Lobar pneumonia, ICD code 10. Nosocomial pneumonia. Spread of community-acquired pneumonia

In most cases, pneumonia is caused by the penetration of pathogenic microorganisms into the respiratory tract or the activation of opportunistic flora. The most common infectious agents are the following:

pneumococci;
staphylococci;
hemophilus influenzae;
streptococci;
legionella;
chlamydia;
protozoa (mycoplasma).

Focal pneumonia begins less violently. The temperature rarely exceeds 38.5 °C. Sputum when coughing is mucopurulent in nature. If foci of inflammation merge with each other, the condition of the sick person worsens. During physical examination, it is often possible to identify wheezing and dullness of percussion sound. Pneumonia requires urgent treatment.

Opportunistic microorganisms (Klebsiella, Escherichia coli) are most often isolated from those individuals who suffer from severe somatic pathology. In this case, the disease occurs against the background of a severe weakening of the immune system. Viruses can also be the cause. Initially they cause inflammation of the oropharynx and trachea. In the absence of proper treatment, the infection affects the bronchi and lung tissue.

The following predisposing factors are of great importance in the development of community-acquired pneumonia:

smoking;
decreased body resistance;
long stay in a horizontal position;
presence of chronic bronchitis;
presence of diabetes mellitus;
presence of HIV infection;
oncological diseases;
congestive heart failure;
diseases of the upper respiratory tract;
regular alcohol consumption;
hypovitaminosis;
influenza and ARVI;
epilepsy;
renal failure;
chest injuries;
inhalation of toxic substances;
harmful occupational factors;
severe vomiting (can lead to vomit entering the respiratory tract).

Pneumonia is a very common inflammatory disease. It primarily affects the alveoli, in which inflammatory exudation develops (the release of inflammatory fluid from the blood into the tissues). According to the international characteristics of diseases, pneumonia code according to ICD 10 corresponds to codes J12-J18, this depends on the type of disease. Below we describe the characteristics of the disease according to ICD 10 codes, factors for development, forms, types and treatment of the disease.

Characteristics of the disease

Pneumonia is a disease characterized by inflammation in the tissues of the respiratory organs with damage to the bronchioles and alveoli. The disease is widespread among adults and young children. The danger lies in the complications that develop against the background of the disease. In some severe cases, the death of the patient may occur.

The pneumonia code, according to ICD 10, is distributed depending on the form of the disease. Pneumonia is divided into 2 types: hospital-acquired, or nosocomial (acquired in a hospital after hospitalization for another disease) and community-acquired (acquired on an outpatient basis, outside the hospital). Nosocomial inflammation of the lung tissue is highly resistant to antibiotics and high risk lethal outcome. Accounts for 10% of the total number of cases of inflammation of the lung tissue. The community-acquired form is more common than the hospital-acquired form.

Community-acquired pneumonia code according to ICD 10 is determined according to the type of illness. According to international classification diseases, the classification of pneumonia has the following categories:

viral, unclassified;
bacterial, unclassified;
streptococcal;
provoked by chlamydia;
provoked by hemophilus influenzae infection;
caused by other ailments;
unknown etiology.

Most often, the disease occurs due to penetration into respiratory system various microorganisms. Children and the elderly are most susceptible to the disease. A common phenomenon is congestive (hypostatic) pneumonia, which occurs when a person’s movement is limited. Due to stagnation of blood in the pulmonary circulation, inflammatory damage to the lung tissue develops.

Forms and types of disease

Pneumonia code according to ICD 10 has the following forms.

Primary – develops after hypothermia or contact with someone who is already sick.
Secondary – occurs due to other health problems of the respiratory system (bronchitis, pharyngitis).
Aspiration pneumonia is an inflammatory lesion of the lung tissue caused by the penetration of foreign bodies or substances into the respiratory system.
Post-traumatic - appears after trauma to the area thoracic. Post-traumatic pneumonia is usually diagnosed after car accidents, falls from a height, or beatings.
Thromboembolic – caused by blockage pulmonary artery infected thrombus.

Inflammation of lung tissue can be unilateral (the tissue of one lung is inflamed) or bilateral (both lungs are inflamed). It can take place in complex form and no. Judging by the area of damage to the lung tissue, pneumonia occurs:

total (damage to the entire area of the organ);
central (defeat in the center);
segmental (damage to a separate segment);
lobar (damage to a separate lobe);
lobular (inflammation of an individual lobule).

Based on the size of the lesion in the lung tissue, test results, and the presence of complications, 3 stages of severity of the disease are distinguished. There are different acute, chronic form illness and protracted

Typically, inflammation in the lung tissue is caused by the ingestion of various microorganisms (pneumococci, streptococci, mycoplasmas, chlamydia and others) into the respiratory organs or by the intensification of the growth of pathogenic microflora of the human body.

Lung damage does not begin aggressively. The patient's temperature varies in the range of 38-38.5 degrees. When you cough, purulent mucous-type sputum comes out. In the case of fusion of lung lesions, the patient’s condition worsens. Inflammation of the lower respiratory organs requires immediate treatment.

Due to a weakened immune system, the disease may develop from inflammation upper organs breathing or trachea. If there is no adequate treatment, the disease spreads to the bronchi and lungs.

Factors contributing to the development of the disease

There are factors that contribute to more intense development of the inflammatory process:

staying immobile for a long time;
smoking, alcohol abuse;
diseases of the upper respiratory organs, respiratory infections, flu;
diabetes;
heart disease, oncology, HIV;
epilepsy;
weakened immunity, hypovitaminosis;
kidney diseases;
injuries and bruises of the thoracic spine;
severe vomiting (vomit may enter the respiratory system);
inhalation of toxic chemicals.

Pneumonia is characterized by the following symptoms:

hyperthermia (high temperature);
productive cough (purulent sputum, possibly with blood);
discomfort in the chest;
shortness of breath, wheezing, chest discomfort;
insomnia;
decreased appetite.

If treatment is not timely, there is a high probability of complications in the form of pleurisy, myocarditis, glomerulonephritis, abscess, and gangrene. For correct diagnosis, blood and urine tests, sputum tests, lung x-rays are prescribed, and general state respiratory and heart organs. Treatment involves the use of antibiotics, elimination of intoxication of the body, and the use of agents that help liquefy and remove sputum.

Pneumonia is a fairly common disease that requires surgical treatment. Often the cause of the disease is microorganisms that have entered the respiratory organs. They actively develop and provoke an inflammatory process in the lung tissues. Lack of adequate medical intervention leads to complications of the disease and fatal outcome.

Sources used: infekcionist.com

Forms and types of disease

In accordance with the International Classification of Diseases, Injuries and Causes of Death, 10th revision, pneumonia belongs to class X - respiratory diseases. The class is coded with the letter J.

The modern classification of pneumonia is based on the etiological principle. Depending on the pathogen isolated during microbiological testing, pneumonia is assigned one of the following codes:

J13 P. caused by Streptococcus pneumoniae;
J14 P. caused by Haemophilus influenzae;
J15 bacterial P., not classified elsewhere, caused by: J15. 0 K. pneumoniae; J15. 1 Pseudomonas aeruginosa; J15. 2 staphylococci; J15. 3 group B streptococci; J15. 4 other streptococci; J15. 5 E. coli; J15. 6 other gram-negative bacteria; J15. 7 M. pneumoniae; 15. 8 other bacterial P.; J15. 9 bacterial P. unspecified;
J16 P. caused by others infectious agents, not classified elsewhere;
J18 P. without specifying the pathogen: J18. 0 bronchopneumonia, unspecified; J18. 1 lobar P. unspecified; J18. 2 hypostatic (stagnant) P. unspecified; J18. 8 other P.; J18. 9 P. unspecified.

*P. - pneumonia.

In Russian realities, for material and technical reasons, identification of the pathogen is not always carried out. Routine microbiological studies, used in domestic clinics, have low information content. The most common class is J18, which corresponds to pneumonia of unspecified etiology.

If a person is diagnosed with community-acquired pneumonia, the ICD-10 code in the medical history will depend on the form of pneumonia. Pneumonia is a very common disease in adults and children. Often this lung pathology leads to various complications and death of the sick person. All pneumonia is divided into 2 types: nosocomial and community-acquired. What is the etiology, clinical picture and treatment of pneumonia?

Features of community-acquired pneumonia

Pneumonia is an acute, predominantly infectious, disease of the lower respiratory tract, in which the bronchioles and alveoli are involved in the process. When community-acquired pneumonia is detected in a person, the ICD-10 code is determined by the type of disease. The International Classification of Diseases divides pneumonia into the following categories:

unclassified viral;
streptococcal;
caused by Haemophilus influenzae;
unclassified bacterial;
caused by chlamydia;
pneumonia caused by other diseases;
unspecified etiology.

