Pneumonia symptoms and signs. Inflammation of the lungs (pneumonia)

Unfortunately, pneumonia is quite common. very sensitive to all kinds of infections, bacteria and fungi. Many people often ask the question: “What are the symptoms of pneumonia?” Does the temperature have to be high? Many diseases are latent. It often occurs in a latent form and Symptoms without fever significantly complicate the diagnosis.

Pneumonia

Pneumonia is serious disease respiratory organs, which affects the lung tissue. This condition can be provoked by streptococci, staphylococci, other bacteria, chlamydia, legionella, some fungi (for example, candida), influenza viruses, herpes. The infection does not “settle” in the nasopharynx, but descends below, causing an inflammatory process in the lungs. The waste products of pathogens, which are essentially toxins, poison the body. Particular harm is caused to the central nervous system, heart and bloodstream organs. Pathogens enter the body by airborne droplets. Often the disease can be caused by bacteria that inhabit the area of ​​the upper respiratory tract.

Causes

Pneumonia mainly develops against a background of weakened immunity and respiratory diseases. With significant hypothermia, the body's defenses are weakened, and harmful microbes easily penetrate into the lung tissue. In addition, overwork poor nutrition, absence essential vitamins and minerals, stress and strong emotional outbursts also contribute to the development of diseases such as pneumonia. Symptoms (without temperature or with a significant increase in temperature), cough should alert the patient. The danger of the latent course of the disease is that there is a high risk of all kinds of complications (damage to the central nervous system and cerebral cortex, decreased levels of red blood cells in the blood) and so on. They don’t pay much attention to a mild illness; it is easy to confuse it with other similar ailments.

Types of pneumonia

Classic symptoms of pneumonia

Pneumonia is the most common complication of acute respiratory diseases. As an independent disease during infections, it is not so widespread. What are the first symptoms of pneumonia? A cough that is constant, and over time it becomes hacking, with sputum. The body temperature rises significantly, the person shudders. Often paracetamol has no effect. It becomes difficult to breathe; trying to take a deep breath provokes a coughing attack. It is worth paying attention to the bluish tint of the skin around the mouth and wings of the nose. If the cold does not go away after a week, or the symptoms worsen, the doctor may also suspect pneumonia. Knowing what symptoms of pneumonia are most common will help you consult a doctor in time. After all, this disease is extremely dangerous, especially in young children.

Unfortunately, it is widely believed that pneumonia is a disease in which high fever is required. Its absence misleads people; they do not even suspect that a disease such as pneumonia is already developing. Symptoms without fever characterize atypical pneumonia. General lethargy, fatigue, headache, nausea - a person often turns a blind eye to all these signs. In addition, pneumonia can be suspected if breathing becomes heavy, chest pain is felt, and shortness of breath appears. A cough that does not go away for a long time should alert you. All this constitutes the main features. Pneumonia (symptoms are often contradictory) requires full examination to confirm the diagnosis, including x-ray examination and a blood test to determine the level of white blood cells.

Pneumonia in children

How does pneumonia occur in children? The disease has its own characteristics. has the following: lethargy, restlessness, bad dream and appetite. Atypical pneumonia is characterized by the fact that the child constantly wants to sleep, he literally falls asleep on the go. He will not perform his usual actions and does not want to play if he develops pneumonia. Symptoms (without fever) also include increased sweating, pain in different parts of the body. Children during illness become more capricious. If there is a suspicion of ordinary pneumonia, Komarovsky identifies the following symptoms: prolonged cough, high body temperature does not go away after 3-4 days. You can do a little test. If more muscles are involved in breathing, it seems to be difficult, then pneumonia may develop. To make a diagnosis, you should consult a pediatrician. A blood test is required to determine the level of leukocytes.

Treatment

If an appropriate diagnosis is made, therapy should be started immediately. Atypical pneumonia is well treated with antibiotics, which are selected depending on the type of pathogen. On average, the duration of treatment is approximately 10 days. Additionally, the doctor prescribes special cough medications. They help thin mucus. Incorrectly selected medications (if the patient decides to prescribe them himself) will only intensify coughing attacks and make it harsh. If you have a high temperature, you can take antipyretic medications yourself. Drinking plenty of warm fluids is recommended throughout the illness. If the patient's age is less than 60 years and there are no accompanying diseases, then therapy can be carried out at home. Indications for hospitalization are the risk of complications, severe form of the disease, and age over 60 years. In addition to antibacterial therapy, a specialist may prescribe breathing exercises, vitamin preparations, massage and physical therapy.

Actions that should not be performed if you have pneumonia

If all the signs are found (pneumonia symptoms are quite characteristic) of this disease, then it is important to remember what absolutely cannot be done. First of all, you should not take antibiotics on your own. Only with a complete clinical picture and the type of pathogen identified, a specialist will prescribe the necessary medications. You cannot warm up the chest. Baths, saunas and hot baths are strictly prohibited. Cough medicines are also prescribed only by a doctor. If your body temperature does not exceed 37.5 °C, then you should not take antipyretic drugs. You need to give your body the opportunity to fight pneumonia on its own. Excessive physical activity and lack of bed rest will only worsen the course of the disease. Even if hospitalization is not needed, you should not endure the disease on your feet.

Pneumonia in animals


Pneumonia often occurs in animals. It is very important to know that this condition is a direct threat to the pet’s life. the symptoms are similar to those observed in humans. First of all, a cough develops. In addition, the animal loses activity and refuses to eat. What other symptoms of pneumonia can be observed? One of them is high temperature. To confirm the diagnosis, it is carried out fluoroscopic examination. the symptoms are the same. However, often four-legged friends maintain their usual activity and lead a seemingly normal lifestyle. In a stable condition, when the animal is active and has a normal appetite, therapy is carried out at home. If the cat or dog is passive and does not eat well, then until the condition normalizes, treatment occurs in a hospital. Everything is like people. It happens to our smaller friends and requires ventilation. As in the case of humans, treatment of cats and dogs is not complete without the use of antibacterial drugs. Additionally, physiotherapy is indicated to promote sputum separation. If therapy is carried out at home, you should pay attention to weather. Walking in damp, rainy weather is not advisable. It is important to complete the course of antibiotics as recommended by your veterinarian.

Pneumonia is a serious infectious disease. IN normal conditions it can be quite pronounced clinical course, however, certain factors can greatly blur the main manifestations of the disease.

