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45. BACTERIAL PNEUMONIA

acute or chronic inflammatory process of the lower respiratory tract of bacterial etiology. Etiology • Streptococcus pneumoniae - most often • Nato-philus influenzae Staphylococcus aureus, Pseudomonas aeruginosa • E. coll • Anaerobic microorganisms • Atypical pneumonia. Risk factors • Recent ARVI • Renal failure • Cardiovascular diseases • Immunodeficiency states: diabetes mellitus, chronic alcoholism, AIDS, malignant neoplasms • Pathogenesis. Ways of infection - hematogenous and bronchogenic (aspiration from the oropharynx, inhalation of infected air). The bronchogenic pathway of infection leads to the formation of peribronchial infiltrates, and the hematogenous pathway leads to the development of interstitial foci of inflammation. Pathomorphology. Segmental, lobar, or multi-focal peribronchial compaction with stages of red (intraalveolar exudation and diapedesis of red blood cells), and then gray (fibrous organization of intraalveolar exudate) hepatitis. Clinical picture • Complaints • Cough with mucopurulent (sometimes rusty) sputum • Chest pain when breathing (with concomitant pleurisy). • Intoxication syndrome • Fever • Tachycardia • Tachypnea • Hyperhidrosis • Myalgia • Headaches. • Objective study data • Cyanosis • Percussion: blunting of percussion sound due to infiltrate or pleurisy • Auscultation • High-pitched wheezing at the end of exhalation due to fluid filling in the alveoli • Low-pitched wheezing at the beginning or middle of the inspiration due to the presence of secretions in the airways • Weakening of breathing over the zones accumulations of pleural effusion • The noise of friction of the pleura with dry pleurisy. • Impairment of consciousness (in severe cases, such as disorientation and anxiety) and meningeal signs. • Changes in the gastrointestinal tract • Abdominal pain • Anorexia. Laboratory tests • Leukocytosis with a shift of the leukoformula to the left • Hyponatremia • Increased levels of transaminases • Bacteriological blood tests to identify the pathogen (a positive result in 20-30% of patients with community-acquired pneumonia, especially before the beginning of antibiotic therapy) • Bacteriological and bacterioscopic examination of sputum with staining according to Thunder • Bacteriological examination of material obtained with bronchoalveolar lavage and pleurocentesis • Study of the immune status in individuals with suspected immunodeficiency. Special studies • Chest x-ray • X-ray diffraction pattern shows areas of pulmonary tissue infiltration of various shapes, sizes and localizations • X-ray patterns when the patient is lying down - to detect empyema or pleurisy • KG lungs are performed if there is a suspicion of destruction or neoplasm • Bronchoscopy - for suspected swelling, bleeding, with a protracted course • Examination of HPF - for differential diagnosis with respiratory distress syndrome.
TREATMENT Diet. A complete diet with a sufficient protein content and a high content of vitamins A, C, group B • Introduction of a sufficient amount of vitamin C and liquid (1,500-1,700 ml / day) Recommended fruit and vegetable juices • Food is given in crushed and liquid form, food intake 6-7 r / day • Energy value from 1,600 kcal / day with an increase in recovery to 2,800 kcal / day. Management tactics • Indications for hospitalization • No effect of outpatient treatment for 3 days, long-term maintenance of intoxication syndrome Antibacterial Therapy is carried out from the moment of diagnosis, but after bacterioscopic and bacteriological examination of sputum. Drug therapy • Antibacterial therapy (the first days of the disease until the results of bacteriological studies are obtained) - empirical (action on the suspected pathogen) • For community-acquired pneumonia - benzylpenicillin sodium salt of 1-2 million IM every 4 hours, outpatient augmentin, ampicillin + sulbactam • For community-acquired pneumonia in young patients, erythromycin 500 mg orally every 6 hours (or spiromycin, or clarithromycin). cephalosporins of the second generation (cefotaxime 2 g every 4-6 hours). In hospital pneumonia - aminoglycosides, derivatives of fluoroquinolone. With the alleged damage to Pseudomonas aeruginosa - 3rd generation cephalosporins (ceftazidime) • After obtaining the results of bacteriological studies. • When pneumococci are affected - benzylpenicillin sodium salt 1-2 ml IU / m every 4 hours, erythromycin 500 mg every 6 hours, With resistant strains - cefotaxime, ceftriaxone, thienam or imipenem. Staphylococcus aureus - oxacillin 6-10 g / day, nafcillin), cephalosporins of the 1st generation With Enterococci, a combination of ampicillin and gentamicin. • Expectorants • Expectorant stimulants • Direct-acting drugs, such as potassium iodide • Reflexive drugs, such as thermopsis herb extract, licorice root preparations, etc. • Mucolytic drugs, such as acetylcysteine, trypsin, bromhexine, ambroxol. • Oxygen therapy for patients with cyanosis, hypoxia, shortness of breath.
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45. BACTERIAL PNEUMONIA

  1. Bacterial and viral airborne infections: influenza, parainfluenza, adenovirus infection, respiratory syncytial infection. Bacterial bronchopneumonia, lobar pneumonia.