The ICD-10 code for pneumonia is J12 - J18. Community-acquired pneumonia is diagnosed most often. The disease received its name due to the fact that the symptoms of the disease develop outside the walls of the medical institution. Sometimes a nosocomial form of pneumonia develops. It is also called hospitalization. A similar diagnosis is made if the disease developed while a person was in medical institution for 3 days or more. Community-acquired pneumonia develops before a person seeks medical attention medical care or no later than 48 hours after hospitalization.

The incidence rate is 10 cases per 1000 people. The risk group includes children and the elderly. In most cases, pneumonia is caused by the penetration of various microorganisms into the lungs. So-called congestive pneumonia often occurs. It occurs against the background of other serious diseases that limit the patient’s movement.

Against the background of physical inactivity and being in a supine position, blood stagnation develops in the small circle, which leads to inflammation of the lung tissue. Community-acquired pneumonia is characterized high percentage lethality. Mortality reaches 50 cases per 100,000 people. In Russia, about 1 million new cases of pneumonia are diagnosed every year.

Types of community-acquired pneumonia

Community-acquired pneumonia is divided into several types. Depending on the mechanism of development, the following forms of the disease are distinguished:

primary;
secondary;
aspiration;
post-traumatic;
thromboembolic.

Primary occurs against the background of absolute health. The provoking factor may be hypothermia or contact with a sick person. Inflammation of the lungs can be unilateral (one lung is affected) or bilateral (both lungs are inflamed). Depending on the size of the inflammatory focus, total, lobar, segmental, lobular and central pneumonias are distinguished. Pneumonia can occur in complicated or uncomplicated forms.

According to the flow, acute, chronic and protracted pneumonia are distinguished. Depending on the pathogen, there are the following types community-acquired pneumonia: bacterial, chlamydial, mycoplasma, viral fungal, mixed. There are 3 degrees of severity of the disease. This division is based on the following characteristics: the size of the focus of inflammation, the presence of complications, data obtained during physical examination.

Main symptoms of pneumonia

The community-acquired form of pneumonia is manifested by the following symptoms:

high temperature (up to 39 °C and above);
cough with sputum;
shortness of breath;
feeling of discomfort in the chest;
increased sweating;
wheezing;
sleep disturbance.

Children often experience decreased appetite. Lobar pneumonia is most often diagnosed. With it, an entire lobe of the lung can be involved in the process. With lobar pneumonia, the cough is initially dry. After a few days he becomes productive. Often the sputum contains an admixture of blood. The sputum takes on a rusty hue.

In its absence, the following complications may arise:

abscess formation;
development of obstructive syndrome;
pleurisy;
acute respiratory failure;
organ gangrene;
inflammation of the membranes of the brain;
meningoencephalitis;
myocarditis;
glomerulonephritis;

Characteristics of congestive pneumonia

People with severe somatic pathology who stay in bed for a long time may develop congestive pneumonia. This is a secondary form of pneumonia. Pneumonia in this situation is a complication of the underlying disease. The basis is hemodynamic disturbances. Impaired ventilation of the lungs leads to the accumulation of sputum and bronchial obstruction, which is a favorable factor for the activation of microbes.

Often this pathology develops in older people. The causative agents of the infection are cocci and Haemophilus influenzae. The disease is manifested by the following symptoms: a slight increase in body temperature, cough with sputum, weakness, shortness of breath. Sometimes hemoptysis is observed. Symptoms are determined by the underlying disease. With a stroke, there may be impaired consciousness and difficulty speaking.

Diagnostic and therapeutic measures

Diagnosis of pneumonia includes:

general blood and urine analysis;
X-ray examination of the lungs;
percussion and auscultation of the lungs and heart;
conducting computed tomography or magnetic resonance imaging;
patient interview;
sputum examination.

To exclude tuberculosis, the Mantoux test and Diaskintest can be performed. If you suspect atypical form pneumonia, the content of specific antibodies to chlamydia, legionella, and mycoplasma in the blood is assessed. Treatment of community-acquired pneumonia is conservative. Treatment includes taking antibiotics (for bacterial etiology), detoxifying the body, using agents that dilute sputum and facilitate its elimination (Lazolvan, ACC, Ambrobene).

Of the antibiotics, the most effective are protected penicillins (Amoxiclav), cephalosporins (Cefazolin), and macrolides (Sumamed).

Physiotherapy is provided during the recovery period. The duration of treatment is determined by the doctor. Treatment is carried out only in consultation with a doctor. Self-medication can lead to complications. In severe cases, hospitalization is required. Thus, community-acquired pneumonia poses a danger to a sick person. If symptoms of the disease appear, you should visit a therapist.

Sources used: stronglung.ru

And the temperature at first is not too high, but there is some kind of weakness, fatigue. Breathing quickens and chest pain appears. And also a cough. Dry, boring, exhausting. We are trying to treat ourselves with improvised means, but there is no improvement. And in the hospital, the doctor, after an examination and a series of tests, makes a diagnosis of “community-acquired pneumonia, ICD code -10.”

Everyone knows that such a disease exists. But what do the other words of the diagnosis mean? How to figure this out and how to get rid of pneumonia?

Definition of disease

Pneumonia, or as it is more often called pneumonia, is an infectious disease that can occur as an independent disease, as well as as a complication of other diseases. The disease affects the lower respiratory tract. It is classified according to forms, as well as timing of occurrence (international classification of the disease or ICD-10).

Out-of-hospital. If a person falls ill at home, or catches pneumonia in the first two days after being hospitalized for treatment.
Hospital. After staying more than two days at inpatient treatment The patient develops symptoms of pneumonia.
Aspiration. This category includes patients who, for a number of reasons, have an impaired swallowing reflex and a weakened cough reflex. This can happen to a person in the strongest stage alcohol intoxication, or may be a consequence of epilepsy or stroke.
Immunodeficiency. Pneumonia develops against the background of loss of immunity or its weakening.

According to the severity of the disease: from mild to extremely severe.

There are also divisions into categories of patients according to the international classification of diseases.

It all depends on the severity of the disease and concomitant diseases, as well as the age of the patient:

The first category includes people whose disease is of viral or bacterial origin, without any pathologies. They easily tolerate the disease, and there are no complications from other organs.
The second category includes patients in whom the disease also progresses in mild form. But this group includes people suffering from chronic diseases of the respiratory system or having disorders of cardio-vascular system. As well as small children under two years old and elderly people.
The third category of patients must be treated for the disease as an inpatient. Since the disease can already be caused by two pathogens. For example, bacteria and viruses and is of moderate severity.
The fourth category of patients are people with severe form diseases. They need intensive care and therefore treatment should only take place under the supervision of a doctor in a hospital.

Forms and types of disease

Gram-positive microorganisms
Gram negative bacteria
Viruses,
fungi,
Worms,
Foreign bodies entering the respiratory tract,
Toxin poisoning
Chest injuries
Allergy,
Alcohol abuse
Tobacco smoking.

Constantly nervous, worried,
Poor or unbalanced diet,
Lead a sedentary lifestyle
Can't get rid of these bad habits like smoking and drinking alcohol,
Suffer from frequent colds,
Have low level immunity,
Elderly people.

Symptoms

Temperature rises even to 39 degrees or higher,
Headache,
Dyspnea,
Sleep disturbance,
lethargy,
Increased breathing,
In some cases, the nasolabial triangle becomes bluish in color.

Possible complications

Bacterial (pneumococcal, staphylococcal);
Viral (exposure to influenza viruses, parainfluenza, adenoviruses, cytomegalovirus)
Allergic
Ornithosis
Gribkovs
Mycoplasma
Rickettsial
Mixed
With an unknown cause of the disease

Forms and types of disease

Modern classification of pneumonia, code according to ICD-10

*P. - pneumonia.

In our country, the most common classification at the moment is one that takes into account the location of the disease. In accordance with this symptom, community-acquired pneumonia is distinguished - outpatient, community-acquired and in-hospital (nosocomial) pneumonia. The reason for highlighting this criterion is the different range of pathogens when the disease occurs at home and when patients in the hospital are infected.

Recently, another category has acquired independent significance - pneumonia, which occurs as a result of medical interventions outside the hospital. The appearance of this category is associated with the impossibility of classifying these cases as outpatient or nosocomial pneumonia. Based on the place of origin, they are classified as the first, and based on the pathogens identified and their resistance to antibacterial drugs, they are classified as the second.

