Consequences of pneumonia in HIV-infected patients: prognosis and treatment of a severe stage of the disease. Pneumocystis pneumonia (PCP) in HIV-infected people Pneumonia in the fourth stage HIV prognosis

Pneumonia is one of the significant causes of morbidity and mortality among HIV-positive patients in the era of highly active combination antiretroviral therapy (HAART). In developed countries, pneumonia is associated with about 10% of cases of serious illness and 5% of deaths among people infected with the immunodeficiency virus.

HIV/AIDS and other opportunistic infections

HIV (human immunodeficiency virus) attacks white blood cells, namely CD4 or T-helpers. This allows opportunistic infections to attack a weakened immune system, causing severe illness, pneumonia, cancer, or neurological disease.

People with HIV status who catch an opportunistic infection can quickly reach the stage of AIDS (acquired immunodeficiency syndrome). But with careful monitoring, self-care and treatment, it is easy to prevent many infections and lead a full healthy life for a long time to come.

Ways of infection of immunodeficient people

A wide variety of pathogens can infect an organism weakened by a virus. These are viruses, bacteria, protozoa or fungi. Even before contracting HIV, people are carriers of agents that do not cause disease. A healthy immune system keeps them in check.

You can catch an opportunistic infection in such cases:

1. Eating raw unprocessed food;
2. In contact with soil and water;
3. On contact with animal faeces;
4. Having unsafe sex with other people;
5. In places of distribution of nosocomial infections (hospitals, kindergartens, schools);
6. By contact with blood through the sharing of syringes during the administration of intravenous drugs.

Photo from en.wikipedia.org. Pneumococcus.

The immune system protects the body from infections. People diagnosed with HIV/AIDS have a compromised immune system, which increases their susceptibility to a variety of pathogens, including those that cause pneumonia.

The same organisms that cause pneumonia in healthy people pose an increased risk for HIV patients. In addition, people with healthy immune systems can easily defend themselves against attacks by viruses and bacteria that cause life-threatening pneumonia in immunocompromised patients.

Pneumonia in AIDS is caused by such pathogens:

Pneumococcus is one of the causative agents of pneumonia.

Streptococcus pneumoniae or pneumococcus remains the leading cause of bacterial pneumonia among immunocompromised patients, according to research from the Centers for Disease Control and Prevention (CDC). People infected with HIV have a significantly higher risk of contracting pneumococcal disease than the general population. The CDC recommends pneumococcal vaccination for people who have been living with HIV for more than 2 years.

Pneumocystis jirovecii causes pneumocystis pneumonia.

Pneumocystis jirovecii or Pneumocystis carinii is a fungus that is widespread in many environments. People come into contact with and acquire immunity to the fungus by the age of 3-4 years, since its spores are easily transmitted through the air. For a person with a healthy immune system, it is not dangerous, but it poses a significant risk for patients with HIV and low white blood cell count (CD4 count less than 200).

Recently, thanks to the combined use of HAART and antibiotics, it has been possible to significantly reduce the risk of developing pneumocystis pneumonia. In the absence of adequate treatment, the pathogen affects the lymph nodes, liver and bone marrow. The fungus Pneumocystis jiroveci is the leading cause of death in AIDS patients in the United States.

Tuberculosis bacillus causes pulmonary tuberculosis.

Photo from en.wikipedia.org. Mycobacterium tuberculosis (Mycobacterium tuberculosis).

People living with HIV infection easily develop active pulmonary tuberculosis.

Unlike other opportunistic infections that affect the body of patients with low levels of T-cells, pulmonary tuberculosis can develop in HIV-infected patients with relatively high levels of immune cells. Without treatment, TB bacteria spreads to other parts of the body, including the brain and bones.

Fungi Coccidioides as a cause of pneumonia.

Fungi of the genus Coccidioides live in the soil. Fungal spores are usually airborne and can cause pneumonia and systemic illness in AIDS patients with low T-cell levels. Initially, the infection develops in the lungs, causing chest pain and coughing fits. In HIV patients who ignore treatment, the fungus attacks the nervous system and bones.

Aspergillus fungi are dangerous for HIV-infected patients.

Aspergillus is commonly found in the environment, causing a severe form of pneumonia if immunocompromised. Fungi can spread from the lungs to other places in the body, such as:

• liver,
• kidney,
• spleen,
• nervous system.

Who is more susceptible to the disease

There are some differences between women and men in adherence to opportunistic infections in HIV. While men with HIV status are eight times more likely to develop Kaposi's sarcoma, women in most cases develop bacterial pneumonia and herpesvirus infections.

People with AIDS often refer to pneumonia as "the old man's good friend" because it delivers a painless death blow at the end of life. But recently, more and more people with HIV are dying at an early age from pneumonia, without proper treatment in time.

Pneumonia in HIV (pneumocystosis) is a common complication of the human immunodeficiency virus, which is diagnosed in more than half of patients. The disease is characterized by damage to the lower organs of the respiratory system, and against the background of a decrease in immunity, it can cause an early death in the absence of timely and correct treatment. After infection, the period of onset of symptoms varies from 7 to 40 days.

