Treatment of pneumonia in patients with diabetes mellitus

Infectious processes covering various systems of the human body in patients with diabetes mellitus are manifested quite often. The danger is that diseases are difficult and often provoke the development of dangerous complications.

For example, pneumonia in diabetes can lead to the development of pathologies that are fatal. In addition, inflammatory processes in the lungs can cause decompensation of the disease in the diabetic.

The most dangerous respiratory tract pathologies for the patient, developing against the background of the activity of Staphylococcus aureus and gram-negative microorganisms. In such conditions, the inflammatory process itself can cause the death of the patient.

How does pneumonia occur in diabetes?

The course of pneumonia in diabetes

Diabetes mellitus is one of the main problems of the modern world. A sufficient number of people suffer from the disease, which increases annually.

The main danger is that diabetes cannot be completely cured. The main goal is to achieve high compensation, acting as a method of preventing dangerous complications of the disease.

Why the risk of developing pneumonia in diabetes rises.

Patients should be aware that diabetes affects many areas of the body. First of all, the immune system suffers, which leads to the progress of various bacterial pathologies, including pneumonia or bronchitis.

Such diseases are quite common and successfully cured, however, with diabetes, the principle of the development of the disease looks different. Dangerous complications, despite the timely use of antibacterial components, develop often, there is a likelihood of death.

In diabetes mellitus, pneumonia develops in the decompensation stage, when various lung lesions occur due to high blood sugar levels, and pulmonary microangiopathy develops.

The main reasons that contribute to the development of pneumonia in patients with diabetes mellitus:

  • reduced immunity and general weakening of the body,
  • increased chance of infection in the respiratory tract, i.e. aspiration,
  • hyperglycemia, which not only contributes to the development of pneumonia, but also leads to a more severe course of the disease than in patients with normal blood sugar,
  • pathological changes in the vessels of the lungs (pulmonary microangiopathy), which, according to medical statistics, are twice as common in patients with diabetes as in healthy people,
  • accompanying illnesses.

All these factors, as well as poor control over blood sugar, create favorable conditions in the human body for damage to the respiratory tract, including pneumonia. And an infection that penetrates the lungs becomes the destabilizing factor that aggravates the situation of a weakened organism. A general decrease in immunity not only increases the likelihood of pneumonia, but can also lead to a severe course of the disease, various complications and a long recovery. Another danger of a disease accompanied by an inflammatory process for people with metabolic disorders is the possibility of diabetes mellitus becoming more severe

Symptoms of pneumonia in patients with diabetes mellitus.

Symptoms of pneumonia in patients with diabetes are typical and do not differ much from the symptoms of healthy people. Basically, they may differ depending on the type of pneumonia and some other factors. For example, elderly people or people with an extremely weak body as a result of an illness tend to have less fever and less obvious symptoms, although lung damage is more dangerous for such patients.

So, the main symptoms of pneumonia include:

  • high fever (usually above 38 degrees) and chills,
  • cough, which can persist up to 1.5-2 months after recovery,
  • chest pain when inhaling,
  • general weakness, fatigue, headache, muscle pain,
  • increased sweating,
  • sore throat
  • loss of appetite,
  • bluish tint of the skin near the lips and nose,
  • in serious cases - difficulty breathing, confusion.

Pneumonia in diabetes mellitus most often develops, as statistics show, in the lower lobes or posterior parts of the upper lobes of the lungs. In this case, the right lung is most often affected. Diabetics quite often develop necrosis and extensive abscesses. In addition, studies have shown that in people with metabolic diseases, a bacterial infection penetrates the blood much more often than in healthy people with pneumonia. This leads to an increase in mortality by one and a half times. That is why diabetics need to be responsible for the prevention and treatment of respiratory diseases with all responsibility.

Prevention of pneumonia.

Preventive measures, first of all, include complete cessation of smoking and vaccination. The main bacteria that are found in diabetics with pneumonia are staphylococcus and gram-negative bacilli. These infections can cause serious complications even with mild flu in people with reduced immunity. Given this danger, patients with diabetes should be vaccinated against pneumococcal pneumonia and influenza.

The pneumococcal pneumonia vaccine provides long-term protection and is required only once. A flu shot is recommended annually (especially for people over 65).

