HealthDiseases and Conditions

Pneumocystis pneumonia: causes, symptoms, treatment. Pneumocystis pneumonia in HIV-infected

Health is the most valuable thing a person has. Everyone hopes to live a long time and not suffer from this or that disease. The disease changes people beyond recognition - they become depressed, their appearance leaves much to be desired, there is indifference to everything that happens around, and in some cases once good and responsive to other people's ills turn into embittered and cynical.

The disease spares no one. Even newborns are not immune from the risk of contracting an infection. In addition, the sufferings are experienced not only by the patients themselves, but also by their relatives. It is especially difficult to cope with their emotions and feelings to parents whose children have been diagnosed with this or that pathology. Kids in view of their early age can not yet explain what exactly bothers them, in which part of the body they experience pain and how it manifests itself.

Insidious disease is pneumocystis pneumonia. You can get infected anywhere and, paradoxically, even in medical institutions. The situation is complicated by the fact that it is very difficult to detect an infection at the initial stage of its development. Often people understand that they need medical help when precious time is already lost. That is why the mortality from pneumocystis is very high. Doctors do not always manage to save a person's life.

Have diagnosed "pneumocystosis"

People who have nothing to do with medicine, for the most part, have little knowledge of medical terminology. Therefore, after hearing the diagnosis of "pneumocystosis", or "pneumocystis pneumonia", they are in some confusion, and even fall into a stupor. In fact, do not panic. First of all, you need to calm down, pull yourself together and ask the attending physician in detail, in simple words to explain what it is.

Pneumocystis is often called pneumocystic pneumonia, which is a protozoal disease that affects the lungs. The causative agents of pathology are microorganisms known as Pneumocystis carinii. Until recently, scientists believed that they belonged to the species of protozoa. However, relatively recently, based on numerous studies, it was concluded that these microorganisms possess some features characteristic of fungi. Pneumocystis carinii is a parasite that infects only humans. At least in animals, he has not been detected until now.

What happens in the patient with pneumocystis pneumonia?

Changes in the body due to pneumocystosis depend on two factors: on what biological properties are the pathogens of pneumonia, and on the state of the human immune system. Pneumocysts, after getting into the body, begin their advance through the respiratory tract, pass them and enter the alveoli. Here begins their life cycle. They proliferate, they come into contact with the surfactant and release toxic metabolites. The T-lymphocytes, as well as the so-called alveolar macrophages, are being controlled with Pneumocystis carinii. However, the weakened immune system is not only unable to protect its host from infection, but even vice versa - it has the opposite effect: it stimulates and promotes an increase in the number of pneumocysts.

To a fully healthy person, the rapid reproduction of Pneumocystis carinii does not threaten. But the situation changes radically, if the state of the immune system leaves much to be desired. In this case, the disease is rapidly becoming more active, and in a relatively short period of time the number of pneumocysts caught in the lungs reaches one billion. Gradually, the space of the alveoli is completely filled, which leads to the appearance of a foamy exudate, a violation of the integrity of the membrane of the leukocytes of the alveoli, and ultimately to damage and, consequently, subsequent destruction of the alveolocytes. Due to the fact that the pneumocysts fit tightly to the alveolocytes, the respiratory surface of the lungs is reduced. As a result of damage to the lung tissue begins the process of development of the alveolar-capillary blockade.

To build its own cell membrane, Pneumocystis carinii, phospholipids of human surfactant are needed. As a result, there is a disruption of the surfactant metabolism and the hypoxia of the lung tissues is significantly aggravated.

Who is most at risk of the disease?

Known to date, the types of pneumonia differ from each other, including the fact that the risk of falling ill are different categories of people. Pneumocystosis in this sense is no exception. It often develops in:

  • Prematurely born children;
  • Infants and children who, being exposed to acute bronchopulmonary diseases of severe forms, were forced to stay in the hospital for a long time and undergo complex and lengthy therapy;
  • People suffering from cancer and hemopoiesis and receiving cytostatics and corticosteroids, as well as those struggling with various pathologies of the kidneys and connective tissues that have arisen as a result of transplantation of an internal organ;
  • Patients with tuberculosis, who for a long time received strong antibacterial drugs;
  • Of HIV-infected people.

As a rule, the infection is transmitted by airborne droplets, and its source is healthy people, most often - workers in medical institutions. Proceeding from this, the overwhelming majority of scientists assert that pneumocystic pneumonia is an exclusively stationary infection. Despite this, it is necessary to clarify that some doctors support the view that the development of pneumocystosis in the neonatal period is the result of infection of the fetus in the womb.

What symptoms are a signal about the development of pneumocystis pneumonia in children?

Moms and dads are always very sensitive to the health of their children. Therefore it is not surprising that they want to know how to determine the inflammation of the lungs in time. Of course, the final diagnosis can only be made by a doctor, but any conscious parent should be able to identify the first signs of the disease. Each lost day can lead to the fact that the child can experience bilateral pneumonia, pneumocystis and other complications.