Pneumonia in adults: causes under normal conditions

This disease occurs due to the development of microflora in lung tissue and its gradual defeat. Such a pathological process can be initiated by the entry into the body of a wide variety of infections.

Another factor contributing to the development of pneumonia is a local or general decrease in immunity.

Among the main symptoms of this disease, it is necessary to note, first of all, an increase in body temperature, coughing, the occurrence of shortness of breath with the slightest physical activity, poor general health.

Pneumonia in adults: symptoms, causes, types in unusual conditions

There are two main reasons why clinical manifestations the inflammatory process in the lungs will differ from the classics. Among them, the following should be noted:

  • decreased immunity;
  • uncontrolled use of antibacterial agents.

Both of these reasons can quite significantly change the clinical picture of pneumonia.

Inappropriate use of antibiotics

Today, the uncontrolled use of antimicrobial drugs has become a real problem for society. The fact is that over time, this circumstance gradually leads to the formation of resistance to the antibacterial agent in the infection. Eventually antimicrobial drug simply ceases to have a sufficient effect on pathogenic bacteria.

In addition, self-administration of such drugs can significantly reduce the severity of the main clinical manifestations of the disease. For example, pneumonia occurs in children and adults. Without a temperature reaching high enough levels, few people will immediately become concerned and decide to see a doctor. As a result, the disease will occur in a latent form, and the patient will not receive rational treatment. This will lead to the gradual involvement of more and more areas of lung tissue in the pathological process. As a result, the patient will experience other, more health-threatening clinical manifestations. The main signs of pneumonia in adults without fever are an increase in shortness of breath, the appearance of blood streaks in the sputum released during coughing, as well as chest pain that occurs when the pleura is involved in the pathological process.

Now doctors are trying to limit the self-administration of antibacterial drugs by patients. One of the main ways was to issue such drugs only with a doctor’s prescription.

About decreased immunity

The clinical picture can change greatly not only under the influence of antibacterial agents, but also under conditions of decreased protective properties body. As a result, the typical first signs of pneumonia in adults may not be present. As a result, the patient does not immediately notice a serious problem. Signs of pneumonia in adults without fever in such conditions are expressed in the appearance of a painful blush on the side of the affected lung tissue. This symptom has a particularly high diagnostic value in the case of an isolated lesion of one lung.

Temperature rises in in this case is not observed for the reason that the body’s defenses are depleted. At the same time, hyperthermia is the most important factor defense The fact is that in conditions of elevated temperature it is much more difficult to grow and reproduce. As a result, they are gradually destroyed by white blood cells.

Additional signs

Without fever, adults are quite varied. First of all, we are talking about the appearance of a painful blush. This sign especially clearly visible if the patient has unilateral inflammation lungs without fever. The signs are less noticeable, since the blush will be located on both cheeks.

In addition, a patient with pneumonia, for which no rational treatment is carried out, has a pale complexion. When breathing, there may be a lag in the excursion of that half chest in which the inflammatory process occurs. Naturally, such signs of pneumonia in adults without fever are clearly detected only in cases with unilateral pathology. In this case, the second cheek may be paler than usual.

There are several other signs that pneumonia is developing in children and adults. Without fever, people often experience pain in the chest, which intensifies with every breath. This approach is dangerous because you can miss serious pathology. So if you experience pain in the chest that intensifies during inhalation, it is better to consult a specialist so that he can rule out an inflammatory process in the lung tissue.

When should shortness of breath give you pause?

The symptoms of pneumonia without fever in adults, as you can already see, are quite varied. One of the manifestations of the disease is shortness of breath. Normally, it can occur in any person after certain physical activities. If shortness of breath occurs at rest, one of the reasons may be an inflammatory process occurring in the lung tissue. At the same time, despite the lack of physical activity, without rational antibacterial therapy, shortness of breath gradually increases.

However, this symptom does not always indicate that pneumonia is developing without fever. Signs of the same type occur in cardiac pathology, when the patient gradually develops congestion. A chest x-ray will help identify the exact cause of shortness of breath.

It must also be remembered that young patients should pay special attention to shortness of breath at rest, since in the vast majority of cases they do not have significant cardiac pathology.

What should you do first?

If the typical first signs of pneumonia in adults occur, you should immediately contact a specialist - a general practitioner or a pulmonologist. They will conduct a general examination, including auscultation of the lungs. Based on the results of the primary diagnostic measures the doctor will decide whether it is necessary to carry out X-ray examination chest organs. If the doctor suspects something and sends the patient for such an examination, then under no circumstances should he refuse. After the x-ray, the doctor will be able to accurately establish the diagnosis and prescribe rational treatment.

How dangerous is pneumonia without fever?

This disease, if it occurs without hyperthermia, is very insidious. The fact is that in itself, even with timely rational treatment, pneumonia is very, very dangerous. If, during inflammation of the lung tissue antibacterial therapy is not carried out, then there is a real danger that the disease will lead to the most disastrous consequences. But this is not the only thing that should scare you about pneumonia without fever. This disease is also dangerous because the patient most likely has a weakened immune system, or has recently taken certain antibacterial drugs. In both cases, it is usually necessary to use some of the most modern antimicrobial agents. In a situation with reduced immunity, we are talking about the fact that the body itself does not have the strength to resist infection. In the second situation, stability has already developed in pathogenic microorganisms to one or another type of antibiotic.

How to reduce the risk of pneumonia?

First of all, it is necessary to avoid severe hypothermia. The fact is that with a significant decrease in temperature in a particular area human body The level of local immunity also decreases. As a result, pathogenic microorganisms have an excellent opportunity to multiply unhindered, affecting more and more new areas of lung tissue.

In addition, it is very important to take strictly according to the recommendations of doctors. At the same time, it is necessary to stop using them not when the signs of a particular infectious disease stop making themselves felt, but only after completing a full course of treatment. Otherwise, some pathogenic microorganisms will remain. Moreover, the next time the use of the same antibiotic will have much more modest success, and the drug will have to be changed.

One more important point is immune support. In order for it to be normal, it is necessary to maintain a normal level physical activity, eat properly and in sufficient quantities, devote proper time to sleep and regular rest.