Features of the treatment of pneumonia in patients with diabetes mellitus.

The main treatment for any pneumonia is the appointment of antibacterial drugs that must be taken for a certain period. Interruption of treatment even with the complete disappearance of the symptoms of the disease can lead to relapse. When choosing an antibiotic, doctors must take into account the severity of diabetes, as well as the presence of possible allergic reactions. As a rule, with mild pneumonia or moderate pneumonia, antibiotics such as azithromycin, clarithromycin, amoxicillin are prescribed, which are well tolerated by patients with diabetes mellitus. However, while taking antibacterial drugs, as well as other drugs, patients with diabetes should especially carefully monitor their blood glucose levels to avoid adverse effects and complications.

For the treatment of pneumonia, it is also very often prescribed:

  • antiviral drugs that allow you to quickly cope with some types of viral infections (ribavirin, ganciclovir, acyclovir and others),
  • analgesics that reduce pain and fever,
  • cough medicine
  • bed rest.

In some cases, it may be necessary to remove excess fluid in the area around the lungs, an oxygen mask, or a respirator to facilitate breathing. To reduce the accumulation of mucus in the lungs, doctors recommend drinking at least 2 liters of water per day (unless the patient has heart or kidney failure). Quite often, drainage massage, exercise therapy and physiotherapy are prescribed.

In the early stages of pneumonia, hospitalization may be recommended. This is especially true for elderly patients.

In any case, treatment for pneumonia, especially for patients with diabetes mellitus, should be prescribed by a doctor who will monitor the patient's condition throughout the illness. In addition, the patient himself must be very attentive to his health, following all the instructions of the doctor, and constantly monitoring the level of sugar in the blood.

Causes of pathology

The following factors lead to pathologies of the respiratory tract in a patient:

  • decrease in the body's defenses,
  • increased risk of recurrence of systemic diseases in acute and chronic form,
  • hyperglycemia leads to intoxication and impaired trophism of the lung tissue, as a result of which it becomes vulnerable to pathogenic microflora,
  • diabetic angiopathy (destructive changes in blood vessels, loss of their tone and elasticity, narrowing of the lumen) is observed, including in the pulmonary arteries,
  • metabolic disease,
  • imbalance of the endocrine system.

Increased sugar causes negative changes in the cells, making them more susceptible to pathogens. Nosocomial and community-acquired pneumonia in diabetes causes the most common pathogen - Staphylococcus aureus. The bacterial form of the disease can also provoke Klebsiella pneumoniae. In some cases, the disease is caused by fungi (Coccidioides, Cryptococcus).

In the chronic form of hyperglycemia, pneumonia proceeds atypically against the background of a viral infection. Then the bacterial one joins, which leads to a decrease in blood pressure, a change in the psychoemotional background. In diabetics with pneumonia, the risk of developing tuberculosis is significantly increased.

Clinical picture

In people with diabetes, the symptoms of pneumonia are more pronounced. For example, they often develop edema of the respiratory system at the background of increased penetration of capillaries, dysfunction of neutrophils and macrophages, and general weakening of immunity.

In elderly diabetics, the clinical picture may not be sufficiently expressed, and the temperature may be moderate.

  • wet chest cough, which can persist for several months,
  • pressing and aching pain in the sternum, which intensifies with a change in body position, wearing compressive clothing, as well as exhaling,
  • general weakness and lethargy,
  • loss of appetite,
  • fluid accumulation in the lungs with diabetes,
  • hyperthermia (temperature may exceed 38 ° C), fever and fever,
  • sleep disturbances
  • respiratory symptoms
  • increased sweating
  • inflammatory processes of the oropharynx, throat,
  • blue skin and mucous membranes in the area of ​​ENT organs,
  • confusion, fainting,
  • difficulty breathing
  • discharge of blood or pus with sputum,
  • thickening of the blood (toxins, waste products of pathogens, dead white blood cells, etc. accumulate in it).

According to medical statistics, in patients with hyperglycemia, the lower lobes of the respiratory organs, as well as the posterior parts of the upper, are more often affected. It was noted that inflammation often spreads to the vulnerable right lung.

