia is most often croupous pneumonia or focal bronchopneumonia. In the largest number of cases, the disease occurs as a "home" or out-of-hospital infection. It is caused by a fairly virulent and common pathogen - Streptococcus pneumoniae - pneumococcus.

Pneumococcal bacteria under a microscope.

Etiology and clinical picture of croupous inflammation

Pneumococci are representatives of the microflora of the human upper respiratory tract. When it gets into the underlying respiratory sections, they cause inflammation even with the slightest decrease in protective mechanisms.

Microorganisms are immobile anaerobic rounded cells, diplococci, allowing growth in short chains. Resistant to some types of antibiotics. They are the source of pneumonia in more than 30% of cases detected.

Pneumococcal pneumonia - mainly inflammation of one or two segments, less often - lobar. The upper lobe of the right lung and the lower lobe of the left lung are more often affected.

Two most common routes of infection are characteristic: endogenous - pneumonia often occurs as a secondary infection against the background of ARVI, bronchitis and airborne - mass transmission of the pathogen during an epidemic. There have been cases of intrauterine infection of the fetus.

General signs of the disease

Pneumonia begins acutely with symptoms of increasing weakness and intoxication up to depression of consciousness.

• General condition: chills, severe weakness;
• From the side nervous system: headaches, insomnia;
• From the gastrointestinal tract: there is no appetite, flatulence, vomiting is possible, the tongue is coated with a white coating;
• Skin: hyperemia of the face on the side of inflammation, the skin is moist. Herpetic eruptions in the lips, nose. During the development of pneumonia - acrocyanosis.
• Respiration is frequent, shallow. Dyspnea. The affected side lags behind when breathing, the intercostal spaces are smoothed. In children, exhalation is accompanied by a groan.
• From the side of the cardiovascular system: tachycardia up to 125 beats per minute, the pulse is uneven, weak filling, the pressure is reduced.

Fever develops rapidly up to 39-40 degrees C. Temperature decrease occurs during the day critically with the development of hypotension, up to collapse and pulmonary edema. A pseudo-crisis is characteristic. With a timely start of treatment, the condition is more favorable, lytic, the temperature decreases within 1-2 days.

Involvement of the pleura - pain.

Chest pains force the patient to spare his breathing, to take a forced lying position on the healthy side, lifting the torso. Localization depends on the focus of the inflammatory process. Possible pseudo-abdominal or meningeal syndromes, irradiation of pain. Lower lobe pneumonia mimics an "acute abdomen" and appendicitis.

At the beginning of pneumococcal pneumonia, cough with a small amount of expectorated sputum. The discharge is viscous, mucous, gray in color with an admixture of blood. The red-brown tint of the discharge increases with the development of the disease. On the second day, "rusty" sputum appears.

In the phase of resolution of pneumonia, mucopurulent sputum leaves easily.

Diagnostic picture

The beginning of the development of pneumonia is characterized by a dull tympanic sound over the affected area. With the development of the process - a dull sound, without femoral (absolute) dullness.

In the resolution phase, a dull-tympanic sound is determined. With central and upper lobe forms of pneumonia, diagnosis based on physical signs is difficult due to the depth of the infiltration focus.

In the stage of hyperemia, wheezing is heard at the height of inspiration. Vocal tremor and bronchophonia are not expressed. Breathing is weakened. The most distinct auscultation in the phase of gray and red hepatization: bronchial breathing, voice tremor and bronchophonia are enhanced, scattered dry wheezing, no crepitus.

In the phase of resorption of the exudate, various moist rales are determined, there is no crepitus, bronchial breathing weakens.

Laboratory indicators

Signs of inflammation and intoxication: leukocytosis, an increase in the number of segmented and stab cells with a decrease in lymphocytes, toxigenic granularity of neutrophils. The number of monocytes is increased. Eosinopenia. ESR is accelerated. Thrombocytopenia. Atypical forms of croupous pneumonia occur with leukopenia.

The content of total protein in the blood serum decreases, mainly due to albumin. A sharp shift in the albumin-globulin coefficient. Fibrinogen is significantly increased. The content of urea and glucose at the peak of pneumonia is increased.

The specific gravity of urine increases. Protein, cylindruria, hematuria appear. The appearance of bile pigments is possible.