Pneumocystis pneumonia in children develops usually starting at two months of age. Most often, the disease affects those children who previously had a cytomegalovirus infection. This disease occurs in them as a classic interstitsianalnoy pneumonia. Unfortunately, doctors admit that at the initial stage it is almost impossible to detect such a disease as pneumocystis pneumonia. Symptoms appear later. The main signs indicating the rapid development of infection include:

  • Very strong pertussis-continuous cough;
  • Periodic outbreaks of suffocation (mainly at night);
  • In some children, vitreous, foamy, gray and viscous sputum is observed.

The incubation period of the disease is 28 days. In the absence of adequate and timely treatment, the mortality of children with pneumocystis is 60%. In addition, in newborns, whose pneumocystis pneumonia occurs without visible signs, there is a huge likelihood of an obstructive syndrome occurring in the near future. This is mainly due to the swelling of the mucous membranes. If the baby is not immediately provided with qualified medical care, obstructive syndrome can be transformed into laryngitis, and in older children - in asthmatic syndrome.

Symptoms of the disease appearing in adults

Pneumonia in the elderly, as well as in young people, takes place in a more complex form than in newborns and young children. The disease attacks mainly people born with immunodeficiency, or those who have developed it throughout life. However, this is not a rule that does not tolerate the slightest deviation. In some cases, pneumocystis pneumonia develops in patients with a completely healthy immune system.

The incubation period of the disease ranges from 2 to 5 days. The patient has the following symptoms:

  • fever,
  • migraine,
  • Weakness in the whole body,
  • Increased sweating,
  • Pain, palpable in the chest,
  • Severe respiratory failure, accompanied by a dry or wet cough and tachypnea.

In addition to the main symptoms listed above, sometimes such signs as acrocyanosis, retraction of gaps between the ribs, cyanosis (blueing) of the nasolabial triangle are noted .

Even after completing the full course of treatment, some patients experience a number of specific pneumocystis pneumonia complications. Some patients experience a relapse. Doctors say that if the relapse occurs no later than 6 months from the first case of the disease, then this indicates that the body resumes the infection. And if it comes in more than 6 months, then it is already a new infection or reinfection.

Without adequate treatment, mortality in adults with pneumocystis is from 90 to 100%.

Symptoms of the disease in HIV-infected

Pneumocystis pneumonia in HIV-infected people, unlike people who do not have this virus, develops very slowly. From the moment when the prodromal phenomena begin, and before the clearly expressed pulmonary symptoms come, it can take from 4 to 8-12 weeks. Therefore, doctors at the slightest suspicion of the presence of an infection in the body, except for other tests, recommend such patients to make a fluorography.

The main symptoms of pneumocystosis in AIDS patients are:

  • High temperature (from 38 to 40 ° C), which does not drop for 2-3 months;
  • A sharp loss of body weight;
  • dry cough;
  • dyspnea;
  • Increasing respiratory failure.

Most scientists hold the view that other types of pneumonia in HIV-infected people have the same symptomatology as pneumocystis. Therefore, at the early stages of the development of the disease it is practically impossible to determine which type of pneumonia the patient has in place. Unfortunately, when pneumocystic pneumonia in HIV-infected people is detected, it is already too much time wasted, and it is very difficult for an exhausted organism to fight infection.

How is pneumocystosis diagnosed?

Surely everyone knows how the lungs of a man look. A photo of this body was singled out either in the textbook on anatomy, or at the stands in the polyclinic, or in any other sources. In the information for today there is no shortage. In addition, annually, doctors remind all of their patients that they should do a fluorography. Contrary to the opinion of many, this is not the whim of "picky" doctors, but an urgent need. Thanks to this, it is possible to detect the darkening of the lung on the X-ray in time and to start treatment without losing time. The sooner you become aware of the disease, the more likely it is that you will recover.

However, hardly anyone of us knows how the pneumocystis pneumonia manifests on X-rays. Photos of this kind in school textbooks can not be found, and medical reference books and encyclopedias in most ordinary people do not cause any interest. Moreover, we even have no idea how this disease is diagnosed, although it would not hurt to know.

First, a preliminary diagnosis is made. The doctor is interested in the patient about his contacts with people at risk (HIV-infected and AIDS patients).