The lack of prompt and competent treatment leads to complications of the disease: extensive purulent abscesses, pulmonary embolism, tissue necrosis. It must be understood that when a bacterial infection from the upper respiratory tract enters the bloodstream (sepsis), the risk of death is 1.5 times higher.

Therapies

Therapy of pneumonia, first of all, involves the use of antibiotics for a long course, that is, even after the symptoms are completely eliminated (the disease tends to recur in the early period of rehabilitation).

Before prescribing drugs, doctors evaluate the stage and form of diabetes, the presence of individual reactions. Mild and moderate pneumonia in diabetes mellitus involves the use of the following antibiotics: Amoxicillin, Azithromycin, Clarithromycin. Also, the sugar level is carefully monitored and, if necessary, the regimen of insulin intake is changed.

Additionally, for the treatment of inflammatory processes, it is prescribed:

  1. antiviral drugs (Ganciclovir, Ribarivin, Acyclovir and others),
  2. analgesic systemic drugs (not antispasmodics) that will help eliminate symptomatic pain in the sternum,
  3. syrups and cough tablets, which facilitate the discharge of sputum,
  4. anti-inflammatory and antipyretic drugs for fever and fever (for example, Ibuprofen, Paracetamol),
  5. physiotherapeutic procedures and punctures that will allow you to remove excess fluid from the respiratory organs,
  6. a respirator or oxygen mask to restore normal breathing,
  7. drainage massage, facilitating the outflow of fluid and sputum discharge,
  8. bed rest
  9. physical therapy courses.

Causes of inflammation

Diabetes mellitus is a severe, systemic pathology, which is considered a chronic disease that does not pose a threat to the patient’s life under the condition of timely therapeutic intervention.

Treatment is based not only on the use of medications, the course of therapy without fail includes following the rules of a healthy lifestyle. The greatest danger to the health of a patient with diabetes is represented by diseases progressing against the background of a significant decrease in immunity.

Attention! If a patient has diabetes, a cold can cause pneumonia. Diseases progress quickly and lead to dangerous disorders.

The causes of pneumonia in diabetes can be represented as follows:

  • decrease in protective properties of the body,
  • general weakening of the body against the background of the inflammatory process,
  • hyperglycemia
  • pathological changes in the vessels of the lung,
  • the presence of concomitant diseases.

Infections quickly enter the patient's lungs and lead to a rapid deterioration in his health.

Causes and Risk Factors

Often, pneumonia develops against the background of a seasonal cold or flu. But there are other causes of pneumonia in diabetics:

  • chronic hyperglycemia,
  • weakened immunity
  • pulmonary microangiopathy, in which pathological changes occur in the vessels of the respiratory organs,
  • all kinds of concomitant diseases.

Since elevated sugar creates a favorable environment in the patient's body for the penetration of infection, diabetics need to know which pathogens can trigger pulmonary inflammation.

The most common causative agent of pneumonia of nosocomial and community-based nature is Staphylococcus aureus. And bacterial pneumonia in diabetics is caused not only by staphylococcal infection, but also by Klebsiella pneumoniae.

Often with chronic hyperglycemia, atypical pneumonia caused by viruses first develops. After a bacterial infection joins it.

The peculiarity of the course of the inflammatory process in the lungs with diabetes is hypotension and a change in the mental state, while in ordinary patients the symptoms of the disease are similar to signs of a simple respiratory infection. Moreover, in diabetics, the clinical picture is more pronounced.

Also, with an ailment, such as hyperglycemia in diabetes mellitus, pulmonary edema more often occurs. This is due to the fact that capillaries become more penetrating, the function of macrophages and neutrophils is distorted, and the immune system is also weakened.

It is noteworthy that pneumonia caused by fungi (Coccidioides, Cryptococcus), staphylococcus and Klebsiella in people with impaired insulin production, is much more difficult than in patients who do not have metabolic problems. The likelihood of tuberculosis also increases significantly.

Even metabolic failures have an adverse effect on the immune system. As a result, the likelihood of developing an abscess of the lungs, asymptomatic bacteremia, and even death is increased.

Features of pneumonia in diabetes

A disease like diabetes is the scourge of our time. Around the world, annually, a huge number of people with diabetes die. However, it is not the disease itself that is terrible, but the complications that it can provoke in a person.

