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La pneumonie est une maladie infectieuse et inflammatoire aiguë qui affecte toutes les unités structurelles du tissu pulmonaire, pour la plupart - les alvéoles et les cellules interstitielles. Cliniquement, la pathologie se manifeste par des symptômes tels que fièvre, faiblesse, transpiration, essoufflement, toux avec crachats, qui peuvent être purulents, muqueux, sanglants (« rouillés »). Le diagnostic repose sur l'auscultation et la radiographie. Les principales méthodes de traitement: antibiothérapie, désintoxication, immunostimulation, prise de mucolytiques, expectorants, antihistaminiques, physiothérapie et thérapie par l'exercice.
Symptômes et signes de pneumonie
La symptomatologie clinique de la maladie est déterminée par sa forme. La pneumonie croupeuse se caractérise par un début aigu, une fièvre supérieure à 39 °C, des frissons, des douleurs thoraciques, un essoufflement et une faiblesse marquée. Les attaques de toux sont d'abord improductives, après quelques jours, les crachats « rouillés » commencent à partir. La fièvre persiste. Les symptômes se manifestent pendant 10 jours. Dans les cas graves, la peau est hyperémique, le triangle nasolabial est cyanosé. La nature de la respiration est superficielle, rapide. Lors de l'auscultation, le médecin écoute des crépitements et des râles bouillonnants fins et humides. La pression est faible, les bruits cardiaques étouffés, le pouls s'accélère, une arythmie est possible.
La pneumonie focale se caractérise par un début progressif et discret. La maladie se développe après des infections virales respiratoires aiguës ou une trachéobronchite. La température atteint des valeurs fébriles (38-38,5°C). Avec les attaques de toux, des expectorations mucopurulentes sont évacuées. La transpiration, la faiblesse, la douleur dans la poitrine lors des attaques de toux et à l'inspiration sont caractéristiques. Pendant l'auscultation, le médecin écoute la respiration difficile, les crépitements sur le foyer inflammatoire, les râles bouillonnants fins et moyens secs.
Causes du développement et voies d'infection par la pneumonie
La cause de la progression de la pneumonie est l'infection, le plus souvent par des agents pathogènes bactériens. Les agents responsables de la maladie comprennent:
- gram (+) pathogène - pneumocoques, staphylocoques, streptocoques;
- pathogènes gram (-) - bacille de Friedlander, Haemophilus influenzae, entérobactéries, Proteus, Escherichia coli, Legionella;
- mycoplasme;
- virus de la grippe, parainfluenza, herpès, adénovirus;
- champignons.
De plus, la pneumonie peut évoluer sous l'action de provocateurs non infectieux : traumatisme thoracique, composés toxiques, rayonnements ionisants, allergènes.
Facteurs de risque
Le groupe à risque pour la maladie comprend les personnes atteintes de pathologies telles que:
- insuffisance cardiaque congestive;
- bronchite chronique;
- infection nasopharyngée chronique;
- malformations des poumons;
- immunodéficience.
De plus, le groupe à risque comprend les patients malnutris qui sont alités pendant une longue période, les personnes âgées. Sujet à la pneumonie et ceux qui fument et abusent de l'alcool.
Complications
L'évolution de la pneumonie est compliquée si elle s'accompagne de la progression de processus inflammatoires dans le système respiratoire et d'autres organes. La présence ou l'absence de complications détermine la nature de l'évolution et le pronostic de la maladie. Les complications pulmonaires comprennent :
- syndrome d'obstruction;
- abcès pulmonaire;
- gangrène du tissu pulmonaire;
- pleurésie exsudative;
- insuffisance respiratoire aiguë.
Les complications extrapulmonaires comprennent :
- insuffisance cardiopulmonaire aiguë;
- myocardite, endocardite;
- méningo-encéphalite, méningite;
- choc infectieux-toxique;
- glomérulonéphrite;
- anémie.