Pathogenic microorganisms begin to multiply on the respiratory organs

Pneumocystis carinii is a unicellular fungus that causes pneumocystis pneumonia in HIV-infected people. The pathogenic microorganism is transmitted by airborne droplets from an infected person or animal. It can also live in the air for a long time.

Most often, infection occurs in childhood, but with normal immunity does not cause the development of the disease. With a decrease in the protective properties of the body, penetrating into the organs of the respiratory system, it causes a disease.

Inflammation of the lungs in case of damage by pneumocysts is characterized by the development of extensive edema and purulent abscesses in the tissues of the lower organs of the respiratory system.

Most often, the diagnosis appears after an x-ray of the lungs.

Should know! According to statistics, the carrier of pneumocystosis is more than 90% of those infected with HIV and about 80% of medical personnel.

Pathogenesis

With human immunodeficiency, a decrease in T-lymphocytes responsible for the immune response is dangerous to life and health.

Against the background of the reduction of T-helpers, pneumocysts penetrate into the organs of the respiratory system and actively multiply in the alveoli, which, as they spread, occupy the alveolar space and cover the entire lung tissue. This entails compaction and an increase in the size of the membranes, which leads to disruption of gas exchange and hypoxia. In addition, at the sites of attachment of pneumocytes, lung tissues are damaged, which leads to the accumulation of infiltrate and purulent exudate.

The described pathological processes lead to the development of respiratory failure.

Should know! In patients with pneumonia with HIV infection, there is a high probability of spread of the pathogenic microorganism from the lungs to other organs with the blood or lymph flow.

Features of the flow

Pneumocystis pneumonia in HIV develops gradually, due to the presence of a long incubation period, from one week to 40 days. During this time, infection and reproduction of pathogenic flora in the alveoli of the lungs occurs. During this period, the patient begins to be disturbed by an episodic increase in body temperature, weakness, increased sweating, loss of appetite. As a rule, during the latent period of the course, patients do not seek medical help, which aggravates the general condition and complicates future treatment.

A feature of pneumonia in immunodeficiency is the frequent recurrence of the disease or the transition to a chronic form of the course. Often, pneumocystosis can occur in a latent form and disguise itself as acute respiratory diseases, bronchitis or laryngitis, while white foamy discharge from the mouth is a distinctive feature.

How the disease manifests itself

Symptoms and treatment in adults are interrelated, so it is important to accurately identify the former. At the initial stage of the development of the disease, the patient may be disturbed by a deterioration in appetite and a slight decrease in body weight. Periodic increases in body temperature to subfebrile levels are possible. As the pathological process progresses, symptoms of a violation of the respiratory system increase, which are accompanied by pallor of the skin, cyanosis of the lips.

The disease is difficult to tolerate, even for a person who is not infected with HIV, it is difficult to cope with this disease, so you cannot do without potent drugs

Dyspnea

Shortness of breath is the leading symptom of pneumonia, diagnosed in almost 100% of cases of pneumonia. At the initial stages of development, pneumocystosis can disturb the patient only during intense physical exertion, but after 14 days it accompanies the patient even in a state of complete rest.

Shortness of breath has an expiratory form and is characterized by the occurrence of difficulties on exhalation, which is associated with the appearance of obstacles in the path of air passage. The muscles of the abdominal region are involved in the process when the chest remains motionless.

Cough

In almost all patients, the disease is accompanied by an unproductive or dry cough, which intensifies in the morning or at night. Sputum separation is possible in active smokers. The symptom is paroxysmal.

Cough will torment throughout the illness

Chest pain

Cough may be accompanied by irritation, pain and discomfort in the chest area, which indicates the development of complications from the organs of the respiratory system.

Fever

An immunodeficiency state is accompanied by a decrease in body temperature. When infected with pneumocystosis, there is an increase in body temperature to subfebrile marks. In the last stages of the disease, hyperthermia is possible with critical levels - 38-39 0 C.

pathogens

Pathogenic microorganisms become the causative agents of the disease:

Diagnosis of the disease begins with a survey of the patient for complaints, medical history. After that, the patient's lungs are listened to, during which it is possible to determine wheezing, as well as a change in breathing. Based on the data obtained, an initial diagnosis is made and the patient is sent for laboratory and instrumental studies.

An experienced doctor will immediately hear characteristic wheezing in the lungs and prescribe treatment

The first group of diagnostic measures includes:

• general clinical and biochemical blood test, during which a change in the number of leukocytes, erythrocytes, protein and erythrocyte sedimentation rate is detected, which indicate the presence of an inflammatory process in the body;
• microscopic examination of sputum (bronchial secretion) by ELISA or PCR, which can determine the DNA or antibodies of the pathogen;
• bacteriological examination of sputum or bronchial secretions allows you to determine the resistance of pathological microorganisms to antibiotics, which allows you to choose the most effective treatment.

In order to determine the degree and nature of the lesion of the bronchopulmonary system, a chest x-ray is prescribed. During the study, a modification of the lungs is diagnosed, the presence of blackouts that indicate an inflammatory process, an accumulation of infiltrate or purulent exudate.