The X-ray picture of the onset of pneumonia is not pronounced, the strengthening of the pulmonary pattern, diffuse darkening without clear boundaries is determined. In the development of pneumonia - homogeneous infiltration without foci of destruction in the projection of the affected area. The lung root is enlarged, not structured.

The stage of regression is radiologically determined by a decrease in the intensity of the shadow, which indicates resorption of the infiltrate. Strengthening of the pulmonary pattern and signs of pleural compaction are preserved. The picture normalization occurs approximately in 30 days.

Who is at risk

Risk groups for pneumococcal pneumonia:

1. Persons over the age of 65, a special risk group - those living in nursing homes, staying in 24-hour departments, with diseases of the cardiovascular system;
2. Children, a special risk group - organized children attending nurseries preschool institutionsprone to frequent acute respiratory infections;
3. All immunocompromised;
4. Persons with asplenia;
5. Systematically exposed to hypothermia, mental stress, nutritional deficiencies;
6. Persons who are constantly in a close team: military personnel, prisoners.

Prevention and treatment of pneumococcal pneumonia

1. Non-specific prophylaxis:

• compliance with the rules of a healthy lifestyle;
• rejection of bad habits;
• observance of the rules of rational nutrition;
• hardening;
• adequate and timely treatment of viral infections;
• remediation of the carriage of pneumococcal infection.

1. Specific prophylaxis: vaccination with pneumococcal vaccine, which has shown good clinical results. The vaccine is administered once. High-risk groups are being revaccinated.

1. Timely antibacterial treatment with drugs with anti-pneumococcal activity. Depending on the severity of the course, the admission is prescribed periorally, intramuscularly, intravenously. It is possible to carry out stepwise therapy.
2. Detoxification therapy;
3. Mucolytics;
4. Bronchodilators;
5. Analgesics;
6. Oxygen therapy;
7. Immunocorrectors;
8. Physical treatment UHF, exercise therapy, inhalation.

Possible complications and prognosis

A protracted course of pneumonia is observed in 40% of patients, which depends on age, state of the body, pathogenicity of the pathogen, localization of the process, and the success of therapy. With adequate treatment, the onset of resorption of exudate occurs on the 7-8th day.

Does the phlegm come off badly?

For a quick recovery, it is important that the sputum is coughing up and excreted from the body, as the pulmonologist Tolbuzina E.V. tells how to do this.

Possible complications: pleurisy, abscess formation. Meningitis, bacteremia, pericarditis occur much less frequently.

In young people, competent treatment ensures a positive outcome of the disease. A high degree of risk persists in the elderly, burdened by concomitant pathologies, as well as in the development of atypical pneumonia.

First line antibiotic in the treatment of pneumococcal pneumonia is benzylpenicillin (see Table 10). With mild pneumonia, it is prescribed intramuscularly every 4 hours at a daily dose of 3 million IU, and with pneumonia of moderate severity - up to 6 million IU. Penicillin is a low-toxic, bactericidal and highly effective antibiotic in moderate therapeutic doses. Treatment lasts an average of 7-10 days, if there are complications, then the treatment time increases. High doses of penicillin are not necessary for mild to moderate pneumonia (they are best avoided). Lack of fast bactericidal effect to benzylpenicillin (drug "crisis") within 48 hours indicates the erroneousness of the etiological diagnosis of pneumonia and requires revision of the antibiotic with a preliminary re-analysis of sputum. Many antibiotics will be effective for this pneumonia. So, second-line antibiotics (they are not always as effective as the antibiotics of choice) are cephalosporins, macrolides. In severe pneumonia caused by penicillin-resistant pneumococcus (in foreign countries, the number of such strains has increased 30 times), vancomycin or cephalosporins of 2-3 generations (cefotetan, cefuroxime or cephobid) are immediately prescribed intravenously every 12 hours at a daily dose of 2-4 g. The choice of antibiotic for pneumonia of different etiology is given in table. ten .

For outpatient treatment For patients with pneumococcal pneumonia, it is better to prescribe ampicillin (or amoxiclav) in a daily dose of 2-3 g. 1st generation cephalosporins (cephalexin) do not have significant advantages over semisynthetic penicillins, except in cases of allergy to the latter. Therefore, if an allergy to ampicillin occurs, then cephalosporins are prescribed (in 10% of cases there is a cross-sensitivity with benzylpenicillin), fluoroquinolones or macrolides (preferably azithromycin). To erythromycin, tetracyclines, microflora resistance develops rather quickly. Thus, 15% of pneumococci developed resistance to erythromycin. All pneumococci are resistant to aminoglycosides and tetracyclines. Very convenient for outpatient treatment patients with pneumonia are ceftriaxone (3 generation cephalosporin) with a long-term (more than a day) bactericidal effect. It can be administered intramuscularly 1 time per day at a dose of 1-2 g.