Community-acquired	Nosocomial	Related to the provision of medical care
I. Typical. Develops in patients with normal immunity. II. Pneumonia in patients with reduced immune status. III. Aspiration. Occurs as a result of massive intake of vomit into the respiratory tract).	I. Actually nosocomial. II.Fan-associated. III. In patients with reduced immunity.	I. Residents of nursing homes. II. Categories of citizens: those who have received antibiotics in the last 3 months; patients on chronic hemodialysis; patients who have had short-term hospitalization (less than 2 days) over the past 3 months; patients treating wounds at home, etc.

Community-acquired pneumonia - infectious disease, which arose at home or no later than 48 hours from the moment of admission to the hospital in a patient in the hospital. The disease must be accompanied by certain symptoms (cough with sputum, shortness of breath, fever, pain in the chest) and radiological changes.

If a clinical picture of pneumonia occurs after 2 days from the time the patient was admitted to the hospital, the case is considered as a nosocomial infection. The need to divide into these categories is associated with different approaches to antibacterial therapy. In patients with nosocomial infection, it is necessary to take into account possible antibiotic resistance of pathogens.

*P. - pneumonia.

The long-existing division into 3 degrees of severity (mild, moderate, severe) has now lost its meaning. It did not have clear criteria or significant clinical significance.

It is now customary to divide the disease into severe (requiring treatment in the intensive care unit) and not severe. Severe pneumonia is considered in the presence of severe respiratory failure and signs of sepsis.

Clinical and instrumental criteria of severity:

shortness of breath with a respiratory rate of more than 30 per minute;
oxygen saturation less than 90%;
low arterial pressure(systolic (SBP) less than 90 mm Hg and/or diastolic (DBP) less than 60 mm Hg);
involvement in pathological process more than 1 lobe of the lung, bilateral damage;
disorders of consciousness;
extrapulmonary metastatic foci;
anuria.

Laboratory criteria for severity:

decrease in the level of leukocytes in the blood test less than 4000/μl;
partial oxygen tension is less than 60 mmHg;
hemoglobin level less than 100 g/l;
hematocrit value less than 30%;
an acute increase in creatinine levels over 176.7 µmol/l or urea levels over 7.0 mmol/l.

To quickly assess the condition of a patient with pneumonia in clinical practice the CURB-65 and CRB-65 scales are used. The scales contain the following criteria: age over 65 years, impaired consciousness, respiratory rate more than 30 per minute, SBP level less than 90 mmHg. and/or DBP less than 60 mmHg, urea level over 7 mmol/l (urea level is assessed only using the CURB-65 scale).

More often in the clinic, CRB-65 is used, which does not require the determination of laboratory parameters. Each criterion is worth 1 point. If the patient scores 0-1 on the scale, he is subject to outpatient treatment, 2 points - inpatient, 3-4 points - treatment in the intensive care unit.

The term “chronic pneumonia” is currently considered incorrect. Pneumonia - always acute illness, lasting on average 2-3 weeks.

However, in some patients various reasons X-ray remission of the disease does not occur for 4 weeks or more. The diagnosis in this case is formulated as “prolonged pneumonia.”

The disease can be complicated or uncomplicated. The present complication must be included in the diagnosis.

Complications of pneumonia include the following conditions:

exudative pleurisy;
lung abscess (abscess pneumonia);
adult respiratory distress syndrome;
acute respiratory failure (1, 2, 3 degrees);
sepsis.

The diagnosis must include the localization of pneumonia on the affected side (right-, left-, bilateral), along the lobes and segments (S1-S10) of the lungs. An approximate diagnosis might sound like this:

1. Community-acquired right-sided lower lobe pneumonia of non-severe course. Respiratory failure 0.
2. Nosocomial right-sided lower lobe pneumonia (S6, S7, S8, S10) of severe course, complicated by right-sided exudative pleurisy. Respiratory failure 2.

Whatever class pneumonia belongs to, this disease requires immediate medical treatment under the supervision of a specialist.

Sources used: lecheniegorla.ru

*P. - pneumonia.

*P. - pneumonia.

*P. - pneumonia.

Possible complications

Pleurisy is inflammation of the membrane surrounding the lungs. Chest pain when inhaling, accumulation of fluid in the pleural cavity.
Pericarditis is inflammation of the pericardium.
Hepatitis, gastrointestinal diseases. They may be caused by the fact that by taking large quantities of antibiotics, the patient kills beneficial microflora.
Chronic bronchitis is damage to the walls of the bronchi.
Asthma – allergic disease, the main symptom of which is asthma attacks. At the same time, exhalation is difficult.

But with community-acquired pneumonia there will never be such complications, since the disease occurs in mild to moderate form.

Treatment

Currently, most experts believe that patients with community-acquired pneumonia can be treated at home, that is, on an outpatient basis, but under the supervision of a doctor who will prescribe a medication regimen.

Community-acquired pneumonia ICD 10 in children: treatment and recommendations, causative agent.

Community-acquired pneumonia is an inflammatory process in the lungs that occurred in a patient at home or in the first two days after hospitalization.

This is an infectious disease that poses a threat to human health and life.

Spread of community-acquired pneumonia

The incidence of community-acquired pneumonia is directly proportional to age. The disease occurs more often in elderly and senile people than in young people.

Mortality from the pathology is low. Indicators increase with increasing severity of the disease and the age of the patient.

Classification of community-acquired pneumonia

There are three types of community-acquired pneumonia.

One of the most serious illnesses lungs is pneumonia. It is caused by a variety of pathogens and leads to a large number of deaths among children and adults in our country. All these facts make it necessary to understand the issues related to this disease.

Definition of pneumonia

Pneumonia- spicy inflammatory disease lungs, characterized by exudation of fluid in the alveoli, caused by various types microorganisms.

Classification of community-acquired pneumonia

Based on the cause of pneumonia, it is divided into:

Bacterial (pneumococcal, staphylococcal);
Viral (exposure to influenza viruses, parainfluenza, adenoviruses, cytomegalovirus)
Allergic
Ornithosis
Gribkovs
Mycoplasma
Rickettsial
Mixed
With an unknown cause of the disease

The modern classification of the disease, developed by the European Respiratory Society, allows us to assess not only the causative agent of pneumonia, but also the severity of the patient’s condition.

mild pneumococcal pneumonia;
mild atypical pneumonia;
pneumonia, probably of severe pneumococcal etiology;
pneumonia caused by an unknown pathogen;
aspiration pneumonia.

According to the International Classification of Diseases and Deaths of 1992 (ICD-10), there are 8 types of pneumonia depending on the pathogen that caused the disease:

J12 Viral pneumonia, not classified elsewhere;
J13 Pneumonia caused by Streptococcus pneumoniae;
J14 Pneumonia caused by Haemophilus influenzae;
J15 Bacterial pneumonia, not classified;
J16 Pneumonia caused by other infectious agents;
J17 Pneumonia in diseases classified elsewhere;
J18 Pneumonia without specifying the causative agent.

The International Classification of Pneumonia distinguishes the following types of pneumonia:

Community-acquired;
Hospital;
Aspiration;
Pneumonia accompanying severe diseases;
Pneumonia in persons with immunodeficiency conditions;

Community-acquired pneumonia is a lung disease infectious nature which developed before hospitalization in medical organization influenced various groups microorganisms.

Etiology of community-acquired pneumonia

Most often, the disease is caused by opportunistic bacteria, which are normally natural inhabitants of the human body. Under the influence of various factors, they become pathogenic and cause the development of pneumonia.

Factors contributing to the development of pneumonia:

Hypothermia;
Lack of vitamins;
Being near air conditioners and humidifiers;
Availability bronchial asthma and other lung diseases;
Tobacco use.

The main sources of community-acquired pneumonia:

Pulmonary pneumococcus;
Mycoplasmas;
Pulmonary chlamydia;
Haemophilus influenzae;
Influenza virus, parainfluenza, adenoviral infection.

The main ways that microorganisms that cause pneumonia enter the lung tissue are ingestion of microorganisms with air or inhalation of a suspension containing pathogens.

Under normal conditions, the respiratory tract is sterile, and any microorganism that enters the lungs is destroyed using the lungs’ drainage system. If the functioning of this drainage system is disrupted, the pathogen is not destroyed and remains in the lungs, where it affects the lung tissue, causing the development of the disease and the manifestation of all clinical symptoms.

Symptoms of community-acquired pneumonia

The disease always begins suddenly and manifests itself with various signs.