Therapeutic tactics

Treatment of pneumonia in HIV-infected people begins immediately, without waiting for the results of studies - delay can cost the patient's life. For this purpose, drugs of complex action with the active substance 5-[(3,4,5-trimethoxyphenyl)methyl]-2,4-pyrimidinediamine, Co-trimoxazole, and alpha-difluoromethylornithine are prescribed (this drug is currently used most often) , (Pentamidine) 4,4' (Pentamethylenedioxy) dibenzamidine.

Further treatment is selected individually by the attending physician, based on the general condition and effectiveness of the initial therapy, and is aimed at destroying the pathogen, maintaining the protective properties of the body and normalizing the functioning of the respiratory system.

Which doctor should I contact?

When the first signs of an inflammatory process appear in the lower organs of the respiratory system, you should contact a pulmonologist. During therapy, you will also need to consult an infectious disease specialist.

Treatment of HIV-infected people is carried out in a general hospital, as they do not pose an epidemiological threat to others.

Treatment

Treatment of pneumocystis pneumonia or pneumocystosis lasts 21 days, during which regular monitoring of the patient's condition, blood counts and the effectiveness of the chosen direction of treatment is carried out.

Antibacterial therapy

To suppress the activity of pneumococci that caused pneumonia, broad-spectrum antibacterial drugs are prescribed: Trimethoprim (Trimethoprim), Sulfamethoxazole (Sulfamethoxazole), Co-trimoxazole. The latter is prescribed for severe pneumonia by intramuscular injection. This group of medicines is also indicated for the prevention of the attachment of bacterial flora in viral or fungal pathology etiology.

Antiretroviral therapy

ARVT (antiretroviral therapy) is aimed at suppressing the activity and rate of HIV reproduction, restoring the immune system, and improving the patient's quality of life. ARVT requires a clear schedule of intake, with dosage compliance. This group includes:

• nucleoside reverse transcriptase inhibitors (Zidovudine, Didanosine, Abacavir);
• non-nucleoside reverse transcriptase inhibitors (Saquinavir, Nevirapine, Tenofovir, Emtricitabine, Rilpivirine);
• protease inhibitors -furanyl ether, Ritonavir(Ritonavir), N-(3-[(1R)-1-[(2R)-6-Hydroxy-4-oxo-2-(2-phenylethyl)-2-propyl-3,4- dihydro-2H-pyran-5-yl]propyl]phenyl)-5-yl(trifluoromethyl)pyridine-2-sulfonamide (and as disodium salt));
• integrase inhibitors (Raltegravir, Elvitegravir);
• receptor inhibitors (Maraviroc);
• fusion inhibitors (enfuvirtide).

Anti-inflammatory therapy

With inflammation of the lungs, anti-inflammatory drugs of the group of glucocorticosteroid drugs (Dexamethasone, Prednisolone) are prescribed. From the group of anti-inflammatory nonsteroidal drugs to reduce body temperature and stop the inflammatory process, a course of Ibuprofen, Nurofen, Paracetamol is recommended.

Improved drainage function

To improve sputum discharge, a course of expectorants and sputum thinners is prescribed: Bromhexine, ACC, Carbocysteine. To stimulate the drainage function, medications with a bronchodilatory effect (Eufillin) are also prescribed.

Prevention and treatment of respiratory failure

To prevent pneumonia and complications from HIV, you should lead a healthy lifestyle: give up alcohol, smoking, eat right, and engage in physical activity as much as possible. For this purpose, retroviral therapy is also important, which is prescribed to patients with HIV.

With the rapid development of respiratory failure, a course of corticosteroids, oxygen therapy, vibration massage, and artificial ventilation of the lungs are indicated.

Forecast

With timely treatment of pneumocystis pneumonia, the prognosis is favorable. In the absence of therapy and in the last stages of the disease, there is a high risk of the pathology becoming chronic with frequent relapses or death from respiratory failure.

Complications

• pneumothorax - accumulation of air in the pleural cavity;
• acute respiratory failure;
• abscessing pneumonia - a purulent-destructive process;
• pleurisy - inflammation of the pleural sheets;
• bronchial obstruction syndrome.

Conclusion

Pneumonia in AIDS is a dangerous complication that can cost the patient's life. The probability of developing the disease is more than 50% in all HIV positive, which is associated with weak immunity. When diagnosing pneumocystosis, a combination therapy is prescribed, aimed at destroying the pathogen, maintaining the protective properties of the body, stopping the inflammatory process and normalizing respiratory activity.

Any treatment must be prescribed by a doctor! Attention - do not self-medicate. This article is informational and aimed at specialists.

​ Not all of us value our health, but at the same time, many expect to live to a ripe old age and not suffer from this or that ailment. Diseases cause serious changes in a person - this affects not only the state of the body, but also the appearance. A person's state of health changes, he becomes indifferent to everything, sometimes it comes to the fact that a person suffering from this or that disease becomes embittered and cynical.

