Acute pneumonia

Acute pneumonia - one of the most common diseases. They occur more often in men than in women, increased in periods, characterized by sharp fluctuations of meteorological factors in times of epidemic outbreaks of infectious diseases (influenza).
There are several classifications of acute pneumonia. American authors adhere etiological classification. So, for example, Reimann (N. A. Reimann) has more than 50 forms of varying etiology of pneumonia; Bulova (J. G. Bullowa) distinguishes P. bacterial, viral and P. caused by chemical and mechanical effects. The term bacterial P. enjoys Spencer (N. Spenser), and other
Soviet clinicians adhere to the classification, based not only on etiological, but also on clinical-anatomical and pathogenetic features. So, memorial plaques Tushino distinguish acute (primary) P. - bacterial and viral. I. A. Cashiers allocates pneumonia infectious diseases (influenza, measles and other), kollagenozy and non-specific chemical (petrol, smoke and other), mechanical, systems and blastnya.
The Congress of physicians in 1962, adopted the following classification of acute P. (table. 1).

Table 1. Classification of acute pneumonia
Etiology For clinical and morphological features With the flow
Viral and Ku-ricketsiosis
Due to the chemical and physical stimulation
a) lobar
b) focal

The etiology and pathogenesis
Etiological significance of infection in acute pneumonia is well recognized. When sputum examination of such patients or histological examination of the lung tissue (sectional material), as a rule, find microflora. When lobar P. approximately 95% of cases (I.e., Etinger, M. C. Burgdorf, M. C. Vovsi and others) were found diplococci Frenkel; much less to Diplomatie Friedlander, Pfeifer, Streptococcus, Staphylococcus, and other With lobar pneumonia often identified pneumococcus I, II and III types. With focal P. (pneumonia) often find Association of microbes, which may include haemolytic and non-haemolytic Streptococcus, wand of Pfeifer, and Golden Staphylococcus and others; from the types of pneumococcus was allocated mainly IV type.
Existed for a long time about the dominant role of pneumococcus in the emergence of lobar P. at the present time must be left. The use of significant quantities of antibiotics, sulfa drugs and other medicinal substances could not affect the condition of the General reactivity of the organism and the nature of bacterial flora, causing various diseases. So, in the sputum of patients with acute pneumonia some foreign authors found pneumococci 3.1-26,3% . G. Century Vyhodcev in the sputum of patients with lobar P. discovered pneumococci in only 10%. At the same time significantly increased share of Staphylococcus, Streptococcus and other
In the result of the progress made in the field of Virology, it is established that in a relatively large percentage of cases, the emergence of severe P. due to one or another virus. It is now known 96 types of viruses, which are associated with diseases of the respiratory system (O. Century, Baroyan). The observations carried out mainly in institutions for children of early age and in the clinic of the Institute of Virology them. D. I. Ivanovsky AMS of the USSR, found that pneumonia is revealed not less than 25% of patients adenovirus infections. The viral etiology of flu P. confirmed by special virological studies: in some cases it is possible to detect a virus or another strain, others mix it with bacterial flora. Among diseases, often accompanied P. viral etiology, attracting the attention of influenza, adenovirus disease and ornitz; the latter are sick birds, especially pigeons, ducks, parrots and other Pathogens with bird droppings fall into the environment and airborne droplets come in the nasopharynx of a person causing the disease.
In the study of the etiology of acute pneumonia should stay as the role of chemical and physical factors (the action of strong acids, alkalis, radiation damage, and so on), and some pathological processes, in particular rheumatism (3. Century Gorbunova, B. C. Ilyinsky). In connection with long-term (often wrong) antibiotics sometimes there fungal, or mycotic, P.
Finally, the experience of the great Patriotic war of 1941 -1945, showed that a significant role in causing pneumonia play injury (wounding, contusion, burns); essential combinations damage with secondary infection from microbes from the throat or upper respiratory tract which is often conditionally pathogenic (aureus, E. coli and other).
Acute P. can result from exposure to various hazards; very often there is a combination of both. It is known that bacteria and viruses are commonly found on the mucous membrane of the oral cavity, upper respiratory tract, lung tissue, causing lung disease. Required, therefore, some predispose to the disease factors that would influence the reactivity, lowered resistance, resistance of organism. These factors include some meteorological effects on the body, primarily cooling in combination with high humidity, intoxications and injuries, breach of normal conditions of work and life, a previous lung diseases, bad habits (Smoking, alcohol abuse), the change of immunobiological properties of the organism, violations "cleansing" function of bronchi (N. N. Anichkov), etc.

Clinical and morphological observations show that the pneumococcus of the same type can cause the development and lobar, and focal pneumonia. On the other hand, the presence of bacterial flora and even pneumococcus in the upper respiratory tract is not always accompanied P. On the nature of local and General reactions significantly affect immunobiological characteristics of the microorganism, its reactivity, state of Central nervous system function. Still S. P. Botkin indicated that the nervous breakdown are one of the factors contributing to the development of pneumonia. I. P. Pavlov emphasized the role of external factors that modify the reactivity of the nervous system in the development of various diseases. The works of A. D. Speranskii and his al. the role of disorders of Central nervous system function in Genesis of pneumonia. Very interesting in the sense clarify the pathogenesis of P. are observations A. C. Thin, which received in experiment in ligation stray nerves, when the electrification of them at atropinopodobnykh animals and at crushing tweezers ganglion nodosum II. (leaked by type of inflammatory edema lung tissue or focal P. with edema), which led within 5 days of animals to death. Transection stray nerves after removal of the pituitary gland in most cases did not cause the development of P. P. Emergence in traumatisation stray nerves in this regard explain the influence on light reflex increased production of vasopressin. This amyotrophy hormone, according to A. C. Thin, leads to vasoconstriction of the big circle and expansion of the arteries and capillaries of the lungs difficulty outflow from the small circle in connection with the narrowing of the pulmonary veins and the increase in pressure. These data do not reveal completely pathogenesis of pneumonia, but they reveal a certain role in the Central nervous system. Apparently, the relationship between macro - and micro-organism can be substantially altered when the dysfunction of the Central nervous system in the result of suppression or modification of the neurovascular, phagocytic, immunological reactions. Only this mechanism can explain observed in P. violations "cleansing functions of the bronchi. It is known that in physiological conditions powerful factor preventing people from P., are friendly functioning adaptive mechanisms as preventing the entry Airways and lungs foreign particles and microbes, and leading to the purification of the respiratory system from penetrating the foreign material. These mechanisms include the closure of the epiglottis and the glottis, cough, reduction of bronchial muscles, atrial movement of respiratory epithelium, the secretion of mucus, etc. centuries Voino-Yasenetsky in the experiment showed the possibility of violation of the "cleansing" function of bronchi under the influence of harmful factors and, in particular, cooling.