Pneumonia is characterized by the following clinical symptoms:

A rise in body temperature to 38-40 C. The main clinical symptom of the disease in people over 60 years of age, an increase in temperature can remain within 37-37.5 C, which indicates a low immune response to the introduction of the pathogen.
Persistent cough characterized by the production of rust-colored sputum
Chills
General malaise
Weakness
Decreased performance
Sweating
Pain when breathing in the chest area, which proves the transition of inflammation to the pleura
Shortness of breath is associated with significant damage to areas of the lung.

Features of clinical symptoms associated with damage to certain areas of the lung. With focal broncho-pneumonia, the disease begins slowly a week after initial signs ailments. The pathology covers both lungs and is characterized by the development acute failure breathing and general intoxication of the body.

For segmental lesions lung is characterized by the development of the inflammatory process as a whole lung segment. The disease progresses generally favorably, without fever or cough, and the diagnosis can be made accidentally during an X-ray examination.

For lobar pneumonia clinical symptoms are vivid, heat the body worsens the condition up to the development of delirium, and if the inflammation is located in the lower parts of the lungs, abdominal pain appears.

Interstitial pneumonia possible when viruses enter the lungs. It is quite rare and often affects children under 15 years of age. There is an acute and subacute course. The outcome of this type of pneumonia is pneumosclerosis.

For acute course Characteristic phenomena are severe intoxication and the development of neurotoxicosis. The course is severe with a high rise in temperature and persistent residual effects. Children aged 2-6 years are often affected.
Subacute course characterized by cough, increased lethargy and fatigue. It is widespread among children 7-10 years of age who have had ARVI.

There are features of the course of community-acquired pneumonia in people who have reached retirement age. Due to age-related changes in immunity and the addition of chronic diseases, the development of numerous complications and erased forms of the disease is possible.

Severe respiratory failure develops it is possible to develop disturbances in the blood supply to the brain, accompanied by psychoses and neuroses.

Types of hospital-acquired pneumonia

Hospital-acquired pneumonia is an infectious disease of the respiratory tract that develops 2-3 days after hospitalization in a hospital, in the absence of symptoms of pneumonia before admission to the hospital.

Among all nosocomial infections ranks 1st in terms of the number of complications. Renders big influence for the cost therapeutic measures, increases the number of complications and deaths.

Divided by time of occurrence:

Early- occurs in the first 5 days after hospitalization. Caused by microorganisms already present in the body of the infected person ( Staphylococcus aureus, Haemophilus influenzae and others);
Late- develops 6-12 days after being admitted to the hospital. The causative agents are hospital strains of microorganisms. The most difficult to treat due to the development of resistance of microorganisms to the effects of disinfectants and antibiotics.

There are several types of infection due to their occurrence:

Ventilator-associated pneumonia- occurs in patients who long time are on artificial ventilation. According to doctors, one day of a patient being on a ventilator increases the likelihood of contracting pneumonia by 3%.

Violation drainage function lungs;
Not a large number of ingested contents of the oropharynx containing the causative agent of pneumonia;
Oxygen-air mixture contaminated with microorganisms;
Infection from carriers of hospital infection strains among medical personnel.

Causes of postoperative pneumonia:

Stagnation of the pulmonary circulation;
Low ventilation;
Therapeutic manipulations on the lungs and bronchi.

Aspiration pneumonia - infectious disease lungs, resulting from the entry of the contents of the stomach and oropharynx into the lower respiratory tract.

Hospital-acquired pneumonia requires serious treatment with the most modern medications due to the resistance of pathogens to various antibacterial drugs.

Diagnosis of community-acquired pneumonia

Today there is a complete list of clinical and paraclinical methods.

The diagnosis of pneumonia is made after the following studies:

Clinical data about the disease
Data general analysis blood. Increased leukocytes, neutrophils;
Sputum culture to identify the pathogen and its sensitivity to an antibacterial drug;
X-ray of the lungs, which reveals the presence of shadows in various lobes of the lung.

Treatment of community-acquired pneumonia

The process of treating pneumonia can take place both in a medical institution and at home.

Indications for hospitalization of a patient in a hospital:

Age. Patients younger age and pensioners after 70 years of age should be hospitalized in order to prevent the development of complications;
Disturbed consciousness
Presence of chronic diseases (bronchial asthma, COPD, diabetes mellitus, immunodeficiency);
Inability to leave.

The main drugs used to treat pneumonia are antibacterial drugs:

Cephalosporins: ceftriaxone, cefurotoxime;
Penicillins: amoxicillin, amoxiclav;
Macrolides: azithromycin, roxithromycin, clarithromycin.

If there is no effect from taking the drug within several days, it is necessary to change the antibacterial drug. To improve sputum discharge, mucolytics (ambrocol, bromhexine, ACC) are used.

Complications of community-acquired pneumonia

With untimely treatment or its absence, the following complications may develop:

Exudative pleurisy
Development of respiratory failure
Purulent processes in the lung
Respiratory distress syndrome

Prognosis for pneumonia

In 80% of cases, the disease is successfully treated and does not lead to serious adverse consequences. After 21 days, the patient’s well-being improves, and X-ray images show partial resorption of the infiltrative shadows.

Prevention of pneumonia

In order to prevent the development of pneumococcal pneumonia, vaccination is carried out with an influenza vaccine containing antibodies against pneumococcus.

Pneumonia is a dangerous and insidious enemy for humans, especially if it occurs unnoticed and has few symptoms. Therefore, it is necessary to be attentive to your own health, get vaccinated, consult a doctor at the first signs of illness, and remember what serious complications pneumonia can cause.

Focal lower lobe pneumonia on the right, moderate severity ICD-10 J18 (page 1 of 3)

Federal Agency for Health and social development Russian Federation

State educational institution higher professional education

Altai State medical University Roszdrav

Department of Pediatrics No. 2

Propaedeutics of childhood diseases

Head of the Department: Doctor of Medical Sciences Professor …

Teacher: Doctor of Medical Sciences, Professor of the Department...

Curator: student of group 435...

age: 12 years old date of birth July 8, 1994

Main disease: Focal lower lobe pneumonia on the right, moderate severity ICD-10 J18. . Acute respiratory viral infection ICD-10 J06. Moderate rhinopharyngitis

Supervision period: from 12/12/06 to 12/15/06

Date and time of discharge: 12/15/06.

Somatic-pediatric department, ward No. 10

10 bed days were spent.

Admitted to the department by ambulance

Blood type: II Rhesus - Rh +

Side effects There are no medications (intolerances).

Full Name:

Gender husband, age 12 years, date of birth 07/08/1994

Permanent place of residence: Barnaul

Referred to: delivered by ambulance.

Diagnosis of the referring institution: Acute respiratory viral infection. Rhinopharyngitis, acute bronchitis.

Diagnosis on admission: Acute respiratory viral infection. Rhinopharyngitis, tracheitis.

Clinical diagnosis: Focal lower lobe pneumonia on the right, moderate severity. Acute respiratory viral infection. Rhinopharyngitis of moderate severity.

Final clinical diagnosis:

a) main: Focal lower lobe pneumonia on the right, moderate severity.

Hospitalized for the first time this year.

Outcome of the disease: discharged with improvement.

Date of supervision 12.12.06

The main ones: frequent, rough, dry cough, runny nose, nasal congestion, increased body temperature up to 39°C.

Associated symptoms: weakness, fatigue, malaise.

At the time of supervision, the patient has no complaints.

On December 4, he became hypothermic, after which he developed a periodic dry cough, runny nose, nasal congestion, weakness, and malaise. On the morning of 12/5/06. The body temperature rose to 38°C. He was treated at home, which the child does not remember. There was no improvement. 6.12.06. There is an increase in cough, an increase in body temperature to 40°C, and an increase in weakness. Called ambulance. He was taken to Children's Hospital No. 1.

The child is from the first pregnancy, the first birth, there are no other children in the family. This pregnancy was in danger of being terminated (at 6-8 weeks the mother was in the hospital), the second half of the pregnancy was without pathology. The birth was term (38 weeks), normal.

Body weight at birth is 4000 g, body length is 53 cm. He cried out immediately, was attached to the breast for the 2nd day, and sucked actively. The umbilical cord fell off on the 4th day, the umbilical wound healed quickly, and was discharged from the maternity hospital on the 7th day.

Unfavorable factors in the prenatal period were the threat of miscarriage at 6-8 weeks of pregnancy.

Neuropsychic development of the child

Development of motor skills: began to hold his head at 1.5 months, roll over from back to side at 3 months, onto stomach at 4 months, began to sit at 5.5 months, stand at 8 months, walk at 10 months.

Mental development: the first smile appeared at 1 month, he began to walk at 3 months, to pronounce individual syllables at 6 months, words at 11 months, to recognize his mother at 4 months, by the first year he uttered 7 words. Teeth erupted at 6 months, by 1 year – 8 teeth.