No one can avoid contracting one disease or another. This also applies to newborns, who are even larger than adults. susceptible to various infections. And if one of the family members falls ill, then the others are at risk of catching a dangerous virus. It is extremely difficult for parents to restrain themselves if their children have been diagnosed with a particular disease.

Few people know about such a disease as pneumocystis pneumonia, but it is a very insidious disease. It is dangerous because you can catch this infection almost anywhere, even the hospital is no exception. The treatment of this type of pneumonia is complicated by the fact that it is not always possible to detect an infection at the initial stage of development. Usually people realize they are infected too late when precious time wasted. This is precisely the main reason why the number of people who died from pneumacistosis is so high. Even doctors, who today have the most modern medicines and equipment, are sometimes unable to save a person's life.

Diagnosed with pneumocystis

It is most often difficult for an ordinary person who is not related to medicine to understand medical terminology. So its not much to say diagnosis of pneumocystis or pneumocystis pneumonia. In such a situation, few know how to behave. However, this disease should not cause a person to panic. Someone might think that this is one of the incurable diseases and nothing will help you, but you must put such thoughts out of your head. Ask your doctor to tell you more about this disease in terms that are more understandable to you.

In the language of doctors, pneumocystosis or pneumocystis pneumonia means one of the protozoan diseases, in the development of which the lungs suffer. The disease occurs due to the fault of the microorganism Pneumocystis carinii.

Who is more at risk of getting sick than others?

All types of pneumonia, which are known to doctors today, can be classified according to a number of criteria, which include the category of people who are more than others. at risk of contracting this disease.. This fully applies to pneumocystosis. According to statistics, it is most often found in:

• of people with the HIV virus;
• tuberculosis bacillus carriers who have been treated with potent antibacterial drugs for a long time;
• people who have been diagnosed cancer and who were taking cytostatics and corticosteroids. Also, here you can include patients with pathologies of the kidneys and connective tissues that have developed as a result of transplantation of a certain internal organ;
• newborn children who have a tendency to acute diseases in severe forms and who have been treated for a long time in a hospital;
• in children born ahead of schedule.

Symptoms of the disease

To date, it is known that infection with this disease occurs by airborne droplets, and healthy people, primarily employees of medical institutions, spread the infection. This fact contributed to the assertion that pneumocystis pneumonia is a stationary infection. But it should be noted that there is another point of view about the nature of the disease. It is believed that if pneumocystosis began to develop in the neonatal period, then this usually happens due to infection of the fetus in the womb.

Symptoms of the disease in children

From the very birth of a child, parents show maximum care for him. They do not want to miss the moment of the onset of the development of the disease, especially if it is pneumonia.

Of course, only a qualified doctor can make an accurate diagnosis. However, any parent, if you undergo some theoretical training, is able to identify the first signs of this disease. If the onset of the disease is not noticed in time, then every day of inactivity can bring the moment of development of complications closer, which can manifest themselves in the form of unilateral or bilateral pneumonia, pneumocystosis and other serious diseases.

A child can become infected with pneumocystis pneumonia very early - at the age of 2 months. More than others, children who have been diagnosed with cytomegalovirus infection at an earlier age are more susceptible to this disease. Usually this disease manifests itself with symptoms that are characteristic of traditional interstitial pneumonia. Doctors have repeatedly stated that it is almost impossible to detect pneumocystis pneumonia at the inception stage. The clinical picture of the disease occurs only after some time.

It is possible to determine that the disease has entered the active phase by a number of signs:

• the appearance of secretions in the form of glassy, ​​foamy, gray and viscous sputum;
• seizures suffocation, which are periodic;
• very frequent, flowing with exacerbations whooping cough.

From the moment the infection enters the human body and until the first symptoms of the disease appear, 28 days pass. If the correct treatment is not started in time, then the probability of death in children infected with pneumocystosis rises to 60%.

Another danger that newborns with a diagnosis of pneumocystis pneumonia, which occurs in a latent form, are exposed to, is that they may develop an obstructive syndrome after some time. This painful condition is caused by swelling of the mucous membranes. In such a situation, it is very important to provide medical assistance to a sick child in a timely manner. Otherwise, over time, the obstructive syndrome can develop into laryngitis, and in older children even into an asthmatic syndrome.

Symptoms of the disease in adults

Unlike newborns and young children, pneumocystis pneumonia in the elderly and young people is more severe. The most susceptible to infection are people who have been immunodeficient since birth, as well as those who have this condition during their lives.

However, the presence of this pathological condition does not mean that a person will necessarily develop pneumonia. Sometimes Pneumocystis pneumonia is diagnosed even in healthy people with a functioning immune system.

Approximately 2-5 days pass from the moment the infection enters the body of a healthy person until the first symptoms of the disease appear. Clinically, this disease manifests itself with the following symptoms:

• breathing problems causing dry or wet cough and tachypnea;
• acute pain in the chest;
• increased sweating;
• weakness in the whole body;
• migraine;
• fever.

Also, additional signs may indicate the development of the disease - cyanosis of the nasolabial triangle, retraction of the spaces between the ribs, acrocyanosis.

