Bilateral (Double) Pneumonia

Lung inflammation or pneumonia is a viral disease that affects lung tissue and interferes with normal oxygen exchange between air and blood. Inflammatory secretions that enter the alveoli prevent the body from getting enough oxygen. And if the disease affects most of the lungs, acute respiratory failure develops.

Lungs are paired organs located in the right and left half of the chest cavity. With bacterial, viral, and other pneumonia, the inflammatory process can develop in the right, left, and sometimes in both lungs at once – in such cases, it is bilateral pneumonia. 

People with weak immune systems, children, and the elderly are susceptible to pneumonia. Millions of people suffer from the disease every year, and 30% of them are young children and people over 70 years of age.

Double pneumonia is caused by various infectious agents. These are bacteria in about 90% of cases, and 10% are viruses, fungi, protozoa, and helminths (roundworm, toxoplasma, schistosomes).

The most common pathogens include pneumococcus, Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, influenza viruses, and respiratory syncytial infections. Most often, double pneumonia caused by these pathogens develops after hypothermia or as a complication of ARVI.

When does this disease arise, and how does it proceed? What treatment is prescribed in such cases? You can find the answers to all these questions below.

 

Causes of Bilateral Pneumonia in Adults

Depending on the epidemiological conditions, the occurrence of pneumonia is subdivided into:

1. Community-acquired (outpatient) – occur outside the hospital or within 48 hours from the moment of admission to the hospital. Have a favorable prognosis.
2. Nosocomial (hospital) – occurs in a hospital, 48-72 hours after admission. The prognosis largely depends on the resistance of the pathogen to antibiotics.
3. Pneumonia in adults with immunodeficiency states – the prognosis is poor and requires active treatment in a hospital setting.
4. Aspiration pneumonia – pneumonia resulting from the ingestion of the contents of the gastrointestinal tract into the respiratory tract.

Depending on the extent of the lesion and the mechanism of occurrence, pneumonia is divided into focal and lobar.

1. Focal pneumonia is pneumonia with the localization of the inflammatory process in a limited area of ​​the lung tissue, within the small structural units of the lung – lobules. Focal pneumonia usually develops as a complication of ARVI or acute tracheobronchitis. The clinical picture, in this case, can be “erased” and resemble a protracted course of bronchitis.
2. Lobar pneumonia is an inflammation of the lung of an infectious nature, which is characterized by the involvement in the process of one or more lobes of the lung, with the pleura covering them. The clinical picture is manifested by severe intoxication, intense cough, shortness of breath with tachypnea, and tachycardia. Lobar pneumonia most often develops due to prolonged hypothermia.

 

Causes of Double Pneumonia 

 To avoid double pneumonia, you need to know about the causes of its occurrence:

1. With pneumonia in small sacs, alveoli, which are normally filled with air, an inflammatory process develops, which occurs due to infection caused by various pathogens. Most often, these are bacteria that penetrate the lower respiratory tract when inhaling air containing pathogens, primarily pneumococci, less often staphylococci, legionella, mycoplasma, and others. With a bacterial infection, both lungs can be affected. In the latter case, unilateral pneumonia develops – right- or left-sided.
2. Viral infection. The causative agents can be various viruses: influenza A and B viruses, parainfluenza, adenoviruses, respiratory syncytial viruses. All of them are respiratory viruses that cause influenza and SARS.
3. Less commonly, viral pneumonia is caused by cytomegaloviruses, enteroviruses, Epstein-Barr viruses, herpes, and measles. It used to be thought that viral pneumonia in adults with normal immune responses was rare. The disease developed in debilitated patients suffering from concomitant heart pathologies, diabetes mellitus, etc.

 

But with the onset of the novel coronavirus pandemic, the number of viral pneumonia cases has skyrocketed.

Double Pneumonia in COVID-19

Viral pneumonia is considered the main manifestation of COVID-19: according to some experts, it is detected in more than 91% of patients with coronavirus infection. In this case, the disease is bilateral – the alveoli in both lungs are affected.

