Protracted pneumonia: causes, symptoms, diagnosis, treatment

Protracted pneumonia is an inflammatory process in the lungs that began acutely but resolved over a period of more than 4 weeks. Unlike chronic pneumonia, protracted pneumonia necessarily ends in recovery.

Pathogenesis of protracted pneumonia. The leading role belongs to disorders in the system of local bronchopulmonary protection and reactivity of the organism: decreased function of T- and B-lymphocytes, decreased synthesis of IgA in the bronchopulmonary system, suppression of the complement system, inhibition of phagocytosis, dysfunction of alveolar macrophages, which reduces the anti-infective protection of the macroorganism and contributes to a protracted course. A certain role is played by the violation of the glucocorticoid function of the adrenal glands.

Diagnostic criteria for protracted pneumonia:

1. pneumonia lasting more than 4 weeks;
2. radiologically, focal and peribronchial infiltration of segmental localization that does not disappear within 4 weeks;
3. local segmental bronchitis determined by bronchoscopy;
4. persistence of laboratory signs of the inflammatory process: leukocytosis, increased ESR, increased levels of sialic acids, fibrin, and seromucoid in the blood;
5. immunological disorders - increased levels of IgA in the blood and decreased levels of IgM, C4, C3 and C9 components and total hemolytic activity of complement, increased activity of suppressor T-lymphocytes, decreased levels of helper and killer T-lymphocytes;
6. unlike chronic pneumonia, recovery is mandatory (clinical, radiological and laboratory), the time frame is individual (up to 3 months according to Hegglin, according to other data - up to a year or longer).

Treatment of protracted pneumonia

Protracted pneumonia is pneumonia in which the resolution of the acutely onset inflammatory process in the lung does not occur within the usual time frame, but occurs slowly, over 4 weeks or more, but, as a rule, ends in recovery. Acute pneumonia in approximately 30% of cases takes a protracted course.

When starting treatment for a patient with acute pneumonia, it is important to remember that the following factors contribute to the development of protracted pneumonia:

• untimely and incorrect treatment of acute pneumonia;
• premature termination of treatment and discharge of a patient with acute pneumonia;
• insufficient volume of rehabilitation measures;
• smoking and alcohol abuse;
• severe chronic obstructive bronchitis;
• impaired nasal breathing and frequent recurrences of nasopharyngeal infection;
• concomitant diseases that weaken the body's reactivity (diabetes mellitus, etc.);
• superinfection;
• old age of the patient.

The treatment program for protracted pneumonia is generally similar to the program described in "Treatment of acute pneumonia". However, some features of therapy for protracted pneumonia should be taken into account:

• it is necessary to promptly identify the above factors that contribute to the development of a protracted course of pneumonia and eliminate them (this is primarily a thorough sanitation of the oral cavity, nasopharynx, elimination of other foci of infection, cessation of smoking and alcohol consumption);
• it is necessary to carefully analyze the methods and results of previous antibacterial therapy and decide on the need to continue it if severe infiltration of the lung tissue and symptoms of intoxication persist, but antibacterial therapy is prescribed taking into account the results of mandatory bacteriological examination of sputum;
• pay special attention to the restoration of the drainage function of the bronchi and organize the rational use of expectorants, positional drainage, bronchodilators, massage of the difficult cell; in some cases, it may be necessary to perform fiberoptic bronchoscopy and fiberoptic bronchoscopic sanitation in the presence of symptoms of persistent chronic purulent bronchitis;
• make extensive use of physiotherapy, exercise therapy, breathing exercises, massage, and acupuncture;
• It is necessary to carefully examine the immune system, evaluate the factors of non-specific protection and, taking into account the results obtained, carry out immunocorrection.

V. P. Silvestrov (1986) proposes the following program for studying systemic and local immunity in protracted pneumonia:

1. T-system
   1. Total T-lymphocyte count (T-LC).
   2. Assessment of the regulatory link of the T-system:
      • suppressor activity: T cells, theophylline-sensitive ROCs, concanavalin A-induced suppressors, short-lived suppressors;
      • helper activity: Tμ cells, proliferative response to phytohemagglutinin, interleukin-2.
   3. Evaluation of the effective link of the T-system:
      • natural cytotoxicity;
      • antibody-dependent cytotoxicity.
2. B-system
   1. Total B-lymphocyte count (EAC-ROC).
   2. Functional activity of B-lymphocytes (proliferative response to pokeweed mitogen and lipopolysaccharide).
   3. Content of immunoglobulins IgA, IgG, IgM, IgE.
3. Local protective factors (studied in bronchial secretions)
   1. Local immunity system:
      • determination of the total content of T- and B-lymphocytes;
      • determination of natural and antibody-dependent cytotoxicity;
      • determination of secretory immunoglobulins;
      • determination of xenobiotic metabolism enzymes (cytochrome-450, glutathione-8-transferase and epoxide hydratase) of lymphocytes.
   2. Alveolar macrophages
      • determination of the functional capacity of alveolar macrophages;
      • determination of xenobiotic metabolism enzymes and lysosomal enzymes of alveolar macrophages.

Of course, a full immunological examination according to the presented program is not possible in every medical institution, but patients with protracted pneumonia should be examined in immunological terms as fully as possible, because almost all of them have secondary immunodeficiency and it must be corrected taking into account the results of the immunological study.

When treating patients with protracted pneumonia, you should:

• make wider use of such methods of immunocorrective action as laser and ultraviolet irradiation of blood;
• use methods of adrenal stimulation (DKV on the adrenal gland area, treatment with ethimizole, glycyram);
• in the plan of complex therapy, it is necessary to provide for spa treatment; if this is not possible, the rehabilitation program in the rehabilitation departments of polyclinics, hospitals or sanatoriums-preventoriums at the place of residence should be used in full;
• the period of dispensary observation for patients with protracted pneumonia should be increased to 1 year, sometimes longer (i.e. until complete recovery).

• Pneumonia - Treatment regimen and nutrition
• Antibacterial drugs for the treatment of pneumonia
• Pathogenetic treatment of pneumonia
• Symptomatic treatment of pneumonia
• Combating complications of acute pneumonia
• Physiotherapy, exercise therapy, breathing exercises for pneumonia
• Sanatorium and resort treatment and rehabilitation for pneumonia

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