Passing the full course of treatment does not always guarantee the patient a complete cure. Some patients may develop serious complications following this disease. Sometimes the patient's condition worsens due to frequent relapses. According to the doctors, if repeated symptoms of pneumocystis pneumonia occurred earlier than 6 months from the moment of diagnosis, then it can be concluded that the infection is starting to show activity in the body again. If this happens later than after 6 months, then most likely this is due to a new infection or reinfection.

If timely treatment of the disease is not started, then the probability of death in adult patients can increase to 90%.

Pneumocystis pneumonia: symptoms in HIV-infected people

Very often, when the infection enters the body of a person who is a carrier of HIV infection, the disease develops very slowly. The incubation period for this type of pneumonia can be from 4 to 8 weeks. Knowing this, doctors recommend regular examinations. If the patient notices even the slightest sign of an infection in the body, then he will have to not only pass the basic tests, but also undergo a fluorography.

You can determine the presence of the disease in carriers of HIV infection by the following characteristic symptoms:

• progressive respiratory failure;
• dyspnea;
• dry cough;
• sudden weight loss;
• an increase in temperature to 38-40 ° C, which persists for two to three months.

According to scientists, any kind of pneumonia, including pneumocystosis, manifests itself with the same symptoms in HIV-infected patients. This means that at the initial stage of the development of the disease, it is practically impossible to find out what kind of pneumonia struck a person. Most often, pneumocystis pneumonia in carriers of HIV infection is detected when too much time has passed since the moment of infection, and the body's own capabilities are not enough to defeat the infection on its own.

Pneumocystis pneumonia: treatment

It does not hurt for each person to know by what signs pneumonia can be determined. But, unfortunately, this may not be enough in all cases.

Still, without special education, this is difficult to do, so in most cases the diagnosis can be erroneous. Do not forget that there are many varieties of pneumonia, and it is very difficult for an ordinary person to find out which one we are faced with - pneumocystosis, unilateral or bilateral pneumonia, or some other form of the disease.

Accordingly, self-selected treatment of the disease is likely to be ineffective. Therefore, doctors recommend not to delay contacting a specialist. As soon as all the necessary studies have been completed and tests have been passed, the doctor will be able to say exactly what exactly is causing the deterioration in the patient's well-being. And if pneumocystis pneumonia is recognized as the culprit, then the doctor will prescribe treatment, which involves special organizational and regime measures and drug therapy.

Organizational and regime measures are understood as the placement of a patient in a hospital for examination and treatment. While in the hospital, the patient will take medications and adhere to the diet selected by the doctor.

As for drug therapy, it is based on etiotropic, pathogenetic and symptomatic treatment. In order to prevent the disease from progressing further, patients are prescribed drugs such as:

• Biseptol;
• Trichopolum;
• Furazolidone;
• Pentamidine.

In addition, the medicines listed above are supplemented with anti-inflammatory drugs, as well as drugs that stimulate sputum production and facilitate expectoration.

Biseptol, which is most often used in the treatment of pneumocystis pneumonia, is intended for oral or intravenous use. It has few side effects and is the best alternative to pentamidine for the treatment of non-HIV patients.

Pentamidine is administered by intramuscular or intravenous injection. In addition to the main measures, HIV-infected patients are prescribed antiretroviral therapy, since pneumocystis pneumonia in this category of patients occurs as a result of a weakened immune system. Recently, as part of the treatment of pneumacistosis, HIV-infected patients are increasingly being prescribed therapy using alpha-difluoromethylornithine (DFMO).

Conclusion

There are a large number of diseases in the world, some of them are quite dangerous. Pneumocystosis is just one of these and, if not treated in time, can even lead to the death of a person. This disease is of particular danger to the health of a child who does not have a strong enough immune system to effectively resist infection.

The treatment of pneumocystosis is complicated by the fact that the disease is very difficult to detect at the initial stage, therefore, at the time of detection, too much time has passed to quickly cope with the disease and avoid unpleasant consequences. Therefore, any symptoms resembling a cold or flu should not be ignored. If you decide to immediately consult a doctor, even with a mild cough, then you will not only be able to recover faster, but also save yourself from serious health problems in the future.

Pneumocytic pneumonia is a disease that occurs in people with immune problems. It is ubiquitous and can affect people of any age and any gender. Pneumonia can be expressed in different ways, depending on the immune status of the infected person. After the lesion, there is a whooping cough, gray sputum, pain in the chest, fever.

Pneumocystis pneumonia- This is a disease that manifests itself after a couple of weeks, as a result of interaction with a carrier of bacteria. In HIV-infected people, the latent process is much shorter.

Pneumocysts, penetrating through the bronchial tree into the alveoli, begin to develop and provoke inflammatory processes. As a result, the number of healthy cells decreases and an alveolar-capillary block occurs.

If the immune system is weak, the pathogen develops rapidly and provokes pulmonary insufficiency. Due to the disruption of the membrane, pathogens enter the bloodstream and combine with a secondary infection.

