КЛИНИЧЕСКИЙ СЛУЧАЙ ТЯЖЕЛОЙ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ, ПРОТЕКАЮЩЕЙ С ДЕСТРУКЦИЕЙ ЛЕГОЧНОЙ ТКАНИ

Abstract

The сommunity-acquired pneumonia is a widespread pathology of the respiratory organs, which occupies a leading place in the structure of morbidity and mortality from infectious diseases in developed countries. The patients with severe community-acquired pneumonia present the greatest problem for physicians. Despite the available diagnostic and treatment methods, including modern antibacterial medicine, mortality in this category of patients remains high, and treatment is complex and expensive. The purpose of the analysis of this clinical case was to study risk factors, features of clinical manifestations, differential diagnosis and therapy in patients with severe community-acquired pneumonia occurring with lung tissue destruction. In the clinical case, the patient had the background of such risk factors as a long smoking history with a smoker index of 60 pack/years with the formation of chronic obstructive pulmonary disease; alcohol abuse; toxic-alimentary damage to the liver; facts of aspiration on the background of vomiting; prolonged stay in a horizontal position, due to secondary toxic-metabolic polyneuropathy with severe motor disorders. The break in antibiotic therapy developed community-acquired bilateral polysegmental pneumonia, severe form with cavities, destruction of both lungs caused by multiresistant gram-negative microflora, complicated by the development of respiratory failure of degrees 2, polyserositis, and anemia. The patient underwent an extended examination in accordance with the Federal clinical guidelines for the diagnosis and treatment of community-acquired pneumonia. Differential diagnosis was carried out with pulmonary tuberculosis, lung cancer, new coronavirus infection. In the treatment, according to clinical recommendations, controlled oxygen therapy, combined antibiotic therapy taking into account the data of the antibiogram, mucolytic, antioxidant therapy, treatment of underlying diseases and symptomatic therapy were carried out. Against the background of the treatment, the patient showed positive clinical, laboratory and radiological dynamics, in the form of an improvement in general well-being, normalization of laboratory parameters and partial resorption and a decrease in the volume of decay cavities in the lungs.