Quand consulter un médecin
En cas de fièvre, de toux, de séparation des crachats, il est nécessaire de consulter un médecin généraliste ou un pneumologue.
Diagnostic de pneumonie
Dans le processus de diagnostic, il est important de distinguer l'inflammation des autres pathologies pulmonaires, de connaître l'étiologie et la gravité de la maladie. Une pneumonie peut être suspectée sur la base d'une élévation rapide de la température, d'attaques de toux, d'une intoxication. Pour le diagnostic, vous avez besoin de :
- examen physique. Avec percussion, le médecin détermine le compactage du tissu pulmonaire, avec auscultation - respiration sifflante et crépitation;
- diagnostic de laboratoire. Hyperleucocytose (15-30×109/l), déplacement de la leucoformule vers la gauche, augmentation de la VS jusqu'à 50 mm/h. Dans l'urine, une protéinurie est déterminée, parfois une microhématurie. L'analyse des expectorations bactériennes révèle l'agent pathogène, sa sensibilité aux antibiotiques est également déterminée;
- radiographie pulmonaire. Des radiographies sont effectuées au début de la pathologie et après 3-4 semaines à des fins de contrôle.
Traitement
Pendant la montée en température et l'intoxication, le patient a besoin de repos au lit, de beaucoup de liquides, d'aliments riches en calories. Si une insuffisance respiratoire est exprimée, les patients se voient prescrire des inhalations d'oxygène. Les thérapies de base comprennent :
- traitement antibactérien. La sélection des antibiotiques est effectuée par un médecin. En cas de pneumonie communautaire, des pénicillines, des céphalosphorines, des macrolides sont prescrits. Avec les infections nosocomiales, les pénicillines, les fluoroquinolones, les céphalosporines, les aminoglycosides, les carbapénèmes sont prescrits. Une thérapie combinée de 2-3 antibiotiques peut également être prescrite. Le cours est de 1 à 2 semaines. Avec une forme de pathologie virale ou fongique, un traitement antiviral ou antifongique est respectivement prescrit;
- traitement symptomatique. La désintoxication, l'immunostimulation sont effectuées, le médecin prescrit des antipyrétiques, mucolytiques, expectorants, antihistaminiques;
- physiothérapie. À la fin de l'intoxication et de la fièvre, des procédures physiothérapeutiques (électrophorèse, thérapie à ultra-haute fréquence, inhalations, massage) et des exercices de physiothérapie sont prescrits pour stimuler la résolution du foyer inflammatoire.
Des mesures thérapeutiques sont effectuées jusqu'à ce que l'état soit complètement normalisé. Le traitement de la pneumonie avec des remèdes populaires est contre-indiqué. Toutes les mesures thérapeutiques sont prises strictement sous surveillance médicale.
Mythes et idées fausses dangereuses dans le traitement de la pneumonie
La pneumonie est traitée uniquement avec des antibiotiques. Ce n'est pas le cas, car la maladie peut être causée par des virus ou des champignons, et des médicaments appropriés doivent être prescrits pour les éliminer.
Avec la pneumonie, vous devez réchauffer la poitrine. En effet, un échauffement local de la poitrine peut provoquer une aggravation du processus inflammatoire.
Avec la pneumonie, il y a toujours une toux. Chez les patients dont le statut immunitaire est affaibli, la maladie peut se développer avec des symptômes cliniques flous, chez lesquels la toux n'est pas observée.
La prévention
Les mesures préventives sont les suivantes :
- durcir le corps;
- renforcer l'immunité;
- exclure l'hypothermie du corps;
- assainir les foyers d'infections chroniques;
- arrêter de fumer et d'abuser de l'alcool;
- faire des exercices de respiration.
Pour les patients affaiblis qui sont au repos, il est nécessaire d'effectuer des exercices thérapeutiques, des massages, le médecin doit leur prescrire des agents antiplaquettaires - héparine, pentoxifylline.
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