A number of people (COPD, CHF, alcoholism, diabetes, chronic renal failure, blood diseases, old age with secondary immunodeficiency) with high risk development of pneumococcal pneumonia is prescribed pneumococcal vaccine.

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Scientific classification of staphylococcus:
Domain:
A type: Firmicutes (firmicutes)
Class: Bacilli
Order: Lactobacillales (Lactobacillus)
Family: Streptococcaceae (Streptococcal)
View: Pneumococcus (Streptococcus pneumoniae)
International scientific name: Streptococcus pneumoniae

Pneumococcus (Latin Streptococcus pneumoniae) Is a spherical or egg-shaped bacterium belonging to the Streptococcaceae family.

Other names for pneumococcus: Weikselbaum's diplococcus, Frenkel's diplococcus.

Pneumococcus is the most common causative agent of a disease such as -. The mortality rate of pneumonia is up to 5% of cases. Other diseases of pneumococcal etiology include otitis media, sinusitis, laryngitis, tracheitis, bronchitis, meningitis, sepsis and others. Especially pneumococcal infection often causes exacerbation of broncho-pulmonary diseases in children.

Characteristics of streptococci

Like other types of streptococci, pneumococci most often exist in pairs, sometimes forming chains. The size of the bacteria is 0.5-1.25 microns. By behavior, pneumococcal infection is immobile, anaerobic, gram-positive. Rapid reproduction occurs with an increase in carbon dioxide. The basis of pneumococcus is peptidoglycan, in combination with surface proteins, carbohydrates, lipoproteins and teichoic acids, and all this is in a protective powerful polysaccharide capsule that prevents opsonization.

The classification of pneumococci includes up to 100 strains of these bacteria.

Diseases that can cause pneumococci

The most popular diseases of pneumococcal nature are:

• Septic arthritis;
• Otitis media;
• (rhinitis (runny nose), sinusitis, ethmoiditis, sphenoiditis and frontal sinusitis);
• Pneumonia (community-acquired);

The most popular pneumococcal diseases are pneumonia (about 70%), otitis media (about 25%), meningitis (5 to 15%) and endocarditis (about 3%).

In addition, pneumococcal infection can join the already existing diseases of other types of infection -, etc.

How to inactivate pneumococcus?

The pneumococcus bacterium dies when:

• their processing with solutions of antiseptics and disinfectants;
• exposure to antibacterial agents.

How is pneumococcus transmitted? The conditions under which a person begins to develop pneumococcal diseases usually consist of two parts - contact with an infection and a weakened immune system. However, a person can become seriously ill with ordinary contact with this type of bacteria, when its amount in the air is high.

Consider the most popular ways of getting pneumococcal infection:

How can pneumococcus enter the body?

Airborne droplets. The main route of infection with pneumococcal infection is airborne. Coughing and a person standing next to this is the root cause of the majority. The insidiousness of pneumococcal infection lies in the fact that its carrier is often unaware of his role, because it may not cause any symptoms in its host. It is also worth noting that during the period, in the air, especially in enclosed spaces, the concentration of other species increases. That is why the first victims are people who often stay or work in crowded places.

Air and dust path. Dust, including house dust, consists of many particles - pollen of plants, animal hair, particles of peeled skin and paper, as well as viruses, bacteria, fungi and other infections. Finding a person in rooms where little or rarely is cleaned is another factor contributing to infection.

Contact-household way. Most infections do not die on their own, so sharing the same kitchen utensils and personal hygiene items with a sick person increases the risk of getting sick.

Hematogenous pathway. Infection occurs when a person's blood comes into contact with an infected object. People who inject drugs become frequent patients.

Medical way. Contamination occurs when using, for example, routine examination, contaminated medical equipment / tools.

How can pneumococcus seriously harm a person's health, or what weakens the immune system?