Pneumocystis pneumonia - complications and consequences

As a result of the neglect of pneumocystis pneumonia, a lung abscess, escudative pleurisy, and unexpected pneumothorax occur. Pneumocystosis has several definitive options:

• cure
• Death from 1 to 100% depending on the manifested immunodeficiency. Death can occur in case of respiratory failure, when there is a violation of gas exchange. In the absence of treatment, the lethal outcome in children reaches 20-60%, and in adults - 90-100%.

Important. When interacting with those affected by the virus, HIV-infected patients often relapse.

Who is at risk?

The main risk groups among babies and adults:

1. HIV-infected
2. Patients with cancer
3. Patients with blood and connective tissue problems
4. With immunosuppressive therapy, radiation
5. Organ Transplant Patients
6. smokers
7. Elderly people who have diabetes
8. People interacting with harmful and dangerous components.

Often pneumocystis pneumonia affects children at an early age with a weakened immune system due to prematurity, with malformations, in the case of cytomegalovirus infection.

Features of pneumocystis pneumonia in HIV-infected

Pneumocystis pneumonia is a disease that often manifests itself as a result of the presence of HIV infection in patients.

With pneumocystis pneumonia, the following stages of the disease are observed:

• The initial stage is the absence of inflammatory changes in the alveoli, the manifestation of trophosiodes, cysts.
• Intermediate stage - violations of the alveolar epithelium, a significant number of macrophages inside the alveoli, as well as cysts.
• The final stage is marked by the activation of alveolitis, a change in the epithelium. The presence of cysts is noticeable both inside macrophages and in the lumen of the alveoli.

Features of the disease in children

1. The period of occurrence is often children at 5-6 months of age who are at risk (patients with rickets, premature babies, with IUI pathology, central nervous system, oncology).
2. Gradual manifestation of the disease - loss of appetite, low weight gain, subfebrile temperature, cough resembling whooping cough, shortness of breath (more than 70 breaths per minute), pallor of the skin (slightly cyanotic). At this point, consequences may occur - pulmonary edema, which is fatal.
3. When viewed on an X-ray, focal shadows of a "cloudy" lung are noticeable.

Causes

The causative agent of this pneumonia is a unicellular microorganism - pneumocystis, which belongs to fungi. It resides permanently in the lung tissue of every person and is safe. It can provoke pneumonia only in the presence of immunodeficiency states. 70% of those with pneumonia are HIV-infected people. In addition, pneumocystis pneumonia can manifest itself in people prone to the development of pathology:

• Children who were born prematurely, who survived asphyxia, who have developmental anomalies.
• People of any age who are undergoing radiation therapy, or are treated with glucocorticosteroids, cytostatics, or other drugs that destroy the immune system.
• Patients with rheumatoid arthritis, lupus erythematosus, tuberculosis, liver cirrhosis and other chronic diseases.

Attention! Pneumocystis pneumonia spreads by airborne droplets, as well as from mother to baby during pregnancy.

Inflammation does not form stable immunity, as a result of which relapses can occur when interacting with the pathogen in HIV-infected patients, pneumonia recurs in 25%.

Symptoms of pneumocystosis

With pneumocystis pneumonia, the incubation period is 7 to 10 days. It can be in the form of acute chronic bronchitis, acute respiratory infections, laryngitis, or pneumocystis interstitial pneumonia. Pneumonia has 3 stages:

• Edema (7-10 days)
• Atelectatic (no more than 4 weeks)
• Emphysematous (more than 3 weeks)

During the edematous stage, the symptoms of fever and intoxication are not pronounced. The temperature may remain normal or subfebrile. Patients complain of weakness, fatigue, loss of appetite, decreased activity. There is a cough with a small amount of viscous sputum. While listening to the lungs, hard breathing is felt, while there are no wheezing.
During the atelectatic stage, shortness of breath occurs, a bluish tint of the skin appears, sometimes pulmonary - heart failure is observed. The cough is violent and incessant, with clear expectoration which is difficult to pass. When listening to the lungs, small and medium rales are felt.

During the emphysematous stage, the condition improves - shortness of breath passes, and the cough gradually disappears.

In addition, pneumocytic pneumonia is characterized by pain in the chest area. On examination, the doctor determines an increased heartbeat, wheezing in the lungs and a blue nasolabial triangle.

Diagnostics

Diagnosis of pneumocystis pneumonia is carried out on the basis of such measures:

• Anamzez. The doctor finds out about the interaction with an infected person, determines the presence of pathology, clarifies the symptoms.
• Physical examination allows you to determine the presence of shortness of breath, respiratory failure, tachycardia.
• Instrumental methods involve the use of x-rays of the lungs. It is he who will determine the violations that have occurred in the lung zone.
• Laboratory tests are, first of all, a general blood test, lung biopsy, blood serology for the determination of antibodies to pneumocysts.

Treatment

The peculiarity of pneumocystis pneumonia is that the causative agent of the disease is not susceptible to most antibiotics. Often, drugs to which he has sensitivity provoke various negative moments, especially in babies and HIV-infected people.