About laboratory tests

They are carried out if there are signs of pneumonia in adults. This disease occurs without fever or with hyperthermia - laboratory research necessary. First of all, we are talking, of course, about general analysis blood. This study allows you to evaluate how pronounced infectious process occurs in the lung tissue. In this case, the doctor is most interested in the number of leukocytes, as well as the erythrocyte sedimentation rate. The fact that the process has an infectious etiology will be indicated by an increase in the level of white blood cells (more than 9 * 10 9 / l). An increased level of erythrocyte sedimentation rate will indicate that inflammation is occurring in the body. Often, the doctor does not prescribe a regular general blood test, but a study with a formula that allows the doctor to determine what type of microorganisms caused the development of the pathology. At elevated level neutrophils, we can talk about bacterial pneumonia, and with an increase in the number of lymphocytes, we can talk about the viral etiology of this disease.

– acute lesion lungs of an infectious-inflammatory nature, which involves all the structural elements of the lung tissue, mainly the alveoli and interstitial tissue of the lungs. The clinical picture of pneumonia is characterized by fever, weakness, sweating, chest pain, shortness of breath, cough with sputum (mucous, purulent, “rusty”). Pneumonia is diagnosed based on auscultation patterns and chest x-ray data. In the acute period, treatment includes antibiotic therapy, detoxification therapy, immunostimulation; taking mucolytics, expectorants, antihistamines; after the cessation of fever - physiotherapy, exercise therapy.

ICD-10

J18 Pneumonia without specifying the pathogen

General information

Pneumonia is an inflammation of the lower respiratory tract of various etiologies, occurring with intra-alveolar exudation and accompanied by characteristic clinical and radiological signs. Acute pneumonia occurs in 10-14 people out of 1000, in the age group over 50 years - in 17 people out of 1000. The relevance of the problem of the incidence of acute pneumonia remains, despite the introduction of new antimicrobials, as well as a high percentage of complications and mortality (up to 9%) from pneumonia remains. Among the causes of mortality among the population, pneumonia is in 4th place after heart and vascular diseases, malignant neoplasms, injuries and poisonings. Pneumonia can develop in weakened patients, joining the course of heart failure, oncological diseases, cerebrovascular accidents, and complicates the outcome of the latter. In patients with AIDS, pneumonia is the main immediate cause of death.

Causes and mechanism of development of pneumonia

Among the causes of pneumonia, bacterial infection ranks first. The most common causes of pneumonia are:

  • gram-positive microorganisms: pneumococci (40 to 60%), staphylococci (2 to 5%), streptococci (2.5%);
  • gram-negative microorganisms: Friedlander's bacillus (from 3 to 8%), Haemophilus influenzae (7%), enterobacteria (6%), Proteus, E. coli, Legionella, etc. (from 1.5 to 4.5%);
  • viral infections (herpes viruses, influenza and parainfluenza, adenoviruses, etc.);

Pneumonia can also develop due to exposure to non-infectious factors: chest injuries, ionizing radiation, toxic substances, allergic agents.

The risk group for the development of pneumonia includes patients with congestive heart failure, chronic bronchitis, chronic nasopharyngeal infection, congenital malformations of the lungs, with severe immunodeficiency conditions, weakened and exhausted patients, patients who have been on bed rest for a long time, as well as elderly and senile people .

People who smoke and drink alcohol are especially susceptible to developing pneumonia. Nicotine and alcohol vapors damage the bronchial mucosa and inhibit the protective factors of the bronchopulmonary system, creating a favorable environment for the introduction and proliferation of infection.

Infectious pathogens of pneumonia penetrate the lungs through bronchogenic, hematogenous or lymphogenous routes. When there is a decrease in the protective bronchopulmonary barrier in the alveoli, infectious inflammation develops, which spreads through the permeable interalveolar septa to other parts of the lung tissue. Exudate forms in the alveoli, preventing the gas exchange of oxygen between the lung tissue and blood vessels. Oxygen and respiratory failure develop, and with complicated pneumonia, heart failure.

There are 4 stages in the development of pneumonia:

  • tide stage (from 12 hours to 3 days) – characterized by a sharp blood supply to the vessels of the lungs and fibrinous exudation in the alveoli;
  • stage of red hepatization (from 1 to 3 days) – compaction of lung tissue occurs, the structure resembling the liver. Red blood cells are found in large quantities in the alveolar exudate;
  • stage of gray hepatization - (from 2 to 6 days) - characterized by the breakdown of erythrocytes and a massive release of leukocytes into the alveoli;
  • resolution stage – the normal structure of the lung tissue is restored.

Classification of pneumonia

1. Based on epidemiological data, pneumonia is distinguished:
  • out-of-hospital (out-of-hospital)
  • intrahospital (hospital)
  • caused by immunodeficiency conditions
2. According to the etiological factor, with specification of the causative agent, pneumonia is:
  • mycoplasma
  • fungal
  • mixed.
3. According to the mechanism of development, pneumonia is distinguished:
  • primary, developing as an independent pathology
  • secondary, developing as a complication of concomitant diseases (for example, congestive pneumonia)
  • aspiration, developing when foreign bodies enter the bronchi (food particles, vomit, etc.)
  • post-traumatic
  • postoperative
  • heart attack-pneumonia, developing as a result of thromboembolism of small vascular branches of the pulmonary artery.
4. According to the degree of interest of the lung tissue, pneumonia occurs:
  • unilateral (with damage to the right or left lung)
  • bilateral
  • total, lobar, segmental, sublobular, basal (central).
5. According to the nature of the course of pneumonia, there can be:
  • spicy
  • acute lingering
  • chronic
6. Considering development functional disorders pneumonia occurs:
  • with the presence of functional disorders (indicating their characteristics and severity)
  • with no functional impairment.
7. Taking into account the development of complications of pneumonia, there are:
  • uncomplicated course
  • complicated course (pleurisy, abscess, bacterial toxic shock, myocarditis, endocarditis, etc.).
8. Based on clinical and morphological characteristics, pneumonia is distinguished:
  • parenchymal (lobar or lobar)
  • focal (bronchopneumonia, lobular pneumonia)
  • interstitial (more often with mycoplasma lesions).
9. Depending on the severity of pneumonia, they are divided into:
  • mild degree - characterized by mild intoxication (clear consciousness, body temperature up to 38°C, normal blood pressure, tachycardia no more than 90 beats per minute), there is no shortness of breath at rest, a small focus of inflammation is determined by x-ray.
  • moderate degree - signs of moderate intoxication (clear consciousness, sweating, severe weakness, body temperature up to 39°C, blood pressure moderately reduced, tachycardia about 100 beats per minute), respiratory rate - up to 30 per minute. at rest, pronounced infiltration is determined radiologically.
  • severe – characterized by severe intoxication (fever 39-40°C, clouding of the blood, adynamia, delirium, tachycardia over 100 beats per minute, collapse), shortness of breath up to 40 beats per minute. at rest, cyanosis, extensive infiltration is determined radiologically, the development of complications of pneumonia.

