Clinical and epidemiological analysis of complications of community-acquired pneumonia in ATO / JFO participants

  • N. V. Popenko Ukrainian Military Medical Academy
  • М. І. Yarosh Ukrainian Military Medical Academy
Keywords: community-acquired pneumonia, complications, military.


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, winterspring 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.

Author Biography

N. V. Popenko, Ukrainian Military Medical Academy

Candidate of Medical Sciences, Associate Professor of the Department of Military Therapy of the Ukrainian Military Medical Academy


Feshchenko, Yu. I. (2018). Aktualni problemy suchasnoi pulmonolohii [Actual problems of modern pulmonology]. Ukrainskyi pulmonolohichnyi zhurnal - Ukrainian Pulmonology Journal, (3), 5-12. [in Ukrainian].

Feshchenko Yu. I., Belosludtseva K. O., Holubovska O. A. [et al.] (2016). Nehospitalna pnevmoniia u doroslykh osib: etiolohiia, patohenez, klasyfikatsiia, diahnostyka, antybakterialna terapiia ta profilaktyky. Adaptovana klinichna nastanova, zasnovana na dokazakh. [Сommunity-acquired pneumonia in adults: etiology, pathogenesis, classification, diagnosis, antibacterial therapy and prevention. Adapted evidence-based clinical guidelines]. Unifikovanyi protokol nadannia medychnoi dopomohy doroslym khvorym na nehospitalnu pnevmoniiu. K., 111. [in Ukrainian].

Adaptovana klinichna nastanova, zasnovana na dokazakh «Nehospitalna pnevmoniia u doroslykh osib: etiolohiia, patohenez, klasyfikatsiia, diahnostyka, antybakterialna terapiia ta profilaktyka» (2019) [Adapted evidence-based clinical guidelines "Сommunity-acquired pneumonia in adult: etiology, pathogenesis, classification, diagnostics, antibacterial therapy and prevention"] [in Ukrainian].

Dziublyk, Ya. O., Kapitan, H. B., Sukhin, R. Ye. [et al.] (2018). Optymizatsiia likuvannia virusno-bakterialnoi pnevmonii u viiskovosluzhbovtsiv, yaki mobilizovani dlia prokhodzhennia sluzhby v zoni provedennia antyterorystychnoi operatsii [ Optimization of treatment of viral and bacterial pneumonia in servicemen who are mobilized for service in the area of anti-terrorist operation]. Ukrainskyi pulmonolohichnyi zhurnal - Ukrainian Pulmonology Journal, (1), 14-18. [in Ukrainian].

Dziublyk, Ya. O., Sliesarenko, Yu. O., Kapitan, H. B. [et al.] (2019). Antybakterialna terapiia khvorykh na virusno-bakterialnu nehospitalnu pnevmoniiu, shcho vynykla u mobilizovanykh pry prokhodzhenni sluzhby v zoni ATO/OOS pid chas boiovykh dii. [Antibacterial therapy for patients with viral-bacterial community-acquired pneumonia, which occurred in those mobilized during service in the ATO / JFO zone during hostilities]. Ukrainskyi pulmonolohichnyi zhurnal - Ukrainian Pulmonology Journal, (1), 44-48. [in Ukrainian].

Panchenko, L.O., Popova, N.H., Korovaieva, I.V. [et al.] (2012). Nehospitalna pnevmoniia u viiskovosluzhbovtsiv: analiz endohennykh i ekzohennykh faktoriv ryzyku rozvytku zakhvoriuvannia [Сommunity-acquired pneumonia in servicemen: analysis of endogenous and exogenous risk factors for the disease]. Biomedical and Biosocial Anthropology, (18), 144–146. [in Ukrainian].

Zhogolev, S. D., Ogarkov, P. I., Zhogolev, P. D. [et al.] (2013). Epidemiologiya i profilaktika vnebol'nichnykh pnevmonii u voennosluzhashchikh [Epidemiology and prevention of community-acquired pneumonia in military personnel]. Voenno-meditsinskii zhurnal - Military Medical Journal, (11), 55-60. [in Russian].