The character of behavior at home and in the team is sociable.

Conclusion: The neuropsychic development of a child in the first year of life corresponds to age standards.

The mother breastfed the child until 12 months, feeding schedule was every 3 hours. Additional nutritional factors: Apple juice received from 3 months - up to 10.0, at 8 months - up to 100.0; yolk from 6 months, cottage cheese from 5 months, vitamin D2 from 3 months. I complementary foods were introduced at 5.5 months - vegetable puree, II complementary feeding - at 6 months. – buckwheat porridge, sometimes 5% semolina, from 8 months they started giving meat, fish, dairy products, bread. Currently he is receiving 5 meals a day.

Conclusion: The child’s nutrition in the first year of life is correct.

Attended kindergarten regularly, followed daily routine ( night sleep is 9 hours), spends 2 hours daily in the fresh air.

Conclusion: the child’s daily routine was not disturbed throughout his life.

There were no injuries, operations, or blood transfusions.

Preventive vaccination calendar

Vaccination against viral hepatitis IN

Conclusion: Preventive vaccinations were given according to age; no general or local reactions were observed. No vaccination against viral hepatitis B was carried out. The Mantoux test results are negative.

Allergies to medications, no products.

Material and living conditions and information about parents

Mother: works at OJSC "Lakt" as an auxiliary worker, healthy.

No one in the family suffers from alcoholism, tuberculosis, or syphilis. The family consists of 3 people, 1 child lives in a 1-room comfortable apartment, there is running water and sewerage; The child has a separate bed and a place to study. No pets.

I had no contact with infectious patients in my family, school, or neighbors. He drinks pasteurized milk, not boiled water, and there have been no interruptions in the water supply. The patient did not travel outside the city or country and did not eat raw meat or fish. I was treated by a dentist a year ago; there were no blood or plasma transfusions.

Unfavorable factors in the child's life history include: threat of termination of pregnancy at 6-8 weeks, lack of vaccination against viral hepatitis B.

Current condition of the patient

The patient's condition is satisfactory, his health does not suffer. The body position is free, consciousness is clear, the expression of the eyes and face is lively. There are no visible congenital (stigmas of dysembryogenesis) or acquired defects.

No disturbances of surface sensitivity (temperature, pain, tactile) of the conductive, segmental or cortical type were identified.

Deep sensitivity: sense of localization, muscle-articular sense preserved, no astereognosis.

Physiological reflexes: biceps, triceps, carpal, abdominal, knee, Achilles, plantar - animated, manifested on both sides to the same extent.

Pathological reflexes: Rossolimo, Marinescu - Radovich, Bekhterev1,2, Zhukovsky1,2, Oppenheim, Gordon, Shaffard, Babinsky, Poussep - negative.

Meningeal symptoms: stiff neck, Brudzinski upper, middle, lower and Kernig's syndrome are negative.

The pharyngeal and corneal reflexes are preserved and are identical on both sides. The reaction of the pupils to light is direct and friendly, as well as to convergence and accommodation, lively, the same on both sides. Dermographism is red, appears after 35 seconds, disappears after 15 minutes.

Performs toe-to-toe and knee-heel tests correctly. In the Romberg pose, he maintains balance with his eyes open and closed. Graefe's symptom and the "setting sun" symptom are negative.

The patient expresses emotions with restraint, expressive speech is not impaired, and speech understanding is preserved. Emotional reaction on others and on examination is positive.

The mood is good, the child easily comes into contact with the doctor.

Smell, color and sound perception are not impaired, visual acuity is 1.0 in both eyes. Field of view within physiological norm, scatoma, hemianopia were not detected.

Pneumonia without specified pathogen (J18)

Excluded:

lung abscess with pneumonia (J85.1)
drug-induced interstitial lung diseases (J70.2-J70.4)
pneumonia:
- aspiration:
  - NOS (J69.0)
  - during anesthesia:
    - during labor and delivery (O74.0)
    - during pregnancy (O29.0)
    - V postpartum period(O89.0)
- newborn (P24.9)
- when inhaling solids and liquid substances(J69.-)
- congenital (P23.9)
- interstitial NOS (J84.9)
- fat (J69.1)
- ordinary interstitial (J84.1)
pneumonitis caused by external agents (J67-J70)

In Russia International Classification of Diseases 10th revision ( ICD-10) accepted as a single normative document to take into account morbidity, reasons for the population’s appeals to medical institutions all departments, causes of death.

ICD-10 introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

Modern classification of pneumonia, code according to ICD-10

For a long time in our country the term “pneumonia” was used in a broad sense. This term denoted focal inflammation of almost any etiology. Until recently, there was confusion in the classification of the disease, since the following etiological units were included in the category: allergic pneumonia, caused by physical and chemical influences. On modern stage Russian doctors use the classification approved by the Russian Respiratory Society, and also code each case of the disease according to the International Classification of Diseases (ICD-10).

Pneumonia is a large group of acute infectious lung diseases that differ in etiology, development mechanism, and morphology. The main signs are focal damage to the respiratory part of the lungs, the presence of exudate in the cavity of the alveoli. Bacterial pneumonia is the most common, although the causative agents can be viruses, protozoa, and fungi.

In accordance with ICD-10, pneumonia includes infectious inflammatory diseases of the lung tissue. Diseases caused by chemicals physical factors(gasoline pneumonia, radiation pneumonitis), having an allergic nature (eosinophilic pneumonia), are not included in this concept and are classified in other headings.

Focal inflammation of the lung tissue is often a manifestation of a number of diseases caused by special, extremely contagious microorganisms. These diseases include measles, rubella, chicken pox, flu, Q fever. These nosologies are excluded from the section. Interstitial pneumonia caused by specific pathogens, caseous pneumonia, which is one of clinical forms pulmonary tuberculosis, post-traumatic pneumonia are also excluded from the rubric.

In accordance with the International Classification of Diseases, Injuries and Causes of Death, 10th revision, pneumonia belongs to class X - respiratory diseases. The class is coded with the letter J.

The modern classification of pneumonia is based on the etiological principle. Depending on the pathogen isolated during microbiological testing, pneumonia is assigned one of the following codes:

J13 P. caused by Streptococcus pneumoniae;
J14 P. caused by Haemophilus influenzae;
J15 bacterial P., not classified elsewhere, caused by: J15. 0 K. pneumoniae; J15. 1 Pseudomonas aeruginosa; J15. 2 staphylococci; J15. 3 group B streptococci; J15. 4 other streptococci; J15. 5 E. coli; J15. 6 other gram-negative bacteria; J15. 7 M. pneumoniae; 15. 8 other bacterial P.; J15. 9 bacterial P. unspecified;
J16 P. caused by other infectious agents, not classified elsewhere;
J18 P. without specifying the pathogen: J18. 0 bronchopneumonia, unspecified; J18. 1 lobar P. unspecified; J18. 2 hypostatic (stagnant) P. unspecified; J18. 8 other P.; J18. 9 P. unspecified.

*P. - pneumonia.

In Russian realities, for material and technical reasons, identification of the pathogen is not always carried out. Routine microbiological studies used in domestic clinics have low information content. The most common class is J18, which corresponds to pneumonia of unspecified etiology.

Community-acquired pneumonia is an infectious disease that arose at home or no later than 48 hours from the moment of admission to the hospital in a patient in the hospital. The disease must be accompanied by certain symptoms (cough with sputum, shortness of breath, fever, chest pain) and x-ray changes.

If a clinical picture of pneumonia occurs after 2 days from the time the patient was admitted to the hospital, the case is considered as a nosocomial infection. The need to divide into these categories is associated with different approaches to antibacterial therapy. In patients with nosocomial infection, it is necessary to take into account possible antibiotic resistance of pathogens.

A similar classification is proposed by WHO experts ( World Organization healthcare). They propose to distinguish community-acquired, hospital-acquired, aspiration pneumonia, as well as pneumonia in persons with concomitant immunodeficiency.

The long-existing division into 3 degrees of severity (mild, moderate, severe) has now lost its meaning. It did not have clear criteria or significant clinical significance.

Clinical and instrumental criteria of severity:

shortness of breath with a respiratory rate of more than 30 per minute;
oxygen saturation less than 90%;
low blood pressure (systolic (SBP) less than 90 mm Hg and/or diastolic (DBP) less than 60 mm Hg);
involvement of more than 1 lobe of the lung in the pathological process, bilateral damage;
disorders of consciousness;
extrapulmonary metastatic foci;
anuria.