Symptoms of pneumonia

Lobar pneumonia

Characterized by an acute onset with fever above 39°C, chills, chest pain, shortness of breath, and weakness. The cough is disturbing: at first it is dry, unproductive, then, on the 3-4th day, with “rusty” sputum. Body temperature is constantly high. With lobar pneumonia, fever, cough and sputum production last up to 10 days.

In severe cases of lobar pneumonia, hyperemia of the skin and cyanosis of the nasolabial triangle are determined. Herpetic rashes are visible on the lips, cheeks, chin, and wings of the nose. The patient's condition is serious. Breathing is shallow, rapid, with flaring of the wings of the nose. On auscultation, crepitus and moist fine bubbling rales are heard. The pulse is frequent, often arrhythmic, blood pressure is reduced, heart sounds are muffled.

Focal pneumonia

It is characterized by a gradual, subtle onset, most often after acute respiratory viral infection or acute tracheobronchitis. The body temperature is febrile (38-38.5°C) with daily fluctuations, the cough is accompanied by the discharge of mucopurulent sputum, sweating, weakness are noted, when breathing - pain in the chest when inhaling and when coughing, acrocyanosis. With focal confluent pneumonia, the patient's condition worsens: severe shortness of breath and cyanosis appear.

On auscultation, hard breathing is heard, exhalation is prolonged, dry small- and medium-bubble rales, crepitus over the source of inflammation.

Features of the course of pneumonia are determined by the severity, properties of the pathogen and the presence of complications.

Complications of pneumonia

The course of pneumonia is considered complicated, accompanied by the development in the bronchopulmonary system and other organs of inflammatory and reactive processes caused directly by pneumonia. The course and outcome of pneumonia largely depend on the presence of complications. Complications of pneumonia can be pulmonary or extrapulmonary.

Pulmonary complications of pneumonia can be obstructive syndrome, abscess, lung gangrene, acute respiratory failure, parapneumonic exudative pleurisy.

Among the extrapulmonary complications of pneumonia, acute cardiopulmonary failure, endocarditis, myocarditis, meningitis and meningoencephalitis, glomerulonephritis, infectious-toxic shock, anemia, psychosis, etc. often develop.

Diagnosis of pneumonia

When diagnosing pneumonia, several problems are solved at once: differential diagnosis inflammation with other pulmonary processes, determining the etiology and severity (complications) of pneumonia. Pneumonia in a patient should be suspected based on symptomatic signs: rapid development of fever and intoxication, cough.

Physical examination reveals compaction of the lung tissue (based on percussion dullness of pulmonary sound and increased bronchophony), a characteristic auscultatory pattern - focal, moist, fine-bubbly, sonorous rales or crepitus. Echocardiography and ultrasound of the pleural cavity sometimes detect pleural effusion.

As a rule, the diagnosis of pneumonia is confirmed after a chest x-ray. With any type of pneumonia, the process most often affects the lower lobes of the lung. X-rays of pneumonia may reveal the following changes:

  • parenchymal (focal or diffuse darkening of various localization and extent);
  • interstitial (the pulmonary pattern is enhanced due to perivascular and peribronchial infiltration).

X-rays for pneumonia are usually taken at the onset of the disease and after 3-4 weeks to monitor the resolution of inflammation and exclude other pathologies (usually bronchogenic lung cancer). Changes in the general blood test for pneumonia are characterized by leukocytosis from 15 to 30 109/l, band shift leukocyte formula from 6 to 30%, increase in ESR up to 30-50 mm/h. A general urinalysis may reveal proteinuria and, less commonly, microhematuria. Sputum analysis for pneumonia allows you to identify the pathogen and determine its sensitivity to antibiotics.

Treatment of pneumonia

Patients with pneumonia are usually hospitalized in the general medical department or the pulmonology department. For the period of fever and intoxication it is prescribed bed rest, plenty of warm drinks, high-calorie, vitamin-rich food. For severe symptoms of respiratory failure, patients with pneumonia are prescribed oxygen inhalation.

Antibacterial therapy is the mainstay in the treatment of pneumonia. Antibiotics should be prescribed as early as possible, without waiting for the pathogen to be identified. The choice of antibiotic is carried out by a doctor; no self-medication is acceptable! For community-acquired pneumonia, penicillins (amoxicillin with clavulanic acid, ampicillin, etc.), macrolides (spiramycin, roxithromycin), cephalosporins (cefazolin, etc.) are more often prescribed. The choice of method of antibiotic administration is determined by the severity of the pneumonia. For the treatment of nosocomial pneumonia, penicillins, cephalosporins, fluoroquinolones (ciprofloxacin, ofloxacin, etc.), carbapenems (imipenem), aminoglycosides (gentamicin) are used. If the pathogen is unknown, a combination antibiotic therapy of 2-3 drugs is prescribed. The course of treatment can last from 7-10 to 14 days, it is possible to change the antibiotic.

For pneumonia, detoxification therapy, immunostimulation, and the prescription of antipyretics, expectorants, mucolytics, and antihistamines are indicated. After the cessation of fever and intoxication, the regimen is expanded and physiotherapy is prescribed (electrophoresis with calcium chloride, potassium iodide, hyaluronidase, UHF, massage, inhalations) and exercise therapy to stimulate resolution of the inflammatory focus.

Treatment of pneumonia is carried out until the patient’s complete recovery, which is determined by the normalization of condition and well-being, physical, radiological and laboratory parameters. With frequent repeated pneumonia the same localization, the issue of surgical intervention.

Prognosis for pneumonia

In pneumonia, the prognosis is determined by a number of factors: the virulence of the pathogen, the age of the patient, underlying diseases, immune reactivity, adequacy of treatment. Complicated variants of the course of pneumonia, immunodeficiency states, and resistance of pathogens to antibiotic therapy are unfavorable in terms of prognosis. Pneumonia in children under 1 year of age caused by staphylococcus, Pseudomonas aeruginosa, and Klebsiella is especially dangerous: the mortality rate for them ranges from 10 to 30%.

