Clinical and epidemiological analysis of complications of community-acquired pneumonia in ATO / JFO participants
The purpose of the work is to conduct a clinical and epidemiological analysis and determine the risk factors for complications of community-acquired pneumonia (CAP) in military who participated in the anti-terrorist operation / Joint Forces Operation (ATO / JFO) from 2014 to 2018. .
Materials and methods. A retrospective clinical and epidemiological analysis of the course of emergency in 244 military males who were treated in the pulmonology clinic of the National Military Medical Clinical Center "Main Military Clinical Hospital" Kyiv in the period from 2014 by 2018, according to in patient cards. Group I included 164 military-participants of the ATO/JFO, who became ill with a complicated CAP; to the II group – 58 military, who became ill with complicated CAP, but did not take part in ATO / JFO. In each group, certain subgroups were identified depending on the complications. To the control group were selected 22 cards of inpatients military, in whom CAP proceeded without complications. The mean age of patients in group I was (36.0 ± 0.6) years, group II – (31.6 ± 1.1) years and control group – (33.7 ± 1.8) years.
Results. The total number of complications in group I was 269. Among them were cases when one in military was diagnosed with several complications: one complication in 99 (60.4%), two - in 38 (23.2%), three – in 19 (11.6%) military. In 53 military CAP ended with the formation of pneumofibrosis, which is 19.7% of the total number of complications, in 44 (16.4%) complicated by bronchoobstructive syndrome, in 31 (11.5%) – pulmonary insufficiency (PI), in 31 (11.5%) – reactive hepatitis (RG), in 36 (13.4%) – exudative pleurisy, in 24 (8.9%) – destruction of lung tissue, in 11 (4.1%) – infectious–toxic shock (ITS). When analyzing the complications of CAP in group II, it was found that their total number is 103. One military had complications: one complication – 34 (58.6%), two – 12 (20.7%), three – 7 (12, 1%), four – 2 (3.4%), five – 2 (3.4%) and six in 1 (1.8%) cases. Among them there are: RG – 16.6%, bronchoobstructive syndrome – 15.6%, exudative pleurisy – 14.6%, PI – 6.8%, febrile nephropathy – 8.7%, ITS – 6.8%, acute infectious myocarditis – 9.7%, pneumofibrosis – 9.7%, asthenia – 3.9%, destruction of lung tissue – 2.9% military. In group I CAP is significantly more often complicated by destruction of lung tissue and pneumofibrosis than in patients of group II. It was found that in subgroups of group I regression of infiltrative changes occurred more slowly than in subgroups of group II (p <0.05), except for those subgroups where CAP was complicated by destruction of lung tissue and PI. However, it should be noted the tendency to prolong the interval of clinical and radiological recovery in subgroups with destruction of lung tissue and PI. In all subgroups of groups I and II, radiological recovery was observed later than in the control group (p <0.05). Concomitant respiratory pathology (most often acute rhinosinusitis and acute pharyngitis) was detected in 26.8% of I / S group I, in 25.9% – group II and in 13.6% – control group. Lesions of the circulatory system were observed in 22.6% military of the I group, in 18.9% military of the II group and in 9.1% of military of the control group. Pathology of the digestive organs accompanied the course of NP in 24.4% military of the I group, in 18.9% military of the II group and in 9.1% military of the control group.
Conclusions. Patients of group I developed significantly more often the destruction of lung tissue 8.9% and residual changes in the form of pneumofibrosis – in 19.7% than in military group II – in 2.9% and 9.7% of patients, respectively. Clinical and radiological regression of CAP in the military group I took significantly longer than in the military, which did not participate in the ATO / JFO. In case of complication of CAP by bronchoobstructive syndrome, radiological recovery occurred on (12.6 ± 0.9) days in group I and on (8.4 ± 0.6) days in group II; in exudative pleurisy for (23.3 ± 2.7) days in group I and for (20.2 ± 1.9) days in group II; at the revealed pneumofibrosis on (21,2 ± 2) days in the I group and on (16,4 ± 1,9) days in the II group; with complications of reactive hepatitis on (19.5 ± 1.4) days in group I and on (18.3 ± 2.7) days in group II. Causes of severe course and development of complications of CAP in military, who took part in the ATO / JFO were: call for mobilization and service in the ATO / JFO, winter–spring period of the year, late application for qualified medical care from the beginning of acute respiratory disease, delayed initiation of antibacterial drugs against the background of ineffective symptomatic therapy for acute respiratory disease, insufficient effectiveness of initial antibacterial therapy, ≥2-segmental lesion of lung tissue.
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