After this, the final diagnosis is carried out. The following laboratory-instrumental studies are used:

  1. The doctor prescribes the patient a referral for a general blood test. Particular attention is drawn to the increased level of eosinophils, lymphocytes, white blood cells and monocytes. Patients with pneumocystis can have mild anemia and slightly decreased hemoglobin.
  2. Appointed instrumental research. It is a question of a radiography with which help define a stage of development of disease. X-rays are made, on which the lungs of a person are clearly visible. A photograph is attached to the patient's card. In the first stage, the increase in the pattern of the lung is noticeable. If the pneumocystosis has passed to the second stage, the darkening of the lung on the x-ray is clearly visible. Infected with either left or right lung only, or both can be affected.
  3. In order to detect the presence of pneumocystosis, the doctor usually decides to conduct a parasitological examination. What is it? First of all, the patient takes a sample of mucus for analysis. To do this, resort to methods such as bronchoscopy, fibrobronchoscopy and biopsy. In addition, the sample can be obtained using the so-called cough induction method .
  4. In order to detect antibodies against pneumocysts, a serological study is conducted, consisting in that, with a difference of 2 weeks, the patient is taken for analysis of 2 sera. If in each of them the excess of the normal value of the titer is marked by at least 2 times, then it means that the person is sick. This study is conducted in order to exclude the usual carrier, since antibodies are found in about 70% of people.
  5. PCR diagnostics is performed to detect parasite antigens in sputum, as well as in a biopsy specimen and broncho-alveolar lavage.

Stages of pneumocystosis

There are three consecutive stages of pneumocystis pneumonia:

  • Edematous (1-7 weeks);
  • Atelectakticheskuyu (an average of 4 weeks);
  • Emphysematous (of different duration).

The ocular stage of pneumocystosis is characterized first by the appearance of weakness in the entire body, lethargy, and then by a rare cough gradually increasing, and only at the end of the period - by a strong dry cough and shortness of breath during physical exertion. Babies do not suck well, do not gain weight, and sometimes even refuse their mother's milk. No significant changes are observed on the X-ray of the lungs.

During the atelectatic stage febrile fever is observed. Cough greatly increases, and foamy sputum appears. Dyspnea manifests itself even with minor physical exertion. At the X-ray, atelectatic changes are seen.

In patients who survived the first 2 periods, the emphysema stage of pneumocystosis develops, during which the functional parameters of respiration decrease and signs of emphysema are noted .

Degrees of pneumonia

In medicine, it is common to distinguish between the following severity levels of the disease:

  • Light, which is characterized by a weak intoxication (temperature not exceeding 38 ° C and an unclouded consciousness), there is no shortness of breath at rest, a slight eclipse of the lung on the x-ray;
  • Medium, characterized by moderate intoxication (temperature exceeds 38 ° C, heart rate reaches 100 beats per minute, the patient complains of excessive sweating , etc.), dyspnea is observed at rest, X-ray clearly shows lung infiltration;
  • Heavy, flowing with severe intoxication (temperature exceeds 39 ° C, palpitations exceed 100 beats per minute, delusions are observed), respiratory failure progresses, and x-ray shows extensive pulmonary infiltration, there is a high probability of various complications.

What treatment is prescribed for patients with PCP?

Undoubtedly, knowing how to determine pneumonia is a huge plus for every person. However, this is not enough. We are not doctors and we can not give a precise diagnosis. There is not one type of pneumonia, and one-sided or two-sided pneumonia, pneumocystis and other forms of illness can not be determined by a layman. Therefore, self-medication can not go without speech. The main thing is not to delay and trust doctors. After carrying out all the necessary research, the doctor will be able to make a precise conclusion about whether PCP is the cause of the patient's poor health. Treatment is appointed only after confirmation of the diagnosis and consists of conducting organizational and treatment measures and drug therapy.

Organizational-regime measures include the mandatory hospitalization of the patient. In the hospital, the patient receives medication and observes the diet recommended by the doctor.

Medication therapy consists of etiotropic, pathogenetic and symptomatic treatment. Patients are usually prescribed drugs "Pentamidine", "Furazolidon", "Trichopolum", "Biseptol", as well as various anti-inflammatory drugs, medications that help to sputum and facilitate expectoration, mucolytics.

"Biseptol" is administered orally or intravenously. The drug is well tolerated and preferable to "Pentamidine" when administered to patients who do not have AIDS. "Pentamidine" is administered intramuscularly or intravenously.

HIV-infected patients, among other things, undergo antiretroviral therapy, because they have pneumocystis pneumonia due to a weakened immune system. For the treatment of pneumocystisis in AIDS patients, alpha-difluoromethylornithine (DFMO) has been increasingly used lately.

Prevention

Prevention of pneumocystosis includes a number of activities, among which the following should be noted:

  1. To exclude infection in children's medical institutions, in hospitals where oncology and hematology patients are treated, all staff, without exception, should periodically be examined for infection.
  2. Medication prophylaxis of people at risk. This prevention is of two types: primary (before the disease starts to develop) and secondary (prevention after full recovery in order to prevent relapses).
  3. Timely detection of PCP and immediate isolation of the patient.
  4. Regular disinfection in places where pneumocystosis outbreaks were recorded. To do this, do a wet cleaning, using a 5% solution of chloramine.

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