    1. Supplement: Atelectasis of the lungs is _______________________. 2. The clinical and morphological form of bacterial pneumonia is determined by 1. the type of inflammation 3. the etiological agent 2. the affected area 4. the response of the body 3. In case of croupous pneumonia the consistency of the affected lobe 1. dense 2. flabby 3. not changed 4. The ability of the virus to selectively infect cells and tissues
  2. Joint inflammation is bacterial (bacterial arthritis)
    Cause Taking puncture from the joint, trauma, surgery, getting into the joint through the blood of pathogens (tuberculosis, gonorrhea, etc.). Symptoms Fever, swelling and pain in the joint. General poor health, fatigue, lethargy, especially in the morning, decreased performance. Limit joint mobility. First aid for painful swelling in the joints
  3. Pneumonitis caused by food and vomit. Aspiration pneumonia
    ICD-10 code J69.0 Diagnostics Diagnosis Mandatory Level of consciousness, respiratory rate and effectiveness, heart rate, blood pressure, CVP, body temperature, skin condition R-graph of chest organs ECG Laboratory tests: hemoglobin, red blood cells, white blood cells, formula blood count, total protein, bilirubin, urea, creatinine, electrolytes, enzymes, blood coagulation
  4. Pneumonia Acute pneumonia.
    In pregnant women, pneumonia often proceeds more severely due to a decrease in the respiratory surface of the lungs, a high standing of the diaphragm, limiting lung excursion, and an additional burden on the cardiovascular system. The clinical picture of acute pneumonia is not different from that of non-pregnant. With the development of pneumonia shortly before childbirth, development should be delayed if possible
  5. BACTERIAL Meningitis
    Bacterial meningitis is an inflammation of the meninges, acute or chronic, manifested by characteristic clinical symptoms and pleocytosis of the CSF. ACUTE BACTERIAL Meningitis. Main causative agents. The incidence of bacterial meningitis is on average about 3 cases per 100 thousand people. In more than 80% of cases, bacterial meningitis is caused by N.meningitidis, S. pneumoniae and
  6. Bacterial vaginosis
    The term "bacterial vaginosis" defines the pathological condition of the vagina due to general and local factors that contributed to the change in microbiocenosis with certain clinical manifestations. This is a new term that emerged in the 1980s, highlighting some painful conditions of the vagina from the group of non-specific colpitis. On the one hand, this name characterizes
  7. BACTERIAL VAGINOSIS
    This disease is relatively recently isolated in an independent nosological form and is defined as an infectious non-inflammatory syndrome associated with dysbiosis of the vaginal biotope and is characterized by massive reproduction of strictly anaerobic gram-negative bacteria and the disappearance of H2O2-producing lactobacilli. The main pathogens This pathological process is caused
  8. BACTERIAL PROSTATITIS
    ACUTE BACTERIAL PROSTATITIS Main causative agents of E. coli - 64%, Enterococcus spp. - 7%, Pseudomonas spp. - 6%, other representatives of the Enterobacteriaceae family - 12%, much less often - Salmonella spp., Clostridia spp., M. tuberculosis, fungi. Selection of antimicrobial agents. Drugs of choice: fluoroquinolones (norfloxacin, ofloxacin, pefloxacin, ciprofloxacin), oral cephalosporins
  9. Bacterial infections
    Among them, focal pneumonia is of particular importance, not only as one of the most frequent infectious lesions of a person, but also as a banal, sometimes severe, complication of various underlying diseases and as a direct cause of death of many patients. Almost any type of microbe with a sufficient degree of virulence can cause focal pneumonia in certain cases that have this
  10. Pneumonia in children
    Protocol code: 04-040а Profile: pediatric Stage: hospital Purpose of stage: 1. Relief of the inflammatory process in the lungs. 2. Elimination of DN symptoms, general intoxication, fever, restoration of lung excursion, disappearance of local physical data in the lungs, cough. Duration of treatment: 21 days ICD codes: J18 Pneumonia without specifying the pathogen J15.6 Pneumonia caused by
  11. Nutritional Bacterial Toxicosis
    Bacterial toxicosis includes staphylococcal toxicosis and botulism. Staphylococcal toxicosis (staphylococcal intoxication, staphylococcal food poisoning). It makes up more than 30% of all bacterial food poisoning. Among the vast group of staphylococci, pathogenic and non-pathogenic species are distinguished. Pathogenic staphylococci cause inflammatory diseases of the skin, nasopharynx and
  12. Colonization or bacterial seeding
    Colonization or bacterial seeding from the oropharynx and nasopharynx by a conditionally pathogenic flora, such as enterobacter, can occur when microflora is aspirated and is observed in critical patients with mechanical ventilation in surgical IT departments with a frequency of about 50%. In patients with major respiratory problems, colonization by oropharyngeal pathogens is observed in 100%. IN
  13. Nutritional Bacterial Toxicosis
    Bacterial toxicosis includes botulism and staphylococcal toxicosis. Food toxicosis results from the ingestion of toxin released by microbes during growth and reproduction in the product. In this case, the pathogen itself in food may be absent or detected in a small amount. However, a number of authors believe that with botulism, in addition to the toxin, living is also important
  14. Bacterial vaginosis
    This disease is caused by a violation of the biocenosis of the normal microflora of the vagina. The ratio of aerobic and anaerobic microorganisms is changing in the direction of increasing anaerobes. The main complaint of a woman is reduced to an increase in the release of leucorrhoea, sometimes itching (or burning) in the genital area can be. There are no signs of inflammation. When viewed in the mirrors of hyperemia,
  15. Bacterial food poisoning
    Foodborne infections of bacterial origin arise from eating foods containing live microbes or their poisons. Bacterial poisoning accounts for up to 90% of all food poisoning cases. They mainly occur in the summer, as the warm season contributes to the rapid multiplication of microbes in food. Poisoning caused by living bacteria that enter the body through food,
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