Elderly pneumonia

Elderly pneumoniaElderly pneumonia often lack obvious respiratory symptoms, not more typical symptoms, the disease progress faster, prone to misdiagnosis, wrong appointment. It was reported in the literature, pathology proved to be unable to clinical diagnosis of pneumonia but the "misdiagnosis rate" of 3.3% -61.4%, and clinical diagnosis of pneumonia but no corresponding pathological findings of the "wrong attendance rate of" 10.8% -39.3%. Elderly pneumonia generally have the following clinical features.

(1) have no fever, Katan, and other typical symptoms, only 35% of those symptoms.

(2) of the first to speed up breathing and respiratory difficulties, accounting for 56 percent, or disturbance of consciousness, lethargy, dehydration, anorexia, asymptomatic persons accounted for 10 percent.

(3) signs: a clock-speed, rapid breathing, chest auscultation can hear the sound-and moist, or with respiratory and weakened bronchial-pulmonary respiratory sound.

(4) blood tests: blood checks can be increased or the total number of WBC is not high, but more than half of the left visible, C-reactive protein positive, ESR, such as inflammation faster performance.

(5) blood gas analysis: there PaO2 down, but with chronic obstructive pulmonary disease, pulmonary ventilation due to bad carbon dioxide压升高.

(6) chest X-ray was bronchial pneumonia than large-leaved form of pneumonia see more.

(7) elderly pneumonia-prone water, electrolyte imbalance, acid poisoning. For those with chronic diseases, vulnerable to multiple organ failure and high mortality.

The common types of pneumonia and old age

(1) aspiration pneumonia

As the elderly Houqiang mucosal atrophy, thinning and throat feeling subside, pharynx muscle reduction activities reduced role, have swallowed up obstacles to food and parasitic bacteria in the throat into the lower respiratory tract and cause aspiration pneumonia. Clinical symptoms not typical, only 34% of high fever and no respiratory symptoms were 14%, 35% of patients with gastrointestinal symptoms, attending high rate of mistakes. 20% of patients with neurological symptoms, low blood pressure, septic shock, cyanosis, fatigue, chest pain and rust sputum rare white blood cell count is not high, easy to appear water, electrolyte disturbance. Chest film shows spots or small pieces of the shadow. Sputum checks to gram-negative bacilli main point 1/2-1/3, gram-positive cocci only 10 percent, mixed with 1 / 3.

(2) gram-negative bacilli pneumonia

Hospital with pneumonia accounted for 20 percent, and nosocomial infections account for 15% -80%, the mortality rate can reach more than 50 percent. A major pathogen E. coli, Proteus, Pseudomonas aeruginosa, such as Clayton White pneumoniae. Can be divided into: ① community-acquired pneumonia, mostly primary pneumonia; ② hospital-acquired pneumonia, multi-throat secretions caused by inhalation of the ground (in infection), the droplets from the air propagator (of infection ) Rare.

(3) Mycoplasma pneumonia (Mycoplasma Pneumonia, MP)

Mycoplasma pneumonia in the elderly lung infection in 20 per cent, the onset of misprision, the main expression of irritation for dry cough, irregular fever, headache, chest tightness, nausea, chest X-ray lower inflammation, or a spot-point - Shadow, multi-shaped, more than right lung left lung, and a small amount of pleural effusion. Clinical difficult with the virus or bacterial infection distinction between mild, misdiagnosis rate was as high as 55 percent. So in the following circumstances: ① similar clinical manifestations of infection, the antibiotics (erythromycin, tetracycline, except) to poor treatment; ② disease and lesions not commensurate with chest film (that is, chest film clearly inflammatory lesions, The symptoms do not weight) to; ③ lower lung inflammation and a small amount of pleural effusion, difficult to explain to tuberculosis. Should be further mycoplasma antibody serum for examination, serum specific complement of test (+) 1:40-1:80, condensation test (+), contribute to the diagnosis.

(4) end-stage pneumonia

Refer patients dying before the pneumonia, often secondary to other diseases of the late general and pneumonia may be different, pathological data as high as 30% to 60%. Is not included in the independent disease. Clinical features, often no obvious signs of early, with the condition can be aggravated has the following characteristics: ① can not be used to explain the onset of fever or chills; ② respiratory difficulties or cyanotic disease is not commensurate with the original; ③ can not use the original disease or other reasons to explain Low blood pressure, shock or unconscious increase; ④ Nongxue disease; ⑤ more than a rash or septic Paozhen; ⑥ lung-breathing weakened or disappeared, moist-not-to changes in body position changes.

(5) hospital-acquired pneumonia (Noscomial Pneumonia, NP)

Refers to the hospital by bacteria, fungi, Mycoplasma, viruses, protozoa, or caused by inflammation of the lungs. In the elderly in the incidence was significantly higher than that of young people, the incidence rate of 0.5 per cent to 15 per cent of all hospital infections of 1-3 times. Gram-negative bacilli main pathogens to see the most, accounting for 68% -80%, which again pneumoniae, Pseudomonas and Enterobacter, Klebsiella Bacillus common. Gram-positive cocci 24 per cent, accounting for about 5 percent mold.

Diagnostic criteria: ① pneumonia in hospital at least 48 hours before the above; ② pneumonia symptoms and signs seen in the hospital after eight days; ③ prevalence of at least 48 hours before the day stay in hospital a few hours of outpatient visits or patients; ④ hospitalized because of pulmonary inflammation, the treatment was improved, but after reproduction fever and pneumonia symptoms and signs more obvious, once again elevated white blood cell count, chest X-ray examination revealed the infiltration of new video; ⑤ sputum culture for two consecutive times isolated from the same Pathogens.