Keywords: elderly pneumonia clinical manifestations
General pneumonia symptoms, such as chills, chills, fever, cough, chest pain may be obvious, but often appear tachycardia, tachypnea, and for early symptoms of lung inflammation wide range of diseases with hypoxemia performance as lethargy, awareness blurred expressions retardation.
The elderly pneumonia associated with bacteremia, about 20%, 40% of sepsis and corresponding symptoms. Acute onset of aspiration pneumonia, but often the onset implicit latent the sputum anaerobic infections often with the smell. Approximately 20% of patients with white blood cell increased pulmonary local audible and moist rales usually no signs of consolidation.
The chest X-ray diagnosis of pneumonia is extremely important, the new infiltrate the lungs diagnosis can be made, but a variety of different pathogens pulmonary manifestations but lack the characteristic and difficult to distinguish. Patients accompanied by dehydration, especially in low white blood cell, to slow the emergence of lung infiltrate. Should also be noted that the interference of the lungs underlying disease, associated with emphysema, bullae, often appear in the X line incomplete consolidation of the shadow. Associated with congestive heart failure, acute respiratory distress syndrome, atelectasis, pulmonary embolism, pulmonary embolism, often lead to missed diagnosis of pneumonia. Pneumonia lesions were not limited to a single leaf, even if the pneumonia is Streptococcus pneumoniae infections fairly frequently infringe up leaves.
Aspiration pneumonia lesions located in the posterior segment of the upper lobe or lower lobe of the previous paragraph, the right lung is more common, easy purulent lesions, resulting in necrosis, liquefaction and cavity formation, and often complicated by empyema. Pneumonia in the elderly absorption slow delayed until completely absorbed by 8 to 16 weeks beginning. Absorption was slow yet should consider whether the infected bacteria become resistant.
In older people with a high incidence of lung cancer, lung inflammation, especially paragraph pneumonia or pneumonia treatment absorption incomplete, or repeated in a local produce inflammation, sputum, bronchoscopy examination to rule out lung cancer by caused by obstructive pneumonia. Elderly pulmonary tuberculosis have been found, especially associated with diabetes, high incidence of tuberculosis in the treatment of pneumonia by absorption is not ideal, should be further examination to exclude tuberculosis.
The elderly pneumonia pathogens is extremely complex, clinical manifestations and epidemiological presumably pathogens, empiric treatment effect is not satisfied. If we can get the precise etiological diagnosis and antibiotic susceptibility data is very helpful in guiding clinical treatment.
Facilitate the collection of sputum specimens, is widely used in clinical, but because of the elderly population pharyngeal Gram-negative bacilli infection rate than the general population is high, resulting in separation of the resulting bacteria are not necessarily representative of lower respiratory tract infection pathogens.
Thus, the culture of the sputum samples before processing select “qualified" sputum specimens sputum washing is very important as well as quantitative culture of sputum specimens treated to reduce pollution, and to avoid upper respiratory tract contamination ideal way to sample directly from the bottom respiratory specimens collected, such as through endotracheal suction method by bronchoscopy specimens brush double plastic pipe pollution prevention, pollution prevention bronchoalveolar lavage. The above-mentioned methods are traumatic technology, should be weighed considering the selection, mainly used in patients with underlying diseases or hospital-acquired severe pneumonia, severe pneumonia poor empirical antibiotic treatment effect, as well as the lungs of anaerobic infections.