With timely and adequate treatment measures, pneumonia ends in recovery. Depending on the types of changes in the lung tissue, the following outcomes of pneumonia can be observed:

  • complete restoration of the lung tissue structure - 70%;
  • formation of an area of ​​local pneumosclerosis - 20%;
  • formation of a site of local carnification – 7%;
  • reduction of a segment or share in size – 2%;
  • shrinkage of a segment or lobe – 1%.

Prevention of pneumonia

Measures to prevent the development of pneumonia include hardening the body, maintaining immunity, eliminating the factor of hypothermia, sanitizing chronic infectious foci of the nasopharynx, combating dust, stopping smoking and alcohol abuse. In weakened bedridden patients, in order to prevent pneumonia, it is advisable to perform respiratory and therapeutic exercises, massage, prescription of antiplatelet agents (pentoxifylline, heparin).

more

Pneumonia in most cases refers to infectious diseases and is caused by various pathogens (pneumococci, staphylococci, streptococci, mycoplasma, legionella, chlamydia, anaerobic microorganisms, klebsiella, E. coli, viruses, etc.). The characteristic symptoms of the disease make it possible to successfully diagnose and treat this disease. Although in last decades Thanks to the success of antibacterial therapy, mortality from pneumonia has decreased significantly.

The high prevalence of the disease, the severity of development and severity of symptoms in the initial period of the disease, the possibility serious complications make pneumonia a frequent reason for seeking emergency care. There are lobar (lobar) and focal (bronchopneumonia) inflammations. Every person who values ​​owl health should know how to determine pneumonia.

Symptoms and signs of different forms of pneumonia

Symptoms of lobar pneumonia

The clinical picture of lobar pneumonia is characterized by an acute onset with sharp increase temperatures up to 39-40 °C, combined with chills and sweating.

At the same time, the symptoms of pneumonia are accompanied by headache, significant weakness, and lethargy.

With severe hyperthermia and intoxication, cerebral symptoms may be observed - severe headache, vomiting, stupor of the patient or confusion, and even meningeal symptoms.

Very early, pain occurs in the chest on the side of inflammation. Often with pneumonia, the pleural reaction is so severe that chest pain is the main complaint and requires treatment. emergency care.

Distinctive feature pleural pain in pneumonia - its connection with breathing and coughing: a sharp increase in inhalation and coughing. In the first days, a cough may appear with the release of sputum rusty from the admixture of red blood cells, and sometimes mild hemoptysis.

During examination, one often notices the forced position of the patient: more often he lies on the side of inflammation. The face is usually hyperemic, sometimes a feverish blush is more pronounced on the cheek, corresponding to the side of the lesion. A characteristic symptom of pneumonia is shortness of breath up to 30-40 breaths per minute, combined with cyanosis of the lips and swelling of the wings of the nose. Often in the early period of the disease, blistering rashes on the lips (herpes labialis) appear. Examination of the chest usually reveals a delay in breathing on the affected side. Due to severe pleural pain, the patient seems to spare the side of inflammation. Over the zone of inflammation, upon percussion of the lungs, a shortening of the percussion sound is determined, breathing acquires a bronchial hue, and fine-bubbly moist crepitating rales appear early. Characterized by tachycardia up to 100 beats per minute and a slight decrease in blood pressure. A pronounced pleural reaction is sometimes combined with reflex pain in the corresponding half of the abdomen, pain on palpation in its upper parts. Icterus of the skin and mucous membranes may appear due to the destruction of red blood cells in the affected lobe of the lung and, possibly, the formation of focal necrosis in the liver.

How to determine focal pneumonia?

At focal pneumonia, often occurring in patients with chronic inflammation of the upper respiratory tract and bronchi or with heart failure and other serious diseases, the symptoms are usually less pronounced: fever up to 38-38.5 ° C, dry cough or with mucopurulent sputum, There may be pain when coughing and deep breathing, symptoms of inflammation of the lung tissue are objectively revealed, expressed to varying degrees depending on the extent and location (deep or superficial) of the inflammation, most often the focus of crepitant rales is revealed.

How to identify symptoms of pneumonia in older people?

The prognosis is especially unfavorable when acute vascular insufficiency is combined with increasing cardiac weakness, leading to pulmonary edema. In the origin of pulmonary edema during pneumonia, in addition to heart failure, toxic damage to the pulmonary capillaries with increased vascular permeability is important.

The threat of developing pulmonary edema is indicated by the appearance of dry and especially moist rales over healthy lungs against the background of increased shortness of breath and deterioration of the patient’s condition.

The development of pneumonia in elderly people with concomitant diseases of the cardiovascular system, pulmonary emphysema, pneumosclerosis often requires emergency care, but recognition of pneumonia in the early stages of the disease in these patients is often difficult due to the lack of acute onset, a mild pleural reaction with chest pain when breathing, a slight increase in temperature.

The thought of pneumonia in the elderly and weakened patients should arise in cases where, without visible reasons The patient’s activity decreases significantly, weakness increases, he stops moving, lies down all the time, becomes indifferent, often drowsy, and refuses to eat.

A careful examination sometimes reveals a one-sided flush of the cheek, a dry tongue, and always significant shortness of breath and tachycardia.

Auscultation of the lungs usually reveals a focus of sonorous moist rales.

Manifestations of pneumonia in people with alcohol dependence

The acute form of pneumonia is very dangerous in patients suffering from chronic alcoholism and generally abusing alcohol. Usually their pneumonia is severe, with severe intoxication and is often complicated by the development alcoholic psychosis- “delirium tremens”. Psychosis is accompanied by visual and auditory hallucinations, mental and motor agitation, abnormal behavior, disorientation in time and space. Often patients try to escape and even throw themselves out of the window and do not allow themselves to be examined or given injections. Meanwhile, very often pneumonia in patients in a state of “delirium tremens” is complicated by the development of severe shock.

Signs and symptoms of complications of pneumonia

Signs of pneumonia, life-threatening both in the case of lobar and focal forms, may be due to the development of complications - septic shock, pulmonary edema, psychosis. Typically, shock and pulmonary edema are observed when pneumonia develops in elderly, weakened patients with severe concomitant cardiac pathology and often circulatory failure. A harbinger of shock due to pneumonia should be considered the appearance of persistent tachycardia, especially over 120 beats per minute with low pulse filling. The development of shock is accompanied by a significant deterioration in the condition, the appearance of severe weakness, and sometimes a decrease in temperature. The skin takes on a gray tint, facial features become sharper, cyanosis increases, shortness of breath increases significantly, the pulse becomes frequent and small, blood pressure drops below 90/60 mmHg. Art., urination stops.