As we said, the second factor that contributes to the development of pneumococcal disease is a weakened the immune system, which performs the protective function of the body. So, when an infection enters the body, the immune system produces special antibodies, which, reaching the focus of infection or settling the infection, stop it and destroy it. If the immune system is weakened, there is no one to fight the infection, except drugs.

Consider the main causes of weakened immunity:

• The presence of chronic diseases - any disease in the body of a chronic form indicates that the immune system cannot cope with it on its own, while the disease gradually continues to harm health;
• The presence of other infectious diseases - sinusitis, broncho-pulmonary diseases,;
• Insufficient amount of vitamins and minerals in the body ();
• Bad habits - smoking, drugs;
• Sedentary lifestyle;
• Lack of healthy sleep, chronic fatigue;
• Abuse by some medicines, especially antibiotics;
• Very often, children from school and kindergarten bring pneumococcal infection into the house. This is facilitated by close contact between children, as well as not fully developed immunity. Further, if certain preventive measures are not followed in the house, the disease develops in adults.

At-risk groups

Consider a group of people who are at increased risk of contracting pneumococcal diseases:

• Elderly people, over 60 years old and children;
• People working in crowded areas - office workers, drivers and conductors of public transport, employees of large enterprises, medical workers, workers in nursing homes and educational institutions, and the military.
• People who have chronic diseases and systems, as well as diseases such as diabetes, emphysema, kidney disease, HIV.
• Persons consuming alcoholic beverages, smokers.
• Persons who like to walk in frosty and / or cool damp weather without a headdress, in short jackets, thin trousers and other clothes, due to which the body is exposed to hypothermia.
• Persons who have had other infectious diseases - ARVI, ARI, influenza, and others.

Pneumococcus symptoms

The symptoms (clinical picture) of pneumococcal diseases are very extensive, and largely depend on the place (organ) in which the infection, the pneumococcal strain, human health and the state of his immunity occurred.

Common symptoms of pneumococcus include:

• , malaise, and;
• Shortness of breath, sneezing,;
• Increased and high body temperature;
• sometimes strong;
• , impaired consciousness;
• Photophobia;
• Smell disorder;
• , sometimes with;
• All types -, and;
• Respiratory system diseases:, pharyngitis, laryngitis, tracheitis, bronchitis and pneumonia;

Complications of pneumococcus:

• Inflammation of the heart muscle -, endocarditis,;
• Purulent otitis media;
• Decrease or loss of voice or hearing;
• Lung abscess;
• Sepsis;
• Mental retardation;
• Stiffness of movement;
• Epilepsy;
• Death.

Important! Some clinical complications can sometimes accompany a person for the rest of his life.

Diagnosis of pneumococcus

The test for pneumococcus is usually taken from swabs taken from the oropharynx (for diseases of the upper respiratory tract), sputum from the nose and blood.

Thus, the following analyzes and methods of examining the body with pneumococcal infection are distinguished:

• Bacteriological culture of sputum and smears taken from the nasal cavity and oropharynx;
• internal organs;
• lungs;

How is pneumococcus treated? Treatment for pneumococcus usually consists of several points:

1. Antibacterial therapy;
2. Strengthening the immune system;
3. Restoration of normal intestinal microflora, which is usually disturbed by the use of antibacterial drugs;
4. Detoxification of the body;
5. Antihistamines - prescribed for children who are allergic to antibiotics;
6. Symptomatic therapy;
7. In case of simultaneous illness and other diseases, their treatment is also performed.

In any case, treatment of pneumococcal diseases begins with a visit to a doctor and a patient undergoing diagnostics. This must be done to exclude other types of infection, as well as to check the resistance (susceptibility) of the infection to one or another antibacterial drug.

Before considering antibiotics for pneumococcal disease, consider their interaction (resistance).

Antibiotic resistance

Doctors note a not very favorable trend towards the treatment of pneumococcal infection. So, from year to year, all over the world, resistance (resistance) of pneumococci to antibacterial drugs of the penicillin and tetracycline series, as well as macrolides, has been noticed, and the resistance to antibiotics is gradually increasing. The most resistant pneumococci are found in America, Western Europe, Asia, the least in Germany, the Netherlands. If we talk about superficial reasons, then this was largely due to the availability of antibiotics to anyone, even without prescriptions. The fact is that improperly selected antibiotics, or a course of therapy with this group of drugs, contribute to the development of a certain immunity to these drugs in the future, bacteria mutate, their new strains develop. In some countries, such as Germany, it is just impossible to purchase antibiotics without a doctor's prescription, and therefore, many infectious diseases of bacterial nature are more easily treatable, and the number of complications and, accordingly, deaths is much less.