Laboratory criteria for severity:

decrease in the level of leukocytes in the blood test less than 4000/μl;
partial oxygen tension is less than 60 mmHg;
hemoglobin level less than 100 g/l;
hematocrit value less than 30%;
an acute increase in creatinine levels over 176.7 µmol/l or urea levels over 7.0 mmol/l.

To quickly assess the condition of a patient with pneumonia, the CURB-65 and CRB-65 scales are used in clinical practice. The scales contain the following criteria: age over 65 years, impaired consciousness, respiratory rate more than 30 per minute, SBP level less than 90 mmHg. and/or DBP less than 60 mmHg, urea level over 7 mmol/l (urea level is assessed only using the CURB-65 scale).

More often in the clinic, CRB-65 is used, which does not require the determination of laboratory parameters. Each criterion is worth 1 point. If the patient scores 0-1 points on the scale, he is subject to outpatient treatment, 2 points - inpatient, 3-4 points - treatment in the intensive care unit.

The term “chronic pneumonia” is currently considered incorrect. Pneumonia is always an acute disease, lasting an average of 2-3 weeks.

However, in some patients, for various reasons, radiological remission of the disease does not occur for 4 weeks or more. The diagnosis in this case is formulated as “prolonged pneumonia.”

The disease can be complicated or uncomplicated. The present complication must be included in the diagnosis.

Complications of pneumonia include the following conditions:

exudative pleurisy;
lung abscess (abscess pneumonia);
adult respiratory distress syndrome;
acute respiratory failure (1, 2, 3 degrees);
sepsis.

1. Community-acquired right-sided lower lobe pneumonia of non-severe course. Respiratory failure 0.
2. Nosocomial right-sided lower lobe pneumonia (S6, S7, S8, S10) of severe course, complicated by right-sided exudative pleurisy. Respiratory failure 2.

Whatever class pneumonia belongs to, this disease requires immediate medical treatment under the supervision of a specialist.

What is pneumonia code according to ICD 10

Pneumonia is a very common inflammatory disease. It primarily affects the alveoli, in which inflammatory exudation develops (the release of inflammatory fluid from the blood into the tissues). According to the international characteristics of diseases, pneumonia code according to ICD 10 corresponds to codes J12-J18, this depends on the type of disease. Below we describe the characteristics of the disease according to ICD 10 codes, factors for development, forms, types and treatment of the disease.

Characteristics of the disease

The pneumonia code, according to ICD 10, is distributed depending on the form of the disease. Pneumonia is divided into 2 types: hospital-acquired, or nosocomial (acquired in a hospital after hospitalization for another disease) and community-acquired (acquired on an outpatient basis, outside the hospital). Nosocomial inflammation of the lung tissue is highly resistant to antibiotics and has a high risk of death. Accounts for 10% of the total number of cases of inflammation of the lung tissue. The community-acquired form is more common than the hospital-acquired form.

Community-acquired pneumonia code according to ICD 10 is determined according to the type of illness. According to the international classification of diseases, the classification of pneumonia has the following categories:

viral, unclassified;
bacterial, unclassified;
streptococcal;
provoked by chlamydia;
provoked by hemophilus influenzae infection;
caused by other ailments;
unknown etiology.

Most often, the disease occurs due to the penetration of various microorganisms into the respiratory system. Children and the elderly are most susceptible to the disease. A common phenomenon is congestive (hypostatic) pneumonia, which occurs when a person’s movement is limited. Due to stagnation of blood in the pulmonary circulation, inflammatory damage to the lung tissue develops.

Forms and types of disease

Pneumonia code according to ICD 10 has the following forms.

Primary – develops after hypothermia or contact with someone who is already sick.
Secondary – occurs due to other health problems of the respiratory system (bronchitis, pharyngitis).
Aspiration pneumonia is an inflammatory lesion of the lung tissue caused by the penetration of foreign bodies or substances into the respiratory system.
Post-traumatic - appears after injury to the thoracic region. Post-traumatic pneumonia is usually diagnosed after car accidents, falls from a height, or beatings.
Thromboembolic – caused by blockage of a pulmonary artery by an infected blood clot.

Inflammation of lung tissue can be unilateral (the tissue of one lung is inflamed) or bilateral (both lungs are inflamed). It can take place in a complex form or not. Judging by the area of damage to the lung tissue, pneumonia occurs:

total (damage to the entire area of the organ);
central (defeat in the center);
segmental (damage to a separate segment);
lobar (damage to a separate lobe);
lobular (inflammation of an individual lobule).

Based on the size of the lesion in the lung tissue, test results, and the presence of complications, 3 stages of severity of the disease are distinguished. There are acute, chronic and protracted forms of the disease.

Lung damage does not begin aggressively. The patient's temperature varies in the range of 38-38.5 degrees. When you cough, purulent mucous-type sputum comes out. In the case of fusion of lung lesions, the patient’s condition worsens. Inflammation of the lower respiratory organs requires immediate treatment.

Due to a weakened immune system, it is possible to develop a disease from inflammation of the upper respiratory organs or trachea. If there is no adequate treatment, the disease spreads to the bronchi and lungs.

Factors contributing to the development of the disease

There are factors that contribute to more intense development of the inflammatory process:

staying immobile for a long time;
smoking, alcohol abuse;
diseases of the upper respiratory organs, respiratory infections, influenza;
diabetes;
heart disease, oncology, HIV;
epilepsy;
weakened immunity, hypovitaminosis;
kidney diseases;
injuries and bruises of the thoracic spine;
severe vomiting (vomit may enter the respiratory system);
inhalation of toxic chemicals.

Pneumonia is characterized by the following symptoms:

hyperthermia (high temperature);
productive cough (purulent sputum, possibly with blood);
discomfort in the chest;
shortness of breath, wheezing, chest discomfort;
insomnia;
decreased appetite.

If treatment is not timely, there is a high probability of complications in the form of pleurisy, myocarditis, glomerulonephritis, abscess, and gangrene. For correct diagnosis, blood and urine tests, sputum tests, chest x-rays are prescribed, and the general condition of the respiratory and heart organs is determined. Treatment involves the use of antibiotics, elimination of intoxication of the body, and the use of agents that help liquefy and remove sputum.

One of the most serious lung diseases is pneumonia. It is caused by a variety of pathogens and leads to a large number of deaths among children and adults in our country. All these facts make it necessary to understand the issues related to this disease.

Definition of pneumonia

Pneumonia– an acute inflammatory disease of the lungs, characterized by exudation of fluid in the alveoli, caused by various types of microorganisms.

Classification of community-acquired pneumonia

Based on the cause of pneumonia, it is divided into:

Bacterial (pneumococcal, staphylococcal);
Viral (exposure to influenza viruses, parainfluenza, adenoviruses, cytomegalovirus)
Allergic
Ornithosis
Gribkovs
Mycoplasma
Rickettsial
Mixed
With an unknown cause of the disease

mild pneumococcal pneumonia;
mild atypical pneumonia;
pneumonia, probably of severe pneumococcal etiology;
pneumonia caused by an unknown pathogen;
aspiration pneumonia.

According to the International Classification of Diseases and Deaths of 1992 (ICD-10), there are 8 types of pneumonia depending on the pathogen that caused the disease:

J12 Viral pneumonia, not elsewhere classified;
J13 Pneumonia caused by Streptococcus pneumoniae;
J14 Pneumonia caused by Haemophilus influenzae;
J15 Bacterial pneumonia, not classified;
J16 Pneumonia caused by other infectious agents;
J17 Pneumonia in diseases classified elsewhere;
J18 Pneumonia without specifying the causative agent.

Since it is rarely possible to identify the causative agent in pneumonia, code J18 (Pneumonia without specifying the causative agent) is most often assigned.

The International Classification of Pneumonia distinguishes the following types of pneumonia:

Community-acquired;
Hospital;
Aspiration;
Pneumonia accompanying severe diseases;
Pneumonia in persons with immunodeficiency conditions;

Community-acquired pneumonia is a lung disease of an infectious nature that developed before hospitalization in a medical organization under the influence of various groups of microorganisms.

Etiology of community-acquired pneumonia

Factors contributing to the development of pneumonia:

Hypothermia;
Lack of vitamins;
Being near air conditioners and humidifiers;
Presence of bronchial asthma and other lung diseases;
Tobacco use.

The main sources of community-acquired pneumonia:

Pulmonary pneumococcus;
Mycoplasmas;
Pulmonary chlamydia;
Haemophilus influenzae;
Influenza virus, parainfluenza, adenoviral infection.

The main ways that microorganisms that cause pneumonia enter the lung tissue are ingestion of microorganisms with air or inhalation of a suspension containing pathogens.