How to identify pulmonary complications of pneumonia?

Pulmonary complications of pneumonia (exudative pleurisy, abscess formation and especially breakthrough of the abscess in pleural cavity with the development of pyopneumothorax) also require emergency care for the patient. Exudative pleurisy is manifested by a lag in the lower part of the chest on the affected side when breathing, severe dullness and weakening of breathing on the affected side. You should think about abscess formation when intoxication increases, profuse night sweats appear, and the temperature becomes hectic in nature with daily variations of up to 2 °C or more.

A breakthrough of an abscess into the bronchus during pneumonia and the discharge of a large amount of purulent, foul-smelling sputum make the diagnosis of a lung abscess obvious. A sharp deterioration in the condition, increased pain in the side when breathing, a significant, rapid increase in shortness of breath, tachycardia, falling blood pressure may indicate a breakthrough of the abscess into the pleural cavity and the complication of pneumonia by the development of pyopneumothorax. The condition of patients with pyopneumothorax is always severe. Usually, due to pain, they are forced to take a semi-sitting position. Breathing, coughing and movement sharply increase the pain. Shortness of breath is characteristic (over 40 per 1 min). Breathing over the sore side is weakened. Percussion reveals a box sound over the upper and dullness over the lower parts of the lung. Pulse is frequent and small. BP is low. Such a menacing picture of pleural shock requires emergency assistance.

Diagnostic symptoms and signs of pneumonia

Pneumonia is usually successfully recognized based on the characteristic clinical picture disease - a combination of pulmonary, extrapulmonary manifestations and x-ray patterns. Symptoms of pneumonia that allow you to make a diagnosis of prehospital stage:

Pulmonary symptoms– shortness of breath, cough, sputum production (mucous, mucopurulent, etc.), pain when breathing, local Clinical signs(dullness of percussion sound, bronchial breathing, crepitating rales, pleural friction noise).

Extrapulmonary symptoms of pneumonia - fever, chills and sweating, myalgia, headache, cyanosis, tachycardia, herpes labialis, skin rash, damage to the mucous membranes (conjunctivitis), confusion, diarrhea, jaundice, toxic changes in peripheral blood.

Some features of the pneumonia clinic allow etiological diagnosis pneumonia until the results of a microbiological study are received. The most common causative agents of “domestic” pneumonia in people under 60 years of age without severe concomitant pathology are pneumococci; in the appropriate epidemiological situation, mycoplasmas and viruses (Table 7). Elderly patients, with severe somatic diseases and chronic alcoholism are especially susceptible to pneumonia caused by gram-negative microorganisms (Klebsiella, coli, Proteus, Enterobacter), with frequent development of destruction of lung tissue and the formation of lung abscesses.

Diagnostic signs of pneumonia in old age

In elderly patients suffering from severe somatic diseases or severe immunodeficiency, pneumonia can occur atypically. Such patients often have no fever, extrapulmonary symptoms predominate (disorders of the central nervous system, etc.), physical signs of pulmonary inflammation are mild or absent, and identification of the causative agent of pneumonia is difficult.

The most important method to confirm the diagnosis of pneumonia and clarify the localization of the source of inflammation is an X-ray examination of the chest organs. X-ray signs pneumonia appears later than clinical pneumonia, which, along with the characteristics of the pathogen and the localization of the process, causes cases of “X-ray negative” pneumonia.

Differential symptoms of pneumonia

The spread of pain to the upper abdomen, their combination with pain on palpation, especially in the right upper quadrant of the abdomen, and increased pain when tapping along the right costal arch often complicate the diagnosis of pneumonia. All these symptoms of pneumonia are caused by the involvement of the pleura in the inflammatory process and irritation of the endings of the right phrenic and lower intercostal nerves embedded in it, which are also involved in the innervation upper sections anterior abdominal wall and organs abdominal cavity. This explains the frequent occurrence various symptoms from the abdomen (abdominal) in acute diseases of the chest organs.

Severity of abdominal pain combined with other gastrointestinal disorders, often causes misdiagnosis acute diseases abdominal organs in patients with lobar pneumonia, as well as pleurisy, pericarditis, myocardial infarction. Often these patients are referred to surgical departments with a diagnosis acute cholecystitis, appendicitis, perforated ulcer stomach; There are known cases when they were subjected to surgical intervention. In such cases, the diagnosis of pneumonia is helped by the absence of tension in most patients abdominal muscles and symptoms of peritoneal irritation, although this sign is not absolute.

Treatment of incipient pneumonia

Emergency care for pneumonia

The scope of emergency care for pneumonia depends, naturally, on the prevailing symptoms. In the presence of severe respiratory failure, oxygen therapy is indicated, in case of persistent debilitating cough - antitussive drugs, in case of pleural pain - non-narcotic analgesics, in case of severe intoxication - detoxification therapy, in case of infectious-toxic shock - anti-shock therapy.

Development mental disorders in alcoholics, pneumonia requires the use of psychotropic drugs: Seduxen (10 mg intravenously or intramuscularly, the drug is contraindicated in chronic obstructive pulmonary diseases), Haloperidol (1-2 ml of 0.5% solution), Aminazine (2 ml of 2.5% solution). Should be considered hypotensive effect Aminazine, therefore its use in arterial hypotension is contraindicated. In addition, the use of psychotropic drugs is contraindicated in patients with acute alcohol intoxication.

Hospitalization for pneumonia

Establishing a diagnosis of pneumonia entails the need to hospitalize the patient in the therapeutic department of the hospital, because only in a hospital setting can it be completed clinical examination and carry out fairly intensive therapy. Treatment of pneumonia at home is justified only in cases of its mild, uncomplicated course, in the absence of any doubt about the diagnosis.

For pneumonia complicated by cardiac and vascular insufficiency, the development of an abscess or pyopneumothorax, requires immediate hospitalization of the patient. Patients with abnormal behavior, mental and motor agitation should be under the constant supervision of medical personnel.