In the case of present respiratory failure, the following treatment regimens are distinguished:

• With a mild form, sulfamethoxazole, trimethoprim, biseptol are prescribed
• In the moderate form - clindamycin, dapsone, atovaquone
• With a running form - primaquin, pentamidine, trimetrexate.

Medicines must be combined with each other, as they are very toxic and can provoke rashes, fever, neuropathy, hepatitis, and gastrointestinal pathologies.

In addition to these drugs, therapy involves the use of expectorant drugs, mucolytics, anti-inflammatory drugs. In the treatment of HIV-infected patients, in addition to the main drugs, corticosteroids are prescribed to reduce inflammation in the lungs and make breathing easier. Respiratory activity must be constantly monitored. In some embodiments, it is necessary to connect the patient to the ventilator.

The duration of treatment is two weeks, for HIV - infected - three weeks. Often, an improvement in well-being with a properly selected treatment regimen is observed after 4-7 days.

Among the microorganisms that affect the lung tissue and cause pneumonia, the causative agent is in a special place - pneumocyst from the kingdom of protozoan fungi. For a long time, this pathogen was considered not dangerous to human health. The situation changed at the end of the last century with the widespread spread of HIV. Under conditions of a sharp decrease in immunity and the ability of the body to resist external aggressive factors, pneumocystis pneumonia in HIV-infected people has acquired a pronounced character of an "indicator" indicating a sharp decrease in immunity in a particular person and the likelihood of AIDS.

The causative agent Pneumocystiscarinii was first described by the Czech microbiologist Otto Jirovits in 1909, and isolated from the human body in 1912. The new microorganism was not systematized either as a protozoan or as a fungus. Its nature was clarified much later.

Since the presence of pneumocysts was determined in more than 50% of healthy adults, the new microorganism was considered a non-pathogenic saprophytic flora, which is normally present in humans.

For the first time, what pneumocystis pneumonia is and the pathogenic properties of the microorganism were announced in 1942, when the microorganism was isolated from a group of newborns with pneumonia. At the same time, a close relationship with the disease with human immunodeficiency was revealed. Pneumocystis pneumonia in children is likely with a notorious health condition, or an immune deficiency caused by prematurity or congenital diseases.

Important! Pneumocystis pneumonia is an indicator of possible HIV disease. As such, it began to be considered after 1980, when HIV and pneumonia became closely interrelated. In the same period, methods were developed on how to treat this type of pneumonia.

In the structure of the diseased, 2 risk groups are distinguished:

• Newborns (especially at the age of 3-5 months);
• HIV-infected.

Children are about 10% of the risk groups, and in HIV-infected pneumocystosis can reach up to 70% of the total number of cases of various types of pneumonia.

Microbiology of the pathogen

The pneumocyst is a microorganism, about 5 microns in size, that lives exclusively in the lung tissue. They are not commonly found in the blood or other tissues of the body. In a weakened organism (with immunodeficiency), a sporozoid that is normal or penetrated by airborne droplets enters the intercellular alveolar space into the cavity of the pulmonary alveoli, where it actively multiplies.

The pneumocyst has 4 distinct stages of development. The course of the disease and the manifestation of characteristic symptoms are associated with it.
The development of a microorganism can take place inside the body, sexually or asexually.

During the sexual cycle of development, there are:

• Trophozoite;
• Precysta;
• Cyst;
• Sporozoid.

At any of these stages of its development, the microorganism is able to release weak toxins that do not affect the well-being of a healthy person, but are critical for HIV-infected and weakened newborns with an undeveloped immune system.

The source of infection is usually a sick person if the sick person had close contact within a closed institution. In most cases, this source is:

• Carrier of pathogenic flora;
• Employees of children's / medical institutions who have been in constant contact with the sick person;
• Animals that live in a person’s home or with whom he comes into contact during housekeeping: cats, dogs, mice, rabbits, pigs, etc.

The most common route of infection is aerogenic, in which the sick person inhales the air, which contains dried mucus from the nasopharynx of the carrier or the patient.
The mucus secreted by patients when coughing (sneezing) contains much more of the pathogen than in dried sputum, so the risk of infection is higher.

For the epidemiology of newborns, the route of infection through placenta infection is common - from the mother of the carrier of pneumocysts to the fetus. With this mechanism of infection, a disease may occur in a newborn at 1 month of age, which is not typical for a typical etiology.

There is no pronounced seasonality in disease outbreaks, but it is noted that there are more cases in the spring.

At-risk groups

As already noted, among the population there are two separate risk groups:

• Newborns, with malformations of immunity;
• HIV infected.

• People with chronic physiological insufficiency of body functions - the elderly, young children with undeveloped immunity;
• Newborns born prematurely, with signs of asphyxia, congenital birth injuries, heart or respiratory diseases;
• Chronically ill children and adults treated with cytotoxic drugs; glucocorticosteroids, radiological treatment;
• Patients with systemic diseases: lupus erythematosus, liver cirrhosis, rheumatoid arthritis;
• In HIV patients, which make up about 70% of the total number of patients with pneumocystosis.