Particular attention should be paid to such a complication of diabetes as pneumonia.A huge percentage of patients with diabetes face precisely this serious complication, which, if untreated, can lead to death.

Causes and symptoms of pneumonia in diabetics

People with diabetes have a much higher risk of pneumonia than people who don't have the disease. This is preceded by the following reasons:

    as a result of developing metabolic disorders in the body, patients have a decrease in the protective functions of the body. As a result, a person's immunity decreases, and he becomes more susceptible to infections. Thus, even a minor cold or flu can lead to pneumonia, other diseases that accompany diabetes can also cause pneumonia, any pathological change that occurs in the lungs can cause inflammation in the patient’s lung tissue, and there is a high the likelihood of various infections penetrating the respiratory tract, worsening health and causing pneumonia can be caused by hyperglycemia, bacteria such as the intestinal shelf, myco can provoke pathology plasma, pneumococcus, chlamydia, fungi and various viruses, untimely or incompletely cured infectious and viral diseases, can also cause an inflammatory process in the tissues of the lungs of a diabetic.

It is important to say that against the background of a weakened immune system in diabetics, pneumonia leads to a rather severe course of the disease and a longer treatment. The main danger is that pneumonia can provoke a more complex form of diabetes and worsen the condition of the patient.

In most cases, the symptomatology of the disease in diabetics is exactly the same as in people who do not have diabetes. The only thing that is much more pronounced in patients with diabetes with pneumonia is the severity of the symptoms.

Particular attention should be paid to your health if a diabetic shows signs of the disease, such as:

    persistent high temperature, which reaches 39 degrees and above, constant chills and fever, persistent dry cough, gradually turning into a cough with sputum production, headaches and muscle pains that do not go away even with time, severe dizziness, lack of appetite may appear, pain when swallowing, in a patient with diabetes, pneumonia is accompanied by severe sweating, severe shortness of breath, a feeling of lack of air when breathing in and clouding of consciousness are possible. It is characteristic of the more advanced stage of pneumonia, characteristic pains appear in the area of ​​the patient’s lung, aggravated by intense coughing or movement of the patient, as for coughing, he can stay for a sufficiently long period of time, up to several months inclusive, the patient experiences fatigue, he quickly gets tired even with minor physical exertion, the skin around the nose and mouth gradually acquires a characteristic shade of bluish color, sore throat is also one of the symptoms of pneumonia, in abetics with pneumonia, a strong blueing of the nails is possible, with breathing, especially with strong breaths, unpleasant pain appears in the chest area.

In diabetics, inflammation in the lower lobes or posterior segments of the upper lobes of the lungs is most often observed. In this case, the right lung, due to its specific anatomy, is affected much more often than the left.

An infection can enter the blood, because metabolic processes in the body of diabetics occur much worse than in a healthy person. As a result of this, the likelihood of severe complications up to a fatal outcome increases significantly.

If a person with diabetes responds in time to his health condition and turns to a pulmonologist for a diagnosis of the disease, he will be able to avoid the many unpleasant consequences associated with pneumonia.

Inflammation of the lungs with diabetes

Community-acquired pneumonia is an infection of the upper respiratory tract that is received outside a hospital or other medical facility. As a rule, the transmission of the pathogen is carried out by airborne droplets. After the pathogenic microorganism settles in the alveoli, an inflammatory reaction begins.

Diabetes mellitus is a group of metabolic disorders characterized by a state of chronic hyperglycemia as a result of a defect in insulin secretion, the effects of insulin, or both processes. The prevalence of the disease in the world is amazing.

The pathogenesis of the main complications is associated with the microangiopathic process and non-enzymatic glycosylation of tissue proteins. A wide range of neutrophil and macrophage functions is affected in this disorder. Thus, immune cells are not able to perform protective actions:

    chemotaxis, adhesion, phagocytosis, neutralization of phagocytized microorganisms.

The intracellular breakdown of microbes by superoxides and hydrogen peroxide (respiratory burst) is disrupted. In patients with such an ailment, disturbances in the chains of acquired immunity occur.