Inpatient treatment for pneumonia

In a hospital setting, empirical antibacterial therapy is carried out until the sensitivity of the pathogen to antibiotics is established. In severe cases of pneumonia with pronounced physical signs of pulmonary inflammation, pneumonia is regarded as pneumococcal and penicillin is used intramuscularly or intravenously from 6 to 30 million units per day. In patients with chronic nonspecific lung diseases, Ampicillin is preferable in a daily dose of 4-8 g. In patients with chronic alcoholism and severe somatic diseases, as well as in elderly patients, therapy begins with 2nd generation cephalosporins or with a combination of Ampicillin with betalactamase inhibitors. For bilobar (bilobar) pneumonia, severe cases with severe symptoms of intoxication and an unknown pathogen, a combination of antibiotics is used (semi-synthetic Penicillins or Cephalosporins with Aminoglycoside - Gentamicin or Netromycin), Fluoroquinolones, Carbapenems are used.

Along with pneumonia, inflammatory processes are observed, the characteristic feature of which is focal infectious destruction of all elements of the lung tissue - either limited (single or multiple abscesses) or without clear boundaries (pulmonary gangrene).

Many types of pneumonia, as well as abscess and gangrene of the lungs, develop as a result of microaspiration of microflora from the oropharynx - aspiration pneumonia. The term was introduced to refer to a disease associated with aspiration into the lungs of not only the contents of the oropharynx, but also the contents of the stomach by patients who are unconscious at the time of vomiting. The primary reaction of the lungs to aspiration is not of an infectious nature, but is an inflammatory process in the bronchi in response to the irritating effect of hydrochloric acid in gastric juice. This reaction creates favorable conditions for the subsequent development of infection, aspirated along with the contents of the oropharynx and stomach. Mucus from the oropharynx and gastric juice contain only a small amount of microflora, which is normally represented wide range anaerobic and aerobic bacteria. Anaerobes, the number of which significantly exceeds the number of aerobes (10:1 ratio), interact with each other as a mixed infection that can induce not only inflammation of the lung parenchyma, but also necrosis of the lung tissue with subsequent abscess formation.

Complications after treatment for pneumonia

Causes of destruction of lung tissue after inflammation

Typically, the causative agents of infectious destruction of lung tissue are necrotizing infections:

pyogenic bacteria (Staphylococcus aureus, Klebsiella, group A streptococci, bacteroides, fusobacteria, anaerobic streptococci, etc.);

mycobacteria (tuberculosis, etc.);

fungi (aspergillus, Histoplasma, Coccidioides);

Causes of abscess and gangrene after pneumonia

Abscess and gangrene of the lung are characterized by such signs of pneumonia as necrosis of lung tissue, occurring in the central part of the inflammatory infiltrate, almost identical to the infiltrate observed in pneumonia, infarction pneumonia or aspiration pneumonia. Dead tissue undergoes purulent melting with subsequent formation purulent cavities.

Several factors contribute to the development of necrosis:

violation of bronchial obstruction (narrowing of the lumen of small bronchi due to swelling of the mucous membrane);

thrombosis small vessels with subsequent disruption of microcirculation;

necrotizing mixed anaerobic and aerobic infection.

Necrotic lung tissue favors the rapid development of pathogenic microflora, the progression of purulent or putrefactive process, melting of lung tissue with the formation of purulent cavities.

Abscess and gangrene have common origin and the uniformity of the initial phase of development of the disease, identical to that of post-pneumonia. Some authors do not agree with this and tend to consider abscess and gangrene as qualitatively different pathological processes.

Pneumonia is a viral, bacterial infection of the lower respiratory tract of various origins. The main provoking factor is infection of the lungs involving the entire structure.

Symptoms of pneumonia

Not always, but usually the disease begins with an increase in body temperature. For the first two or three days it remains at 37–37.3°. Subsequently, as the colony of bacteria grows, the patient’s well-being worsens, and signs of intoxication appear. The temperature rises to 38.5–39°.

Inflammation is manifested by the following conditions:

  • Chills.
  • Lethargy.
  • Loss of appetite.
  • Fever.
  • Headache.
  • Drowsiness.

In adults, symptoms of pneumonia appear by the end of the third day from the onset of infection.

Typical for early stage A sign of pneumonia is a painful, non-productive cough that gets worse at night. The development of shortness of breath cannot be ruled out. The discharge of mucous sputum with purulent inclusions begins after 5–7 days. The condition requires consultation with the attending physician, since it may indicate the presence of a focus of infection not only in the lung, but also in the bronchi.

The clinical manifestation of the disease is pain behind the sternum, which develops with a deep breath. The symptom indicates inflammation of the pleura.

Pallor skin is characteristic feature pathology and allows you to identify pneumonia before the development of a typical picture. There is also a change in the shade of the mucous membranes. On severe course inflammation is indicated by the appearance of blue areas.

The headache increases gradually, intensifying with sudden body movements. Its maximum is observed on the third or fourth day from the onset of the disease and gradually subsides towards the end of the seventh day.

Confusion is extremely rare - no more than 4% of all cases - and is a sign of a critical level of intoxication. The patient needs urgent hospitalization or transfer to the intensive care unit.

Bilateral inflammation is a serious condition that, if left untreated, can result in death. Treatment is carried out exclusively in a hospital setting.

A characteristic symptom is blue discoloration of the lips, hands and feet, indicating a disruption of the gas exchange process, a slowdown in blood flow in the tissues of the pulmonary system. Heat- unlike the right- or left-sided form - is noted already on the first day.

Typical signs of inflammation when both lungs are involved are as follows:

  • Severe shortness of breath.
  • Painful cough.
  • Pain behind the sternum.
  • Shallow breathing.

A person in this condition requires urgent hospitalization.

If the patient has these symptoms without fever, then this is a bad prognostic sign: the immune system cannot independently resist infection.

Varieties

There are 11 forms of pneumonia:

  • Typical. Characterized by a clear localization of the process. The cause is Escherichia coli. It occurs more often in adulthood.
  • Mycoplasma. Diagnosed in most cases in children 1–15 years old.
  • Chlamydial. The disease is typical for children.
  • Legionnaires' disease.
  • Fungal.
  • Viral. Develops against the background of influenza.
  • Stagnant. Caused by impaired mucus discharge. Often formed when chronic inflammation bronchi (bronchitis).
  • Aspiration. Caused by the penetration of microorganisms into the tissues of the lungs.
  • One- and two-sided.
  • Focal. Accompanied by the formation of a clear area of ​​tissue integrity violation.
  • Croupous. Is a complication pneumococcal infection.

Methods of infection, transmitted or not

Pneumonia is contagious to others; the main mode of transmission of infection is airborne droplets.