According to the selected groups of the population, most often susceptible to infection with pneumocystis, the groups among which the disease is most often recorded are also distinguished:

• Pupils of orphanages and baby houses;
• nursing home patients;
• Patients in cancer centers and hospices;
• Subjected to ionizing radiation with diseases of the blood system (leukemia);
• Patients with various forms of tuberculosis;
• Pneumonia in HIV infection.

The danger of re-infection, or the transition to a chronic form with periodic exacerbations, is higher in the listed categories, since after the disease, stable immunity to the pathogen is not developed and cases of re-infection are frequent.

Important! Men get sick more often than women.

Morphological changes

The morphology of pneumocystis pneumonia is staged.

After entering the respiratory tract of a person, pneumocysts settle in the lung tissue in the interalveolar space and begin to multiply intensively. At the same time, each new oocyst, a microorganism formed as a result of asexual division, surrounds itself with a dense mucous capsule. This is due to the abundant accumulation of mucus in the lung tissue. Mucus is impregnated into the lumen of the bronchi and almost completely fills the alveoli. The circulation of air inside the lungs becomes difficult and severe respiratory failure occurs.

The second stage of microorganism development is the release of metabolic products and the decay of dead pneumocystis. This is accompanied by moderate intoxication, the beginning of the production of specific antibodies by the body. Cells responsible for the destruction of foreign microorganisms - phagocytes are concentrated in large numbers in the lung tissue. What entails an inflammatory reaction in the walls of the alveoli and a violation of the circulation of gases (oxygen -CO2). This reaction of the body is the second cause of respiratory failure.

As the inflammatory process deepens, fibroblasts begin to form in the lung - pulmonary fibrosis or closed pneumothorax may occur - accumulation of air in the pleural cavity.

Symptoms of Pneumocystis Pneumonia

The most typical pneumocystis pneumonia in HIV-infected patients, the symptoms and treatment of which is applicable to all other patients.

It usually takes 6-7 days (5 to 10) before the first symptoms appear. During this period, symptoms characteristic of acute respiratory infections, laryngitis or exacerbation of the nasopharynx may be observed.
During this time, the process in the lungs is on the rise.

Only 3 stages:

• Edema (lasting 7-10 days);
• Atelectatic - the longest (more than 4 weeks);
• Emphysematous - develops in the chronic form (from 3 or more weeks).

For the first stage of pneumocystis pneumonia, the clinic manifests itself in:

• Weakness;
• Increased fatigue;
• Possible weight loss;
• Decreased appetite;

The patient develops a rare cough with a small amount of sputum. Breathing is hard, without wheezing. Percussion in the interscapular region may be a shortened sound, without tympanitis. Fever and intoxication are not the leading symptoms. Body temperature is usually subfebrile (not exceeding 38 ° C).

The second stage is characterized by:

• Growing. The frequency of inhalations / exhalations can reach up to 60-80 per minute;
• Acromegaly cyanosis appears on the face and extremities - Cheeks, ears, tip of the nose, fingertips on the hands become cyanotic;
• Cough becomes more frequent, obsessive, "barking";
• When coughing, a large amount of sputum is separated. It is transparent, thick, stubborn, spitting out in thick clots;
• Against the background of pulmonary insufficiency, heart failure progressively develops;
• On auscultation, small bubbling rales appear. Percussion - a dull sound in the interscapular region is replaced by a "tympanic" - the sound of a blow to an empty drum;
• Often at this stage pneumothorax opens - air accumulates above the lungs in the pleural cavity and acquires a crescent shape on the x-ray - "crescent pneumothorax".

Usually it does not pose a danger to the patient and spontaneously passes after a few days.

The third, final stage of pneumocystis pneumonia - emphysematous is characterized by an improvement in the patient's condition. Shortness of breath gradually passes. Decreases the amount of sputum produced. Cough becomes less frequent and prolonged.
On auscultation, wheezing in the lungs becomes dry, and on percussion it increases and a “box” sound in the lungs persists for a long time.

Pneumocystis is not characterized by generalization of infection. But, against the background of a general decrease in immunity in HIV patients, it is possible for them to spread with the bloodstream throughout the body - the liver, spleen, kidneys, thyroid gland, etc. There may be enlarged lymph nodes in the armpits and neck area.

The X-ray picture is characteristic.

• At an early stage of the disease, the pulmonary pattern intensifies in the picture;
• In the second stage - foci of blackout appear (usually symmetrical, less often on one side) and areas of increased transparency may appear - compensatory efphysema. In these areas, the vascular pattern is clearly visible (syndrome of "falling snow" or "veil").

Treatment

Treatment of pneumocystis pneumonia combines:

• Security measures - hospitalization, bed rest;

Medical treatment is aimed at:

• Impact on the pathogen (etiotropic);
• Interruption of the life chain of the pathogen (pathogenetic);
• Elimination of symptoms (cough, increased sputum, reduced fever, headache).
  The list of drugs required for treatment can only be determined by the attending physician.

There is no specific prevention of pneumocystosis. Pneumonia in HIV-infected people, its course, prognosis and consequences in a particular patient depend on the degree of impairment of the body's immune state and the nature of the underlying disease that led to a decrease in the body's immunity.