 

Symptoms are typical of COVID-19 in general. Among the classic signs:

• increased body temperature (in more than 90% of cases);
• cough, unlike bacterial pneumonia, dry or with little sputum;
• shortness of breath – the appearance of difficulty breathing, a feeling of lack of air, which occurs due to a violation of the gas transport function;
• a feeling of congestion, and chest pain;
• fatigue and weakness, which are the result of general intoxication of the body.

 

Manifestations common to other respiratory infections may also occur:

• sore throat;
• runny nose;
• signs of damage to the conjunctiva of the eye (lacrimation and redness of the eyes);
• muscle pain;
• headache;
• diarrhea.

A decrease or complete loss of smell and taste is very characteristic of coronavirus infection – this is a fairly common but not mandatory sign of the disease.

 

The Course of Pneumonia with Coronavirus Infection

Double pneumonia develops with moderate to severe COVID-19.

 

A moderate course is accompanied by:

• an increase in body temperature of more than 38 ° C;
• an increase in the frequency of respiratory movements more than 22 per minute (at a rate of 16-22 movements);
• shortness of breath on exertion;
• saturation (oxygen level in the blood) from 93 to 95% – at a rate of more than 95%.

 

On computed tomograms in such cases, changes characteristic of “covid pneumonia” are already reflected in the form of areas of “frosted glass”. The volume of lesions is minimal or moderate: the degree of lesion corresponds to 1 or 2 points (the severity of changes is less than 25% or from 25 to 50% of the lungs). This may indicate a mild to moderate form of double pneumonia.

 

With a severe course of the disease, the situation is much more serious:

• respiratory rate exceeds 30 per minute;
• the saturation level is 93% or less;
• the condition worsens, there is excitement or, conversely, depression of consciousness;
• blood pressure decreases – systolic pressure drops less than 90 mm Hg. Art. or diastolic – less than 60 mm Hg. Art .;
• urination is disturbed – the volume of urine excreted within an hour is less than 20 ml (50 ml per hour normally);
• changes are much more pronounced than with a moderate course; the volume of the lesion is more than 50%, according to CT – 3-4 points.

 

Extremely severe pneumonia in adults can be accompanied by a persistent increase in temperature and acute respiratory failure. Sometimes patients need invasive ventilation of the lungs and a complex of severe disorders.

Signs of Pneumonia in a Child and Types of Its Spreading

Signs of Pneumonia in a Child

Often pneumonia in children appears as a complication of any viral infection (ARVI, flu, etc.):

• a cough that gets worse over time;
• if the baby’s well-being has improved, and then it became bad again, this may indicate the presence of complications;
• every deep breath leads to a violent attack of coughing;
• there is a strong pallor of the skin against the background of the development of the listed symptoms;
• shortness of breath.

 

How Does Double Pneumonia Spread?

The disease can be transmitted in different ways:

1. Airborne method. During illness, droplets form on the mucous membrane of the mouth and nose, which spread through the air during sneezing and coughing. You can get infected by airborne droplets in any public place: a hospital, a store, and public transport. The pathogenic pathogen spreads through the air along with particles of mucus, sputum, and saliva.
2. Contact. Also, the infection is transmitted through contact – handshaking, hugging, and kissing. People become infected by touching contaminated objects or touching their mouth, eyes, and nose with dirty hands.
3. Domestic. The infection can be transmitted through shared towels, dishes, and bedding. Therefore, the patient needs to be provided with personal hygiene items, and they should be changed and washed more often. However, personal hygiene items must be handled very carefully. It has been proven that a viral microorganism can survive up to 4 hours on any surface. Pathogenic bacteria are not afraid of frost; even with the bleach, it can be destroyed only five minutes after direct processing.
4. Fecal. The virus survives up to two days in fecal matter with normal bowel movements. The disease can be easily adopted by improper toilet cleaning or personal hygiene. To prevent contamination, especially from small children, it is important to constantly wash your hands after cleaning the baby pot, change diapers frequently and thoroughly wash the place of bowel movement.

