How Pneumonia Is Diagnosed: Why It’s Not Always Easy
Let’s first clarify what pneumonia is. Pneumonia, or inflammation of the lungs, is an infectious disease in which the most distant and important parts of the lungs that are responsible for oxygen supply to the body, the alveoli, become inflamed. Pneumonia is most often caused by bacteria, but there are also viral pneumonias – with influenza and coronavirus infection, for example.
It is quite simple to diagnose “classic” bacterial pneumonia: a sudden increase in body temperature, shortness of breath, cough, auscultated in the lungs, crepitus characteristic of inflammation (a characteristic sound that is detected when listening to the lungs, received such a name in medicine) and changes on the radiograph in the form of a cloud of infiltration, confirmed by abnormalities in blood tests.
Nevertheless, there is a group of viral pneumonias, including the currently relevant COVID-19-associated pneumonia, which cannot always be seen on a conventional radiograph. The fact is that such pneumonia is not classical: initially it is not caused by the filling of lung cells with inflammation and alveoli – decay products, but by damage to the tissues surrounding the alveoli – the pulmonary interstitium – and blood vessels. Doctors call this lesion interstitial pneumonia, or pneumonitis. So, such a pneumonitis is visible only with high-resolution computed tomography – only it allows you to examine all parts of the lungs in layers. A plain radiograph is a summary image of all the structures of the chest; such “gentle” changes as pneumonitis cannot be caught by her.
What is the difference between pneumonia in COVID-19
In the future, COVID-19-associated pneumonia undergoes a number of changes: areas of viral inflammation “compact” and become “visible” on plain radiographs. Fortunately, when diagnosing pneumonia, not only the X-ray method is used: the correct diagnosis is helped to establish the sequence of symptoms, examination data and laboratory tests. So, with typical bacterial pneumonia, in addition to the characteristic wheezing in the lungs, in the analyzes we will see an increase in the number of leukocytes with a shift in the formula to the left, a sharp increase in ESR and C-reactive protein.
With COVID-19-associated pneumonia, we rarely hear any wheezing in the lungs in the first week of illness. Tests, as a rule, reveal “viral” changes: a decrease in the number of leukocytes, including lymphocytes, an increase in monocytes, a greatly elevated ferritin, a normal procalcitonin test, often a positive PCR or rapid antigen test. To assess the involvement of the lungs in the process, pulse oximetry is used – blood oxygen saturation shows how serious the situation is. Normally, this parameter should be from 95% and above.
What drugs are prescribed by doctors
Bacterial pneumonia is treated with antibacterial drugs, depending on the suspected pathogen, penicillin antibiotics, cephalosporins, macrolides, tetracyclines, or fluoroquinolones are prescribed. For pneumonia caused by the influenza virus, antiviral drugs such as oseltamivir or zanamivir are prescribed.
Drugs that effectively act on coronavirus have not yet been developed, so the treatment of COVID-19-associated pneumonia is carried out with drugs that can affect the mechanisms of development of pneumonia and its complications.
There are separate groups of people for whom any pneumonia can be dangerous: these are the elderly, patients with diabetes, serious chronic diseases of the lungs, heart, liver, kidneys; receiving treatment with immunosuppressive or anticancer drugs; HIV-infected, etc. Both typical bacterial and coronavirus pneumonia can be extremely difficult for them and end sadly. We should also not forget that COVID-19-associated infection is not only pneumonia, it is an infection that, in addition to the lungs, affects the central nervous system, heart, and kidneys.
How to help the body recover
The rate of recovery depends on the area of damage to the lungs and whether the pneumonia was viral or bacterial. On average, general weakness after pneumonia persists for 1-2 months. It should be noted that at present, a post-covid syndrome is also isolated, in which general weakness is not directly related to damage to the lungs or heart and can persist for up to six months.
It is important to give yourself time to recover:
try to walk as much as possible – to the best of your ability;
sleep as long as you want;
do therapeutic exercises daily;
Do not forget to take prescribed drugs, vitamins.