Very rarely, a route of infection is possible with chest wounds and infective endocarditis, liver abscesses

Symptoms of community-acquired pneumonia

The disease always begins suddenly and manifests itself with various signs.

Pneumonia is characterized by the following clinical symptoms:

A rise in body temperature to 38-40 C. The main clinical symptom of the disease in people over 60 years of age, an increase in temperature can remain within 37-37.5 C, which indicates a low immune response to the introduction of the pathogen.
Persistent cough characterized by the production of rust-colored sputum
Chills
General malaise
Weakness
Decreased performance
Sweating
Pain when breathing in the chest area, which proves the transition of inflammation to the pleura
Shortness of breath is associated with significant damage to areas of the lung.

Features of clinical symptoms associated with damage to certain areas of the lung. With focal broncho-pneumonia, the disease begins slowly a week after the initial signs of illness. The pathology covers both lungs and is characterized by the development of acute respiratory failure and general intoxication of the body.

For segmental lesions lung is characterized by the development of an inflammatory process in the entire segment of the lung. The disease progresses generally favorably, without fever or cough, and the diagnosis can be made accidentally during an X-ray examination.

For lobar pneumonia clinical symptoms are vivid, high body temperature worsens the condition up to the development of delirium, and if the inflammation is located in the lower parts of the lungs, abdominal pain appears.

For acute course Characteristic phenomena are severe intoxication and the development of neurotoxicosis. The course is severe with a high rise in temperature and persistent residual effects. Children aged 2-6 years are often affected.
Subacute course characterized by cough, increased lethargy and fatigue. It is widespread among children 7-10 years of age who have had ARVI.

Severe respiratory failure develops it is possible to develop disturbances in the blood supply to the brain, accompanied by psychoses and neuroses.

Types of hospital-acquired pneumonia

Among all nosocomial infections it ranks 1st in terms of the number of complications. It has a great impact on the cost of treatment, increases the number of complications and deaths.

Divided by time of occurrence:

Early– occurs in the first 5 days after hospitalization. Caused by microorganisms already present in the body of the infected person (Staphylococcus aureus, Haemophilus influenzae and others);
Late– develops 6-12 days after being admitted to the hospital. The causative agents are hospital strains of microorganisms. It is most difficult to treat due to the development of resistance of microorganisms to the effects of disinfectants and antibiotics.

There are several types of infection due to their occurrence:

Ventilator-associated pneumonia– occurs in patients who have been on mechanical ventilation for a long time. According to doctors, one day of a patient being on a ventilator increases the likelihood of contracting pneumonia by 3%.

Impaired drainage function of the lungs;
A small amount of ingested oropharyngeal contents containing the causative agent of pneumonia;
Oxygen-air mixture contaminated with microorganisms;
Infection from carriers of hospital infection strains among medical personnel.

Postoperative pneumonia is an infectious and inflammatory disease of the lungs that occurs 48 hours after surgery.

Causes of postoperative pneumonia:

Stagnation of the pulmonary circulation;
Low ventilation;
Therapeutic manipulations on the lungs and bronchi.

Aspiration pneumonia– an infectious disease of the lungs that occurs as a result of the contents of the stomach and oropharynx entering the lower respiratory tract.

Hospital-acquired pneumonia requires serious treatment with the most modern medications due to the resistance of pathogens to various antibacterial drugs.

Diagnosis of community-acquired pneumonia

Today there is a complete list of clinical and paraclinical methods.

The diagnosis of pneumonia is made after the following studies:

Clinical data about the disease
General blood test data. Increased leukocytes, neutrophils;
Sputum culture to identify the pathogen and its sensitivity to an antibacterial drug;
X-ray of the lungs, which reveals the presence of shadows in various lobes of the lung.

Treatment of community-acquired pneumonia

The process of treating pneumonia can take place both in a medical institution and at home.

Indications for hospitalization of a patient in a hospital:

Age. Young patients and pensioners after 70 years of age should be hospitalized to prevent the development of complications;
Disturbed consciousness
Presence of chronic diseases (bronchial asthma, COPD, diabetes mellitus, immunodeficiency);
Inability to leave.

The main drugs aimed at treating pneumonia are antibacterial drugs:

Cephalosporins: ceftriaxone, cefurotoxime;
Penicillins: amoxicillin, amoxiclav;
Macrolides: azithromycin, roxithromycin, clarithromycin.

If there is no effect from taking the drug within several days, it is necessary to change the antibacterial drug. To improve sputum discharge, mucolytics (ambrocol, bromhexine, ACC) are used.

During the recovery period, physiotherapeutic procedures (laser therapy, infrared radiation and chest massage) are possible.

Complications of community-acquired pneumonia

With untimely treatment or its absence, the following complications may develop:

Exudative pleurisy
Development of respiratory failure
Purulent processes in the lung
Respiratory distress syndrome

Prognosis for pneumonia

Prevention of pneumonia

In order to prevent the development of pneumococcal pneumonia, vaccination is carried out with an influenza vaccine containing antibodies against pneumococcus.

1401 10/03/2019 6 min.

Pneumonia, or pneumonia, very often frightens people. This diagnosis seems especially scary to parents of young children. This fear is understandable, because for a long time pneumonia was fatal dangerous illness. Modern antibacterial therapy makes treatment as effective as possible. Although even in this case, pneumonia remains fatal dangerous disease. The danger is that it can go unnoticed for a long time. Because of this, a person does not consult a doctor on time, which ultimately leads to a dangerous complication. The article describes the definition of pneumonia according to the ICD-10 code.

What is pneumonia in adults - definition of the disease and code according to ICD-10

Pneumonia is a whole group of diseases, the main symptom of which is an inflammatory process in the lungs. It occupies several entire sections in ICD 10, namely:

J12 – not included in other sections;
J13 – Bacterial pneumonia caused by streptococcal infection;
J14 – Bacterial pneumonia provoked by the Afanasyev-Pfeipffer bacillus;
J15 – Bacterial pneumonia, ;
J16 – Pneumonia caused by other infections;
J17 – Pneumonia caused by other diseases;
J18 – Pneumonia caused by an unrefined pathogen.

Most often, pneumonia is manifested by characteristic respiratory symptoms, such as a painful cough with sputum, a sharp increase in temperature, shortness of breath and heavy sweating. The danger of this disease is that in many cases it is almost asymptomatic. If a person does not consult a doctor, this can even lead to death in the worst case.

The most common factor that provokes pneumonia is weakened immunity.

The expanded classification of pneumonia includes:

According to the method of occurrence (or in-hospital);
Due to the cause (viral, bacterial, aspiration, ventilation, caused by immunodeficiency).

Depending on the severity of the disease, pneumonia can be:

Light;
Medium-heavy;
Heavy;
Extremely heavy.

Gradually developing, the disease passes through the following stages of development:

Tidal stage (from 1 to 3 days);
Gray hepatization stage;
Red liver stage;
Resolution stage.

With timely treatment, the last stage leads to complete recovery and restoration of normal lung function.

Pneumonia leads to impairment important functions throughout the body, because the brain does not receive enough oxygen. With bacterial pneumonia, general intoxication is also added.

Causes

Since pneumonia is not a single disease, but a whole group of diseases, there are a huge number of provoking factors:

Weakening immune system(may be caused by fatigue or hypothermia, or concomitant diseases);
Any chronic diseases(diabetes mellitus of any type, heart failure, liver or kidney failure, congenital pathologies of the respiratory system);
Bad habits, primarily smoking;
Previous surgery;
Chronic fatigue;
Stress;
Prolonged stay in a horizontal position (in bedridden patients);
Violation of basic hygiene rules;
Working in a poorly ventilated area with a lot of dust or particles of caustic substances in the air;
Taking certain medications.

Pneumonia is especially dangerous for children under 2 years of age, as well as older people 65 years of age and later.

Symptoms

The main symptom of any type of pneumonia is a painful cough. It may be dry and nonproductive, or may produce sputum. The disease can proceed rather sluggishly for a long time, after which it passes into a severe stage. A person’s general condition can become severe in less than a day. The following characteristic symptoms appear:

In young children, pneumonia leads to severe general intoxication. Diarrhea, nausea, and vomiting appear. The child becomes capricious and lethargic, often refusing to eat and drink.

With bacterial pneumonia, the cough is accompanied by the release of thick yellow-green or red sputum, sometimes mixed with blood.

Possible complications

Pneumonia is dangerous precisely because of its complications, since gas exchange in the body is disrupted (lack of oxygen leads to the accumulation of carbon dioxide). Violated cerebral circulation, often leads to heart failure. A rapidly developing inflammatory process in the lungs leads to the following serious consequences:

Severe cardiopulmonary failure;
Exudative pleurisy;
Inflammatory processes in the heart (endocarditis, myocarditis, pericarditis);
Anemia;
Meningoencephalitis.