The highest resistance of pneumococci in the territories of Russia and Ukraine is observed in relation to tetracycline (40%) and co-trimoxazole (50%).

1. Antibacterial therapy

Important! Always check with your healthcare professional before using antibiotics.

In brackets, after the name of the antibiotic, the percentage of bacterial resistance to the drug is indicated (in Russia, as of 2002-2012).

Antibiotics against pneumococci for internal use: "Amoxicillin" and "Amoxicillin-Clavulanate" (0.5%), "Vancomycin" (1%), "Levofloxacin" (1%), "Rifampicin" (1%), "Clindamycin" (2%), "Cefotaxime "(2%)," Cefepime "(2%)," Ciprofloxacin "(2%), macrolides (from 7 to 26% -" "," Claritomycin "," Midecamycin "," Spiramycin "," "), Chloramphenicol (5%), "Penicillin" (29%), "" (40%), "Co-trimoxazole" (50%).

Course antibacterial therapy assigned individually by the attending physician. It usually takes 5-10 days.

Topical antibiotics against pneumococci: Bioparox, Hexoral.

Important! Often the doctor selects a combination of 2 antibacterial drugs to treat the disease, which must be taken simultaneously.

2. Strengthening the immune system

To strengthen immunity and stimulate its work, in combination with antibiotics, a reception is prescribed - immunostimulants: "Immunal", "IRS-19", "Imudon".

A natural immunostimulant is, which is present in large quantities in the composition, cranberries, and sea buckthorn.

3. Restoration of normal intestinal microflora

While taking antibacterial drugs, they also get inside the intestine, destroy the beneficial microflora that contributes to the normal absorption of food and participates in other important vital processes of the body. Therefore, when taking antibacterial drugs, recently it has become increasingly popular to take probiotics, which restore the normal intestinal microflora.

Among the probiotics are: "Acipol", "Bifiform", "Linex".

4. Detoxification of the body

Pneumococcal infection, while inside the body, poisons it with the products of its vital activity. Intoxication with infectious enzymes worsens the course of the disease, causing symptoms such as nausea, vomiting, loss of strength, hallucinations and delirium.

To remove the waste products of the infection from the body, detoxification therapy is prescribed, which includes:

• drinking plenty of fluids (up to 3 liters of liquid per day, preferably with the addition of vitamin C);
• rinsing the nose and oropharynx with a weak saline solution or furacillin solution;
• taking detoxification drugs: "Atoxil", "Albumin", "Enterosgel".

5. Antihistamines

Antihistamines are prescribed if, when taking antibiotics, a person develops an allergic reaction - itching of the skin, rash, redness and other manifestations.

Among antihistamines can be distinguished: "", "", "Tsetrin".

6. Symptomatic therapy

To relieve the symptoms of pneumococcal diseases and alleviate their course, symptomatic therapy is prescribed.

At high body temperature: cool compresses on the forehead, neck, wrists, armpits. Among the drugs can be distinguished - "", "".

With a stuffy nose - vasoconstrictor drugs: "Noxprey", "Pharmazolin".

Important! Before using folk remedies, be sure to consult your doctor.

More than one and a half million people die annually from diseases caused by pneumococci, and more than half of them are preschool children and newborns. Pneumococci are a group of subtypes of Streptococcus pneumonia, which includes about 100 species, and more than 20 of them are not only widespread, but also have rapid adaptability and resistance to many modern antibiotics.

A number of diseases caused by them are called pneumococcal infections - these are pneumonia, meningitis, otitis media and many others. When they say - a person has pneumococcal infection, what does it mean? Unfortunately, this does not always mean that a person has become infected and sick - pneumococcal infection is found in 70% of the world's population, and often they are carriers.

Features of the spread of pneumococcal infection

It is easy to get pneumococci, as they are transmitted by airborne droplets. The disease does not always develop during infection, and often it can occur in the form of acute respiratory infections, tonsillitis (tonsillitis). Timely treatment and good immunity can quickly cure it in adults. At the same time, pneumococcus in the body can remain in an inactive form, then a person becomes a carrier.