 

Diagnostics, Treatment, and Vaccination in Double Pneumonia

Diagnostics of Pneumonia

Suspicion of pneumonia should arise if the patient has a fever, productive cough, discharge of mucopurulent sputum, shortness of breath, and/or chest pain. Also, patients with double pneumonia may complain of increased sweating at night, general weakness, rapid fatigue, and increased blood pressure.

At the slightest suspicion of this disease, you should undergo additional examination. The diagnostic minimum should include:

• a clinical blood test;
• a general urinalysis;
• a chest x-ray in two projections;
• a specialist consultation, during which a general examination, palpation of the chest, percussion, and auscultation of the lungs are performed.

To determine the pathogen and differential diagnosis with other diseases, the doctor may prescribe additional studies: 

• general sputum analysis;
• sputum culture for sterility;
• serological tests;
• IgG and IgM determination for individual pathogen;
• PCR diagnostics;
• chest MSCT with contrast;
• tuberculin tests;
• echocardiography;
• ECG.

Treatment

 Therapy depends on which pathogen is causing the infection.

1. For bacterial forms, antibiotics are the first-line drugs. They are prescribed by the attending physician, based on the test data, as well as the characteristics of the course of the disease and other factors. It is important to understand that antibiotics should only be taken on the advice of a doctor.
2. With double pneumonia of viral origin, including coronavirus, antibiotics are most often not indicated. The exception is cases when a bacterial, secondary infection joins the viral one. In such situations, the doctor, based on the data of blood tests and other indicators, decides on the appointment of antibacterial agents in addition to the main treatment regimen.

 

In addition, with pneumonia, regardless of the origin (both viral and bacterial), antipyretic drugs, pain relievers, expectorants can be prescribed. When bronchospasm occurs, bronchodilators may be indicated, including inhalation, using nebulizers. Some expectorants can also be inhaled.

 

Warm drinks, a gentle regimen, and restriction of physical activity are also advised.

 

Vaccination against double pneumonia as prevention

It is worth getting vaccinated against pneumococcal infection in cases where:

• there are frequent outbreaks of disease;
• someone visits public areas;
• someone works in a bacteriological laboratory;
• someone frequently suffers from pneumonia, SARS, and flu.

Several drugs are given intravenously to protect against disease. All of them differ in their composition, cost, and breadth of the spectrum of action.

In adulthood, the vaccine is given once, a persistent immune response to the pathogen is developed in 2-3 weeks. But at the same time, experts recommend vaccinating once every 5 years.

 

 

FAQs

• When will the lungs recover from bacterial pneumonia?

In most patients, the lungs recover completely after a few months – a maximum of six months after the illness. The same recommendations as after any ARVI: frequent airing, proper nutrition, a gradual return to the usual physical activity.

• What is viral bacterial pneumonia?

In some cases, viral pneumonia is complicated by the addition of a secondary bacterial infection. This happens, for example, with the respiratory syncytial virus and coronavirus. Treatment of viral-bacterial pneumonia is carried out using a course of antibiotics, which are selected only after the exact definition of the type of bacterial infection.

• How is bacterial pneumonia diagnosed?

It can be diagnosed with x-rays, blood tests, and sputum culture. They are treated with antibiotics. The risk group includes children under the age of five and the elderly over 60. This type of pneumonia is characterized by the rapid development of complications, the most common of which is respiratory failure and a high probability of mortality.

• How does pneumonia manifest in Covid-19?

All known coronaviruses are characterized by rapid (up to 14 days) development of acute respiratory failure. The virus quickly and aggressively affects the lungs, causing not only an extensive inflammatory process but also concomitant complications: edema of the respiratory organ, fibrosis (scarring of the lungs), acute heart failure, myocarditis.

• What are the symptoms of bacterial pneumonia?

Bacterial pneumonia symptoms can develop suddenly or gradually, resembling a severe cold or flu. Bacterial pneumonia is usually treated with antibacterial drugs. Most patients get better after about two weeks. Sometimes pneumonia can lead to serious complications, including blood poisoning (sepsis), pulmonary failure, and meningitis.