The specified pneumonia can be as independent diseases, and to complicate other infectious diseases.
. Among the illnesses caused , an original pneumonia (illness of legionaries, a legionella-pneumonia) more often is observed. In the USA on it is necessary from 0,5 to 1,5 % of all acute pneumonia. Cases a pneumonia are buy cipro 2mg registered in many countries, including in the USSR. Disease can proceed in the form of sporadic cases and in the form of flashes (epidemic diseases can be carried to illness of legionaries, sporadic - to or legionella-pnev ). The Incubation interval lasts usually 5 … 7 days. Illness begins acutely with occurrence of a high fever (39 … 40 °), the expressed symptoms of the general intoxication. The maximum expression of a toxicosis comes during the first 2 , is more rare - during 3 … than 4 days. The fever becomes perceptible, the general delicacy, weakness, muscular pains accrue. From first days of patients disturb the excruciating tussis, the pricking stethalgias amplifying at tussis and breath. Tussis in the beginning dry, then starts to separate a purulent sputum. The dyspnea develops, frequency of breath reaches 30 … 40 in 1 mines and more. Some patients are disturbed by abdominal pains, there is a vomiting and a liquid chair. At illness height signs of lesion (giddiness, delirium, consciousness disorders) become perceptible. Can develop hemo a syndrome. In these cases pulmonary bleedings are possible. The syndrome of an inflammation of respiratory tracts is not present, arterial pressure is lowered. Physical signs of a pneumonia are taped. At serious disease respiratory insufficiency quickly accrues, can develop but-toxic a shock. The mors comes to the extremity of 1st week of illness. The lethality in the absence of adequate treatment about 20 %, at treatment decreases to 5 … 10 %
About it is necessary to think at development of a serious pneumonia during an unusual season (the extremity of summer) at men of an average or advanced age in the presence of contributing factors (smoking, application , an alcoholism, a diabetes, etc.). From clinical implications diagnostic value the high fever, absence of a previous lesion of the top respiratory tracts (a rhinitis, a pharyngitis, a laryngitis), a diarrhoeia, disturbance of functions of the central nervous system, a liver, have, negative results of usual bacteriological researches of a sputum, and also absence of appreciable therapeutic effect from antibiotics (Penicillinum, streptomycin, Tetracyclinum) which are prescribed for buy rimonabant 2mg treatment sick of an acute pneumonia. For diagnosis acknowledgement use methods (microagglutination reaction, a method of an indirect immunofluorescence) more often. Investigate the didymous Serums taken with an interval in 10 … of 15 days.
Pulmonary tuberculosis. , focal and the pulmonary tuberculosis has clinical implications similar to a pneumonia, and quite often sick of a tuberculosis arrive in infectious hospitals. Necessity of differential diagnostics is dictated by importance of the timely beginning of antituberculous treatment.
the pulmonary tuberculosis (both , and ) can begin from the high fever expressed to the general intoxication, a dyspnea, the liver and lien augmentation sometimes becomes perceptible. Such patient
Quite often the erroneous diagnosis of a typhoid, an acute pneumonia make, etc. at a tuberculosis in lungs are defined plural fine . At subacute a tuberculosis the centres larger, further they can cause occurrence of individual or plural thin-walled caverns. In a sputum tuberculosis micobacteria are found out.
The focal pulmonary tuberculosis meets often (about half of all initially taped sick of a tuberculosis). Proceeds at rather satisfactory state of health of patients, the subfebrile condition, small tussis, more often the dry become perceptible. Micobacteria in a sputum are taped seldom. Differential diagnostics is based mainly on data of radiological inspection. Small the roundish form the centres are more often found out in subclavial area and on apexes of lungs.

Now even more often there is a fixing current of a pneumonia. At 35 … 45 % of patients, especially at the persons of advanced age weakened and with various secondary immunodeficiencies, the inflammatory infiltrations of lungs which are found out , do not resolve more than 4 . The clinical picture in this order ultram 2mg case is characterised by the poor physical
Semiology, flaccid reaction of blood, prevalence of symptoms of the general the patient.
When we deal with a fixing pneumonia at elderly persons, it is necessary to remember always that under “mask” of a focal pneumonia can proceed a pneumonia. The proof fixing current, absence of effect from various antibiotics, a pneumorrhagia, a repeated pneumonia of the same localisation, ESR substantial growth, an anaemia - all it is the indication for carrying out of a tomography, a bronchoscopy for the purpose of an exception of tumoral process.
The focal pneumonia needs to be differentiated also from a tuberculosis (the infiltrativno-pneumonic form), and a lung fever localisations from a caseous pneumonia.
It is necessary to notice, that the prescription of antibiotics of penicillinic group at a pneumococcal pneumonia allows quickly (during 3 … 5 days) to improve general condition, to achieve fever disappearance, to reduce quantity of a separated sputum. Absence of effect from preparations of group of Penicillinum should suggest about other bacteriemic nature of a pneumonia.
Streptococcal pneumonia. Now meets seldom, probably because the hemolitic streptococcus keeps high sensitivity to antibiotics of a penicillinic number. The streptococcal pneumonia can be primary and as complication of other disease (a measles, a flu, etc.) . Begins acutely, proceeds rather hardly. In the beginning one segment is amazed, more often in the bottom share of a lung, then process quickly extends. It is characterised by a high fever with the big daily allowances , repeated cold fits and sweats. There are pricking pains in a side on the lesion party, in a sputum there can be blood streaks. Complication by an exudative pleuritis which develops at 50 … 70 % of patients is typical. Its signs are taped already on 2 … 3rd day of illness. The high leukocytosis - (to 20 … 30) lO9 / “- with the expressed deviation to the left is typical also. A basis for differential diagnostics of a streptococcal pneumonia are: rather serious current, early complication by an exudative pleuritis, a high leukocytosis, presence a streptococcus in a sputum in a considerable quantity. Sometimes it is possible to allocate a hemolitic streptococcus from blood (at 10 … 15 % of patients).
Staphylococcal pneumonia. The staphilococcus can cause a primary pneumonia (seldom), bronchogenic secondary (as complication) a vpxl 2mg pneumonia and a hematogenic pneumonia at a staphylococcal sepsis. Frequency of a staphylococcal pneumonia makes to 10 … 20 % of all acute pneumonia. Clinically staphylococcal pneumonia differs more serious current, predilection to purulent complications (abscesses, an empyema), presence at patients of the expressed dyspnea, a cyanosis. The staphylococcal pneumonia at children, elderly and at the persons weakened by other illnesses especially hardly proceeds. it is characterised by extensive polysegmentary infiltration of a pulmonary tissue, the accompanying pleuritis is quite often taped. In the subsequent bullas and necrotic cavities with horizontal level of a liquid are taped. The configuration and quantity of cavities in a lung quickly vary. At a hematogenic pneumonia the set of the small centres of pneumonic infiltration is characteristic. Signs of the general (septic) disease prevail. The pneumonia of the staphylococcal nature badly gives in to therapy not only antibiotics of a penicillinic number, but also other antibiotics.
The pneumonia caused by a rod, pyocyanic rod, , , etc., become perceptible mainly at the weakened persons, proceed hardly, often formation of abscesses, purulent becomes perceptible
. They badly give in to an antibioticotherapia. Their clinical implications are very similar and do not give the sufficient bases for carrying out of differential diagnostics. Diagnostics is based on bacteriological researches - allocation of the originator from a sputum (in a considerable quantity), from blood, from a pleural exsudate. Serologichesky researches and in practice are not used.