The most vulnerable populations against pneumococcal infection are preschool children and the elderly. The risk group also includes chronic severe patients with diseases of the upper respiratory tract, cardiovascular system, diabetes mellitus or cancer. That is, everyone who has a decrease in general immunity.

The disease spreads rapidly among children, especially in children's groups, children infect adults, and the percentage of carriers who live with children is very high. Pneumococcal infection in children is very dangerous, since the child's immunity is not yet sufficiently developed and is not always able to protect it. In children, diseases of the upper respiratory tract are often complicated by pneumonia, otitis media, and the child may have a pneumococcal infection several times. The most severe diseases caused by pneumococcus occur in infants. But they can become infected when they are 5-6 months old, since before that they have passive immunity - antibodies against pneumococcus received from the mother.

As for the elderly, the incidence and various complications in this group are also high. The immunity of the elderly is reduced, in addition, the number of chronic diseases increases with age. As a result, every cold can quickly turn into pneumonia.

When people at risk become infected with pathogenic pneumococci and develop the disease, it is difficult to treat it. This is because the disease progresses quickly, and even if you see a doctor who prescribes antibiotic treatment, they don't always help. Many pneumococci have long acquired resistance to broad-spectrum antibiotics, namely, they are primarily prescribed during pneumonia, purulent otitis media. It takes time to determine the sensitivity to antibiotics, therefore, in fact, against the background of treatment, the patient's condition does not improve.

This led to the need to develop a vaccine against pneumococcal infection. Early vaccination, and it begins to be carried out for children older than two months, allows you to avoid infection with the most dangerous types of pathogens of pneumococcal infection. Vaccination is also indicated for patients with chronic diseases and people over 65 years of age.

The main symptoms of diseases caused by pneumococcus

Pneumococcal infection is a complex of diseases, among which pneumonia, otitis media, meningitis are most common. So, of all pneumonia, 70% are pneumococcal; also a quarter of otitis media is associated with it; at every tenth meningitis, pneumococcus is found. Based on this, the symptoms of the development of pneumococcal infection may be as follows:

And also other symptoms, depending on where the pneumococcal infection develops, which can cause various diseases, so the symptoms of its manifestation are different.

Diseases caused by pneumococcal infection

The main diseases that are observed with pneumococcal infection are:

• acute respiratory diseases;
• pneumococcal pneumonia;
• acute otitis media;
• purulent meningitis;
• sinusitis;
• chronical bronchitis;
• endocarditis;
• pleurisy;
• arthritis;
• sepsis.

Let's consider some diseases caused by pneumococcal infection in more detail.

Pneumococcal pneumonia

Usually pneumococcal pneumonia is considered a complication of acute respiratory viral disease. Moreover, its development, possibly, both through the penetration of pneumococcus into the lungs from the upper respiratory tract (descending infection), and through the blood (hematogenous).

The main symptoms of pneumococcal pneumonia are:

• weakness;
• dyspnea;
• headache;
• chest pain;
• cough, at first dry, then wet with brownish expectoration "rusty expectoration."

The temperature rises rapidly to 39–40 ° C, chills, symptoms of heart failure (decreased pressure, tachycardia) appear. If the pleura is involved in the process, there are severe pains during breathing, abdominal pain, bloating are possible.

In young children, when breathing, you can notice a lag in one half of the chest. The child becomes pale, cyanosis of the extremities appears, the skin is moist.

Diagnostics is carried out by examination (percussion, auscultation), from laboratory tests, blood tests with leukocytes and urine are prescribed. X-rays of the lungs are taken to confirm the diagnosis.

Treatment of pneumococcal pneumonia is carried out with broad-spectrum antibiotics, mucolytics, with severe intoxication, detoxification therapy is prescribed. If there is no improvement within three days while taking antibiotics, then you need to change the medicine.

Pneumococcal pneumonia can be complicated by pleurisy, a lung abscess. Therefore, if you notice that you or your child have such symptoms, or after taking the prescribed medications, the condition does not improve, immediately consult a doctor.

Pneumococcal otitis media

Pneumococcus is the second most common causative agent of otitis media in babies. Middle ear inflammation occurs against the background of the development of pneumococcal infection.

Symptoms of otitis media:

• feeling of stuffiness in the ears;
• sharp pain in the ear;
• hearing loss;
• purulent discharge from the external auditory canal, which indicates a ruptured eardrum.