As a result of chronic hyperglycemia, capillary endothelial functions, erythrocyte stiffness change, and the oxygen dissociation curve is transformed. All this affects the body's ability to resist infections. As a result, patients with long-term diabetes are more susceptible to infections.

The causative agents of pneumonia in patients with diabetes

Staphylococcus aureus (Staphylococcusaureus) is the most common agent that provokes community-acquired and nosocomial pneumonia in patients with diabetes. Bacterial pneumonia in diabetes caused by Klebsiellapneumoniae and Staphylococcus aureus is very difficult. Such patients often require respiratory support with a ventilator.

Special prevention

People with this chronic illness are three times more likely to die from flu and pneumonia. Inflammation of the lungs is a rather serious disease for everyone, but if the patient has problems with the production or activity of insulin, then he is sick longer and may die from pneumonia.

The real help for these patients is vaccination. The composition of the drug includes a 23-valent pneumococcal polysaccharide that protects against various types of pneumococcal bacteria. This bacterium often causes serious infections in adults and children, including pneumonia, meningitis, and blood poisoning.

As a growing number of pathogens become antibiotic-resistant, it is very important to vaccinate patients with a weakened immune system. Vaccination against pneumonia is recommended:

    children under 2 years old, adults over 65 years old, patients with chronic diseases (diabetes, asthma), patients with damaged immunity (HIV-infected, patients with cancer, undergoing chemotherapy).

The pneumonia vaccine is safe because it does not contain live bacteria. This means that there is no chance of getting pneumonia after immunization.

Specific risk factors

Comparing patients with pneumonia who suffer from diabetes and those who have no problems with carbohydrate metabolism, interesting details can be found. Most diabetics suffer from SARS of viral origin, and then a bacterial infection joins it.

The prevailing clinical features of patients with pneumonia in diabetes mellitus are a change in their mental state and hypotension. And in the usual group of patients, symptoms of a typical respiratory form of the disease are observed. Manifestations of pneumonia in people with diabetes are harder, but this may be due to the large age of patients in this group.

An independent study by Spanish scientists showed that diabetics often develop pleurisy. This is due to an increase in capillary permeability, a less energetic immune response, distorted by the function of neutrophils and macrophages.

Staphylococcal infection, infection with Klebsiellapneumoniae, a fungus of the genus Cryptococcus and Coccidioides in patients with impaired insulin production is also more difficult than in people without this chronic disease. In addition, diabetes is a risk factor for the reactivation of tuberculosis.

A metabolic imbalance impedes the functioning of the immune system, therefore, the risk of asymptomatic bacteremia, pulmonary abscess and death increases.

Causes of pneumonia in diabetes

The danger of diabetes lies in the presence of certain concomitant diseases, among which pneumonia takes the second place. Among the most common causes of pneumonia in patients with diabetes, it is worth highlighting the following:

    weakness of the body and low immunity, the risk of infection in the respiratory tract, hyperglycemia, complicating the course of the disease, pathological changes in the pulmonary vessels, concomitant diseases.

These factors, combined with poor control of blood sugar levels, become ideal conditions for respiratory tract damage. Penetrating into the lungs, the infection exacerbates the situation of an already weakened organism, leading to complications and an increase in the recovery period.

To think about the possible development of pneumonia in patients with diabetes should phenomena like:

    chills and fever up to a high level, cough that persists for up to 2 months after recovery, chest pain when you inhale, sweating, weakness, fatigue, loss of appetite, blurred consciousness, sore throat and shortness of breath, skin becomes bluish (about nose and lips).

Treatment of pneumonia in patients with impaired metabolism

Prescribing antibiotics is the main therapeutic measure in the development of pneumonia in diabetics. In this case, the doctor should consider 2 factors:

    the severity of diabetes, the presence of allergic reactions.

In the treatment of pneumonia, including asymptomatic, accompanying mild or moderate stage of diabetes, such drugs as Amoxicillin, Clarithromycin, Azithromycin will be appropriate, since they are well tolerated by patients.

When using drugs, the patient should control the level of glucose in the blood, avoiding the appearance of complications and adverse effects. Also, a specialist can prescribe analgesics, cough suppressants and antiviral drugs.