The most dangerous complication of pneumonia is severe respiratory failure.

Complications of pneumonia are divided into pulmonary and extrapulmonary.

Out-of-hospital treatment

At the first characteristic symptoms pneumonia, you should immediately consult a therapist; you may also need to consult a pulmonologist. Comprehensive diagnostics includes:

In difficult cases, the following additional studies may be necessary:

Clinical urine analysis;
CT scan;
Lung biopsy.

According to the results comprehensive examination doctor develops individual scheme treatment.

You should be patient, as treatment for pneumonia can take up to 2 to 3 weeks.

The basis of complex treatment for pneumonia is drug therapy, primarily antibacterial drugs. In most cases, treatment can be carried out at home if you strictly follow all the doctor’s instructions. Additionally, the following methods are used:

Steam ;
Physiotherapy (magnetic therapy, electrophoresis, warming up the lungs);
Physiotherapy;

Of great importance proper care for the patient, accelerating recovery. It includes an intensive diet with plenty of vitamins, proteins and carbohydrates, mandatory bed rest and plenty of fluids to drink.

Inpatient treatment is only necessary if the general condition of the sick person sharply worsens, for example, there are signs of respiratory failure.

By medication

Drug treatment of pneumonia in most cases is based on the use of antibiotics wide range. For this purpose, drugs such as Amoxicillin, Clarithromycin, Levofloxacin, Cephalosporin, Rulid, Midecamycin, Avelox, Clavulanate and others can most often be used. The minimum course of treatment is 5 – 7 days.

Any medications, primarily antibiotics, should be used only as prescribed by a doctor. Uncontrolled use of antibiotics leads to the emergence of antibiotic-resistant pathogens. If treatment is carried out at home, proven folk remedies can also come to the rescue. They perfectly complement the main treatment, accelerating recovery. It can be:

Steam inhalations mineral water and decoctions of medicinal plants;

Fortified drinks (fruit juices, fruit drinks, tea with lemon, compotes, jelly);

Warming compresses;

Massotherapy.

Before using any folk remedies You should definitely consult your doctor.

Prevention

In order to protect yourself from pneumonia, you should follow these recommendations:

It is imperative to vaccinate children against pneumococcal and hemophilus influenzae infections;

Following simple hygiene rules can greatly protect against infection;

Active lifestyle, including mandatory physical exercise, sleep 7 - 8 hours and good nutrition strengthen the immune system;

Quitting bad habits, especially smoking.

It is worth dressing according to the weather, avoiding hypothermia. This is what leads to decreased immunity.

Video

conclusions

Pneumonia is a name that unites a whole group of diseases, each of which has its own clinical picture. In the International Classification of Diseases (ICD) it occupies several sections at once - from J12 to J18, as well as P23. Despite the fact that pneumonia is often almost asymptomatic, it should not be considered a serious problem. A sharp deterioration in health can occur literally within a day. General intoxication and lack of oxygen leads to disruption of the proper functioning of the entire body.

Polysegmental pneumonia differs from other types of pneumonia in that it is especially severe. This pathology requires immediate drug therapy, as its consequences can be fatal. Polysegmental pneumonia can affect only one lung or both at once. The inflammatory process leads to disruptions in the functioning of several parts of the lungs at once. If the disease is not stopped in time, the patient may experience respiratory failure. How to treat such pneumonia?

Definition of disease, code according to ICD-10

High body temperature (38–40 ºC). It rises sharply. It is preceded by severe chills and sweating for 3–4 hours. The temperature persists for several days before the healing process begins.
Dizziness, headache. This manifestation is caused by a deterioration in the supply of oxygen to the structures of the brain due to high blood viscosity.
Aches in muscles and joints, muscle weakness. It is explained by impaired microcirculation, which impairs the nutrition of muscle fibers and periosteum.

Bronchopulmonary manifestations:

Moist cough. With this type of pneumonia, the alveoli are filled with a viscous secretion. The lungs cannot get rid of it on their own. A protective reflex mechanism comes to the rescue in the form of a cough, which removes phlegm.
Dyspnea. A decrease in the area of healthy lung tissue leads to oxygen starvation, which, in turn, causes a compensatory increase and increased breathing. Shortness of breath worsens with physical activity.
Chest pain. Signals the involvement of the pleura in the pathological process. The lungs do not have pain receptors, so they cannot get sick on their own.
Wet wheezing. They are diagnosed by a doctor by listening to the lungs.

Possible complications

Polysegmental pneumonia develops very rapidly, destroying more and more alveoli and causing severe respiratory failure. Bilateral pneumonia is considered especially dangerous when both lungs are involved in the pathological process. In this case, the compensatory capabilities of the lungs are minimal.

Inflammation is accompanied by severe tissue breakdown and the release of toxins into the blood. This causes them to thicken and disrupts the nutrition of the heart and brain. The spread of microbes in the body provokes infection of other organs: the heart (endocarditis, pericarditis), the brain (meningitis). It is also possible purulent complications, such as lung abscess, pleural empyema.

The consequences of polysegmental pneumonia are very dangerous and difficult to treat. It is necessary to stop the disease in the early stages.

Polysegmental pneumonia is especially severe in children. One of dangerous complications For children, immediate hypersensitivity occurs. It is localized in the affected areas, resulting in swelling in the organ.

This complication develops mainly against the background of pneumococcal infection. This microorganism contains proteins similar to human proteins, which is why the immune system cannot fully recognize foreign bodies. The immune system begins to actively fight its own proteins, while leaving foreign microorganisms untouched. The danger of this condition is that due to immediate hypersensitivity, all inflammatory processes, so the disease develops much faster than it should.

Community-acquired treatment

Polysegmental pneumonia is a rather insidious disease: if the moment is missed, the outcome of the inflammation can be quite sad. A patient with such a diagnosis should not neglect the proposed conditions of inpatient treatment.

Only strict, daily monitoring by a doctor will help the patient cure polysegmental pneumonia without serious complications.

By medication

Main medicine Antibacterial drugs are used to treat polysegmental pneumonia, such as:

Cephalosporin drugs (Cefalexin, Cefaclor, Cefuroxime, Cefepime, Cephaloridin, Cefotaxime, Cefazolin, etc.);
Penicillin;
Macrolides (Erythromycin, Roxithromycin, etc.);
Fluoroquinolones (Pefloxacin, Ciprofloxacin, Ofloxacin, Mosifloxacin, Levofloxacin, etc.).

To normalize lung ventilation and expand the bronchial lumens, the patient may be prescribed bronchodilators (Theophylline, Euphylline, Broncholitin, etc.).

In order to relieve cough and better discharge of sputum, the patient takes expectorants and mucolytic drugs.

IN complex treatment also include:

, helping to strengthen the body's immune system;
Cardiovascular drugs;
(Indomethacin, Diclofenac, etc.);
Physiotherapeutic procedures.

During the treatment period, the patient is prescribed bed rest. However, prolonged stay in one position causes pleural adhesions, so he should move and turn as often as possible.

It helps a lot in speedy recovery. It is performed while sitting on the bed or standing on the floor. Breathing exercises help to straighten the lungs and eliminate fluid stagnation. Additionally, it is useful to make movements with your arms and legs.

Doctors pay special attention to the treatment of the child’s body. Due to reactive immunity in a child, the disease can return even without signs of inflammation. Medical supervision vital here!

Treatment of polysegmental pneumonia with folk remedies

Folk remedies for polysegmental pneumonia can serve as an addition to treatment. You can try the following recipes:

Prevention of disease in adults and children

For older people one of effective ways To protect yourself from pneumonia is pneumococcal vaccination. This preventive measure is also relevant for the following people:

Experienced smokers;
Patients with lung and heart problems;
People with low immune status.

Vaccination does not provide an absolute guarantee, but it reduces the risk of developing pathological microflora in bronchopulmonary tissue.

Avoid contact with infected people;
Maintain personal hygiene and general household sanitation (wash hands often with soap, do wet cleaning of premises, etc.);
Strengthen immunity through active and healthy image life, eat fortified foods.

TO preventive measures This also includes massage for bedridden patients, which helps prevent the development of congestive pneumonia.

Video

conclusions

Polysegmental pneumonia is very dangerous pathology. The most important thing for the patient is to consult a doctor at the first symptoms and start drug treatment. Delay in this case is tantamount to death. Parents of a child with pneumonia should be especially attentive. Absolute compliance with all doctor’s recommendations and prescriptions is the main condition here.

Also read about the features of the course of pneumonia such as.