If there is no perforation of the tympanic membrane, then it is difficult to identify the pathogen. A doctor should be consulted immediately after a child has ear pain. In newborns, ear pain can be suspected if the child screams, cries with slight pressure in the ear area. With discharge from the ear canal and temperature, you need to urgently call an ambulance.

Although many advise to warm up the ear with a bag of salt, or a blue lamp, young children with pneumococcal infection should not do this, since heat promotes the reproduction of pneumococci, their penetration into the bloodstream and otitis media can be complicated by sepsis or meningitis.

Treatment is carried out with strong antibiotics, which is quite dangerous, as it can cause permanent hearing loss due to damage to the auditory nerve. But such treatment is necessary to avoid complications.

Pneumococcal sinusitis

Sinusitis is an inflammation of the sinuses of the nose (maxillary, frontal). Pneumococcal infections can cause sinusitis, which is characterized by fever, nasal discharge, swelling, and redness around the eyes. When pressure is applied to the forehead or under the eyes, next to the wings of the nose, pain occurs. A complication of pneumococcal sinusitis can become osteomyelitis of the upper jaw.

Suppurative pneumococcal meningitis

This disease occurs against the background of pneumonia, otitis media, sinusitis in children over 10 years old, but it can also occur in babies. It is characterized by severe headache, disorientation, high fever, and repeated vomiting.

In young children, meningitis can be suspected if the child constantly screams, as if moaning, the fontanelle swells. An important symptom is the rigidity of the occipital muscles, it is difficult to bend the patient's head forward, this causes severe pain... A child in bed lies with his head thrown back on his side, arms bent at the elbows. With such symptoms, you need to urgently call an ambulance.

If the treatment of pneumococcal infection is not started on time, neurological symptoms appear (convulsions, paresis, oculomotor disorders), cerebral edema is possible fatal outcome... The prognosis for purulent pneumococcal meningitis is unfavorable, even after its cure, neurological symptoms may remain, which leads to the patient's disability. Meningitis in children causes developmental retardation, deafness, blindness. But the disease can be prevented by vaccination.

Pneumococcal sepsis

Pneumococcal sepsis usually develops against a background of decreased general immunity if there is a primary focus of pneumococcal infection. It can be pneumonia, otitis media, sinusitis. Pneumococcal infection enters the vascular bed and bacteremia occurs, toxic substances secreted by pneumococcus cause severe intoxication, increase vascular permeability, which leads to the development of the following symptoms.

Sepsis is a very dangerous condition that can lead to death within 1 to 2 days. In other cases, sepsis lasts several weeks, months, or even years (chronic sepsis).

Diagnosis of the disease is based on symptoms and blood tests. A blood test reveals anemia, an increase in leukocytes, and a decrease in the number of platelets. To confirm the presence of pneumococcal infection, blood is taken for culture, or polymerase chain reaction (PCR) is used.

The patient requires antibiotic treatment, massive infusion therapy, detoxification, administration of plasma and erythrocyte mass. Usually, anti-inflammatory drugs are also prescribed, since bacteremia causes an inflammatory process in the heart muscle (endocarditis), in the joints (arthritis), which further worsens the prognosis of the disease and subsequently can lead to the development of heart defects, deforming arthrosis.

Prevention of pneumococcal infection

Since the pneumococcal vaccine appeared, it has been included in the vaccination schedule. Many still doubt whether it is worth getting vaccinated against pneumococcal infection?

Consider the advantages and disadvantages of pneumococcal vaccination.

Vaccination against pneumococcal infection

Vaccination is carried out for three-month-old children, but in some cases, vaccination against pneumococcal infection can be done from 2 months. Revaccination is done 2 times in a month. Another revaccination is indicated at a year and a half.

A child under two years of age is given the Prevenar conjugate vaccine. Then you can apply the polysaccharide vaccine against pneumococcal infection "Pneumo-23".

Vaccination against pneumococcal infection is indicated for children, adults over 65, people with chronic diseases, lowered immunity, and conscripts.

The use of a vaccine against pneumococcal infection significantly reduces the incidence of the most pathogenic subtypes, which reduces mortality and the number of complications in children and those at risk. Given that pneumococcal infection is widespread and severe in children, it is imperative to vaccinate from the first months of life, since from 5-6 months the passive immunity received from the mother will cease to protect the child's body and, possibly, infection.