Clinical picture features of community-acquired pneumonia depending on the preventive vaccination against influenza and pneumococcal infection

The aim of the study was to study the clinical features of community-acquired pneumonia, depending on the preventive vaccination against pneumococcal infection and influenza using a computer program for interactive interviewing patients ‘Electronic Polyclinic'. 34 patients with community-acquired pneumonia aged 16-35 years were examined, 19 of whom were vaccinated against pneumococcal infection and influenza, and the second subgroup (15 people) did not receive preventive vaccination. In both subgroups, along with the examination within the verification of the diagnosis, all patients underwent an interactive questionnaire using the respiratory module of the automated system ‘Electronic Polyclinic'. Results. A special feature of community-acquired pneumonia in the group of vaccinated persons (group 1) was mild clinical symptomatology, a smaller amount of pulmonary tissue damage. The main clinical manifestations were presented with mild cough and / or fever. There was a lower incidence of dyspnoea compared with the group of patients ^without preventive vaccination' (group 2). The physical signs of the pulmonary densification syndrome were revealed only in 58% of cases in patients of the 1st group, in the second subgroup - in 95% of cases. In the first group, assessment of the X-ray data allowed us to state a segmental lesion of the lung parenchyma in 95% of cases, and only in 1 case - lobar pneumonia. In the second subgroup, on the contrary, in 14 out of 15 patients, lobar pneumonia was observed, and in 1 case a bilateral polysegmental lesion occurred. Statistically significant differences were obtained (p <0.05): in the first group of patients the median of pneumonia severity index (10%., 90%o) was 19 (18,20) points, in the second group - 26 (24.30). The conclusion. A conclusion was made about less severe symptoms and a decrease in the severity index of pneumonia in group 1, probably influenced by influenza vaccination and pneumococcal infection.Целью исследования явилось изучение особенностей клинической картины внебольничной пневмонии в зависимости от профилактической вакцинации против пневмококковой инфекции и гриппа с использованием компьютерной программы для интерактивного опроса больных «Электронная поликлиника». Обследованы 34 больных внебольничной пневмонией в возрасте 16-35 лет, 19 из которых были привиты от пневмококковой инфекции и гриппа, а вторая подгруппа (15 человек) - не проходили предупредительной вакцинации. В обеих подгруппах наряду с обследованием в рамках верификации диагноза все пациенты прошли интерактивное анкетирование с помощью респираторного модуля автоматизированной системы «Электронная поликлиника». Результаты. Особенностью течения внебольничной пневмонии в группе привитых лиц (группа 1) являлись маловыраженная клиническая симптоматика, меньший объем поражения легочной ткани. Основные клинические проявления были представлены слабовыраженным кашлем и/или лихорадкой. Отмечалась меньшая частота выявления одышки по сравнению с группой больных «без предупредительной вакцинопрофилактики» (группа 2). Физикальные признаки синдрома уплотнения легочной ткани были выявлены лишь в 58% случаев у больных 1-й группы, во второй подгруппе - в 95% случаев. В 1-й группе оценка данных рентгенологической картины позволила констатировать сегментарное поражение паренхимы легких в 95% случаев, и только в 1 случае - долевое поражение. Во второй подгруппе, наоборот, у 14 из 15 пациентов наблюдалась долевая пневмония, и в 1 случае имело место двустороннее полисегментарное поражение. Получены статистически значимые различия (р<0,05): в 1-й группе пациентов медиана (Me) индекса тяжести пневмонии (10%о; 90%о) составила 19 (18; 20) баллов, во второй - 26 (24; 30). Заключение. Сделан вывод о менее выраженных симптомах и снижении индекса тяжести течения пневмонии в 1 группе наблюдения, вероятно, под влиянием вакцинопрофилактики гриппа и пневмококковой инфекции

LEUKOCYTES LIPID RELEASE ABILITY AND CERTAIN IMMUNE DEFICIENCY CRITERIA IN COMMUNITY ACQUIRED PNEUMONIAE PATIENTS

Abstract. The aim of present study was to investigate some indexes of immune deficiency, antimicrobial protective mechanisms, and lipid-releasing ability of leukocytes in patients with community-acquired pneumonia. The study groups involved fifty-two pneumonia patients and 26 healthy people. The patients were subdivided into two age groups, 20-40, and 41-60 years old. We classified the laboratory findings according to severity and clinical phase of the disease, and smoking status. Evaluation of immune deficiency included filling of special questionnaire, drawing of scores, and stratification into two groups, according to presence or absence of clinical immune deficiency. Serum concentrations of IL-6, IL-8, TNFαα and CRP, were detected by enzyme immune assay. An original technique was applied for detection of lipid-releasing ability of leukocytes. It was shown that 46 per cent of pneumonia patients showed clinical signs of immune insufficiency, being more common in cases of severe pneumonia, or extensive lung damage, according to radiological data. A relative quantitative deficiency of serum IL-8 and TNFαα was revealed in patients with severe pneumonia, accompanied by elevated serum IL-6. Lipid-releasing ability of leukocytes was significantly decreased among patients between 20 to 40 years old. This deficiency was more expressed in patients with severe pneumonia, and it returned to near- normal levels upon clinical resolution of the disease