Diabetes pneumonia

My son-in-law, 22 years old, has bilateral pneumonia due to diabetes. Sugar is 8 units, the temperature is already 4 days 39, on the second day there was a cough, sore throat and white plaques. Today they put in a hospital, ceftriaxone was dripped intravenously in the morning.

He also has diarrhea from amoxiclav (he took it at home for 3 days). In the evening the head came. squad and canceled the antibiotic. He said that dysbiosis should be treated and prescribed bifidumbacterin in powders, nystatin in tablets. What should we do with temperature, even an analytical mixture does not knock it down. Can take him to the regional hospital?

Answer

The question of the need for transfer to a regional hospital is decided only by the attending physician. Best regards, endocrinologist Titova Larisa Aleksandrovna.

How to protect yourself from pneumonia

Pneumonia should be understood as a group of acute infectious and inflammatory diseases of the lungs. In a non-medical environment, pneumonia is called "pneumonia." “Inflammation of the lungs” and pneumonia are one and the same thing.

Pneumonia is one of the most common diseases. The incidence of pneumonia in the population is increasing from year to year.

Pneumonia can be caused by a wide range of microargonisms. Microflora enters the lungs from the nasopharynx and oropharynx from the air - the so-called airborne droplet - and when aspirating large amounts of the contents of the oropharynx (vomit, food) by the patient unconscious, with violation of the act of swallowing, weakening of the cough reflex.

The most common pneumococcal pneumonia. It occurs after acute respiratory viral infections, manifested by a stormy onset: sudden severe chills, fever to high numbers, chest pain (pleural pain), cough with mucopurulent, sometimes bloody sputum.

There are varieties of pneumonia that do not have such a rapid onset, but in any case, the disease begins in the form of a respiratory syndrome, malaise, fever, cough with sputum. There may not be pleural pains.

Viral pneumonia is less common, often during an influenza epidemic, but is more severe. Pneumonia begins like normal flu (usually in patients with existing heart and lung diseases, overweight and diabetes, in the elderly).

In elderly patients, the incidence of pneumonia is 2 times more likely than in young people. The frequency of hospitalizations increases with age more than 10 times.

Predisposing factors are dehydration - increased body fluid loss: overheating, sweating, diarrhea, vomiting, insufficient water intake, high temperature, weight loss, lower protective barriers of the skin and mucous membranes as a result of atrophic processes, immunodeficiency.

The diagnosis is usually confirmed by x-ray examination. Pneumonia in patients with chronic alcohol intoxication proceeds in a special way.

It is known that chronic alcohol intoxication affects the liver, stomach, pancreas, heart, nervous system, lungs, kidneys, blood system, endocrine and immune systems.

All this aggravates the course of pneumonia. The clinical picture of pneumonia in this category of patients differs in the erased beginning: a non-burdensome cough, slight weakness, slight shortness of breath, low-grade fever, but it can also be high.

In patients with diabetes, pneumonia manifests itself as common symptoms of the disease with the development of decompensation of diabetes. The danger of pneumonia is that with it often complications appear that threaten the patient's life. These include: acute respiratory failure, pleurisy, lung abscess, toxic pulmonary edema, toxic toxic shock, acute pulmonary heart, myocarditis.

That is why patients with pneumonia, mainly, should be treated in a hospital. Outpatient treatment is acceptable subject to all the rules of the inpatient regimen and treatment. In many cases, hospitalization is a prerequisite for successful treatment.

Treatment includes adherence, good nutrition, and drug therapy. During the period of fever and intoxication, it is necessary to observe bed rest, carefully take care of the skin and oral cavity.

Food should be nutritious, rich in vitamins. For the first time, food should be liquid or semi-liquid. A plentiful drink is recommended: tea, fruit juices, mineral water, broth.

It is necessary to contact the local therapist in a timely manner or call a doctor at home for timely diagnosis, treatment and identification of hospitalization criteria.

A little about the prevention of pneumonia: smoking cessation, sanitation of foci of infection, maintaining a healthy lifestyle, walking in the fresh air, ventilating living quarters, timely seeking medical help if there are signs of upper respiratory tract infections (ARVI), and timely treatment.

Watch the video: Pneumonia. Nucleus Health (February 2020).