Honcharov, K. A. (2015). Osoblyvosti diahnostyky i likuvannia nehospitalnoi pnevmonii virusno-bakterialnoi etiolohii netiazhkoho perebihu u viiskovosluzhbovtsiv zbroinykh syl Ukrainy [Features of diagnosis and treatment of community-acquired pneumonia of viral and bacterial etiology of mild course in servicemen of the Armed Forces of Ukraine]. Extended abstract of candidate’s thesis. Kyiv: Yanovsky National Institute of Tuberculosis and Pulmonology of the Academy of Medical Sciences of Ukraine [in Ukrainian].

Gadsby, N.J., Russell, C.D., McHugh, M.P. et al. (2016). Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis.

Holter, J.C., Muller, F., Bjorang, O. et al. (2015). Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis, (15), 64.

Jain, S., Self, W.H., Wunderink, R.G. et al. (2015). Community-acquired pneumonia requiring hospitalization among U.S. Adults. New England J Med.

Nikolenko, E. E. (2015). Vnebol'nichnye pnevmonii u voennosluzhashchikh: problemy i puti ikh resheniya [Community-acquired pneumonia in military personnel: problems and solutions]. Zdorov'e. Meditsinskaya ekologiya. Nauka - Health. Medical ecology. The science, 1 (59), 66-69. [in Russian].

Pertseva, T. O., Kyreieva, T. V., Belosludtseva, K. O. (2013). Retrospektyvnyi analiz letalnykh vypadkiv tiazhkoi nehospitalnoi pnevmonii: «Masky pnevmonii» [Retrospective analysis of fatal cases of severe community-acquired pneumonia: "Masks of pneumonia"]. Ukrainskyi pulmonolohichnyi zhurnal - Ukrainian Pulmonology Journal, (2), 26-30. [in Ukrainian].

Ovchinnikov, Yu. V., Azarov, I. I., Kuvshinov, K.E. [et al.] (2013). Organizatsiya meropriyatii po profilaktike i lecheniyu zabolevanii organov dykhaniya u voennosluzhashchikh [Organization of measures for the prevention and treatment of respiratory diseases in the military]. Voenno-meditsinskii zhurnal - Military Medical Journal, (10), 21-44. [in Russian].

Nakaz MOZ Ukrainy №128 vid 19.03.2007 r. «Pro zatverdzhennia klinichnykh protokoliv nadannia medychnoi dopomohy za spetsialnistiu «Pulmonolohiia» [Order of the Ministry of Health of Ukraine №128 of 19.03.2007 "On approval of clinical protocols for medical care in the specialty" Pulmonology "] K.: TOV "Veles"[in Ukrainian].

Borodulina, E. A., Borodulin, B. E., Povalyaeva, L. V. [et al.] (2015). Prediktory letal'nosti ot vnebol'nichnoi pnevmonii v sovremennykh usloviyakh raboty pul'monologicheskogo tsentra [Predictors of mortality from community-acquired pneumonia in modern conditions of the pulmonary center]. Vestnik sovremennoi klinicheskoi meditsiny - Bulletin of modern clinical medicine, 8 (4), 19-22. [in Russian].

Serediuk, N. M., Vakaliuk, I. P., Stasyshyn, O. S. [et al.] (2013). Vnutrishnia medytsyna: Terapiia [Internal Medicine: Therapy] K.: VSS «Medytsyna» [in Ukrainian].

Khamitov, R. F., Pal'mova, L. Yu., Sulbaeva, K. R. (2016). Tyazhelye pnevmonii v klinicheskoi praktike [Severe pneumonia in clinical practice]. Kazanskii meditsinskii zhurnal - Kazan Medical Journal, 97, (6), 994-999. [in Russian].

Chuchalin A. G., Sinopal'nikov A. I., Kozlov R. S. [et al.] (2015). Klinicheskie rekomendatsii po diagnostike, lecheniyu i profilaktike tyazheloi vnebol'nichnoi pnevmonii u vzroslykh [Clinical practice guidelines for the diagnosis, treatment and prevention of severe community-acquired pneumonia in adults] Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya - Clinical microbiology and antimicrobial chemotherapy, 17(2), 84-126. [in Russian].

How to Cite
Popenko, N. V., & Yarosh М. І. (2021). Clinical and epidemiological analysis of complications of community-acquired pneumonia in ATO / JFO participants. Ukrainian Journal of Military Medicine, 2(4), 91-103.
Current aspects of diagnosis and treatment