When a patient sneezes, a lot of bacteria are released into the air along with the saliva of the patient. If the person who inhaled this “cocktail” has good immunity, then infection will not occur. Otherwise, infection is inevitable.

The contagiousness of pneumonia has been proven, but the source of the disease cannot be:

  • Sexual contact (however, transmitted through a kiss).
  • Water.
  • Food and food products.
  • Handshake.

Rare cases of infection with pneumonia include the following conditions:

  • Lympho- or hematogenous route. The disease is formed as a result of the spread of microorganisms through tissues. Characteristic of sepsis.
  • Aspiration. This type of condition is caused by blockage of the bronchi. The lack of ventilation in a certain area creates conditions for the development of opportunistic microflora.
  • Congestive pneumonia. It is caused by the patient being in a horizontal position for a long time, which worsens the drainage function. The accumulated secretion becomes a favorable environment for the proliferation of bacteria.

Accurate diagnosis

Detection of pneumonia requires tests and instrumental tests.

Laboratory tests include:

  • UAC. Inflammation is indicated by an increase in white blood cell levels.
  • General urine analysis.
  • Study of the composition of bronchial sputum. Using a sterile stick, biomaterial is collected from the upper respiratory tract. Then it is placed in nutrient media to identify the type of pathogen. Bacterial culture helps determine its sensitivity to antibiotics and prescribe medication for treatment.

Instrumental methods:

  • Radiography. It is used to determine the location of the source of inflammation, the extent of the process, and the presence of associated complications. Shows darkened areas, disruption of the pulmonary pattern, and the presence of connective tissue.
  • Tomography. Allows you to identify tumors or deformed areas.
  • Ultrasound examination. Used to diagnose fluid (exudate) inside lung tissue.
  • Bronchoscopy.
  • Fluorography. An alternative to radiology.

To confirm the diagnosis, the patient is prescribed several studies.

Treatment in adults

Therapy for pneumonia involves A complex approach. In addition to taking medications, the patient is prescribed physiotherapy and diet.

Surgical treatment of the disease is rarely performed - only when pus accumulates.

Proper care

Properly organized care for a patient with the development of pneumonia accelerates the recovery process and improves the person’s condition. Follow the following recommendations:

  • Strict bed rest.
  • To reduce shortness of breath, take a semi-sitting position, changing the position several times a day.
  • Regular ventilation of the room, wet cleaning with disinfectants.
  • Use separate towel, cup, spoon and plate.
  • When coughing up sputum, spit into a special container with a disinfectant solution at the bottom.
  • Monitoring pulse, temperature and blood pressure.

Treatment

Several groups of drugs are prescribed to treat the disease:

  • Antibacterial drugs. The choice of remedy and dosage regimen are individual, depending on the type of pathogen.
  • Expectorants. Used in development productive cough when the sputum is too viscous and its discharge is difficult.
  • Detoxifiers. Prescribed for appointments with severe forms of pathology.
  • Glucocorticosteroids. Indicated for patients with the development of infectious-toxic shock.
  • Antipyretic. Used to normalize body temperature.
  • Cardiovascular. Used for severe shortness of breath and severe hypoxia.

After eliminating the symptoms of inflammation (during the recovery period), the person is prescribed treatment with immunomodulatory drugs, and it is also recommended to take multivitamin complexes. This helps the body recover from illness and strengthen the immune defense.

Physiotherapy

To improve well-being, the patient is prescribed the following physical procedures:

  • Oxygen therapy. A man breathes air from increased content oxygen. Useful for severe respiratory failure and extensive tissue damage.
  • Artificial ventilation. It is carried out in severe forms of the inflammatory process.
  • Inhalations with medications.

Folk remedies

Treatment of pneumonia at home is possible only with a mild course of the disease. To support the body, it is recommended to use the following recipes:

  • Mix honey (750 ml) and birch buds (100 grams). Warm in a water bath for 10 minutes. Filter the resulting product and drink 1 tsp. three times a day half an hour before meals.
  • Place medical tar (0.5 ml) in a 3-liter jar. Fill it up warm water to the top rim. Seal the container with a lid and leave in a dark place for 9 days. Drink the resulting composition 1 tbsp. l. three times a day before meals and gargle with it in the morning and evening. It is allowed to drink it with clean water, since the medicine has an unpleasant aftertaste.
  • Treat the area of ​​inflammation with honey. Soak gauze in strong alcohol and apply as a compress. Warm and leave overnight. If complications occur (purulent contents appear), the prescription cannot be used.

To relieve cough and sputum discharge, mustard plasters can be applied, taking into account existing contraindications.

Diet

Cure pneumonia without following the principles dietary nutrition impossible. Food fasting allows the body to redistribute its strength and quickly cope with the infection.

Allows the following products to be included in the patient’s menu:

  • Fish low-fat varieties– it can be boiled and baked.
  • Chicken bouillon.
  • Vegetables and light soups based on them - carrots, beets, cabbage, potatoes, greens.
  • Fresh fruits - grapes, watermelon, citrus fruits, pears.
  • Dried apricots and prunes.
  • Berry juices, fruit drinks, jelly.
  • Puddings, casseroles.
  • Lean meat - steamed or oven-cooked in foil.
  • Rosehip decoction.
  • Herbal teas.

The patient's diet should include milk and products based on it: kefir, cottage cheese, cream, yogurt. Meals are fractional and portions are small.

During the recovery period, the list can be expanded by offering the patient high-calorie dishes and products. At the same time, they carefully monitor the body’s reaction: weakened by the disease digestive system may refuse to take foods that are difficult to digest. Therefore, if attacks of nausea and vomiting develop, it is better to return to the diet recommended for the acute period of pneumonia.

After complete recovery, you need to return to your usual menu gradually to eliminate problems with the gastrointestinal tract.

Prevention

Timely vaccination will help prevent the disease. Vaccination against influenza, pneumococcal infection and Pseudomonas aeruginosa will help protect against pneumonia. It is recommended to immunize from the beginning of October to the end of November, since it is during this period that outbreaks of ARVI and influenza are recorded.

To avoid the development of pneumonia, you need to treat it in time colds strictly observing everything medical recommendations. Otherwise, the body’s susceptibility to viruses and bacteria that can provoke the development of pneumonia increases significantly.

Doctor's report

Pneumonia is a disease that does not pose a threat to human life if you seek medical help in a timely manner. This is why it is so important to consult a doctor if characteristic symptoms develop.