Development pneumonia in children and adults it has an infectious nature and occurs due to the influence of a number of factors, both physical and chemical. In the process of developing this disease, an inflammatory process in the lung tissue is noted.
With pneumonia, they are mainly affected alveoli, as well as interstitial lung tissue.
Title "pneumonia"unites an extensive group of diseases, each of which is characterized by a specific clinical picture, etiology, signs, laboratory parameters and features of the treatment regimen.
The question of how pneumonia differs from pneumonia is not relevant, since both of these names define a similar disease.
Defining the concept of "pneumonia", the term" should be highlightedpneumonitis". What is it? This name defines diseases associated with non-infectious inflammatory processes in the tissues of the lungs. Against the background of such processes, pneumonia of bacterial, viral, bacterial or fungal origin usually develops.
In the article we will consider the initial symptoms of pneumonia in children and in adult patients, as well as the main causes of the development of this disease, treatment methods, and prevention of complications.
Causes of pneumonia
The causes of the disease are associated with the influence of a number of factors. Specialists determine the following causes of pneumonia:
- complications after viral diseases (a consequence of flu, cold colds or ARVI);
- exposure to atypical bacteria (pathogens - mycoplasma, chlamydia, legionella);
- the influence of various chemical compounds on the human respiratory system (gases and toxic fumes);
- the effect of radiation from an attached infection;
- manifestation in the lungs of allergic processes (bronchial asthma, COPD, allergic cough);
- thermal effect (burnsor hypothermia of the respiratory tract);
- inhalation of food, liquid or foreign bodies (develops aspiration pneumonia).
Wikipedia indicates that the development of pneumonia is associated with the presence of favorable conditions for the active reproduction of pathogenic microorganisms in the lower respiratory tract of a person. What is pneumonia of the lungs, people knew in ancient times. The original causative agent of pneumonia is aspergillus mushroom, due to the impact of which experts who studied the Egyptian pyramids suddenly died.
The division of pneumonia into two subspecies is accepted:
- community-acquired pneumonia - develops as a result of exposure to a number of agents of infectious and non-infectious origin outside the hospital setting;
- hospital pneumonia - develops due to exposure to nosocomial microbes, which are often resistant to antibioticspresent in the traditional treatment regimen.
With community-acquired pneumonia in patients, the following frequency of detection of various pathogens of infectious origin is noted (information is given in the table).
|The name of the pathogen||The percentage of detection of the pathogen (average,%)|
|Streptococcus (most often death from pneumonia is noted in the disease caused by this pathogen)||30,4|
|Mycoplasma (most often causes the disease in children and young people)||12,6|
|Chlamydia (most often causes pneumonia in young and middle-aged people)||12,6|
|Legionella (mainly affects weakened people, after streptococcus most often the disease caused by this pathogen is fatal)||4,7|
|Haemophilus influenzae (provokes the development of pneumonia in people with chronic ailments of the lungs and bronchi, in malicious smokers)||4,4|
|Enterobacteria (rarely affects people with serious diseases - diabetes, kidney, liver failure)||3,1|
|Staphylococcus (affects the elderly, those who have complications after the flu)||0,5|
If the patient is diagnosed with pneumonia, how to treat it is determined depending on the pathogen, concomitant diseases, age of the patient, etc. In severe cases, depending on how the disease develops, appropriate treatment is prescribed and carried out in a hospital. The mild course of the disease does not involve hospitalization.
Symptoms of pneumonia
Symptoms of pneumonia
Signs of pneumonia are most often similar to flu or a cold. How the patient’s symptoms appear depends on the origin of pneumonia.
With bacterial pneumonia, both acute and gradual development of symptoms is possible. Aspen signs in this case are: shiver, fever, increased sweating, frequent pulse and breathing, sharp pain in the chest area, as well as coughin which thick, red or greenish sputum is secreted.
In the case of a viral type of disease, the patient is noted dry cough, heatheadache and muscle pain, fatigue, weakness, dyspnea.
With pneumonia developing as a result of action mycoplasmas, the symptoms are similar to signs of both a viral and bacterial type of illness, but are usually less pronounced.
The first signs of pneumonia
In order to consult a doctor in a timely manner and diagnose the disease, one should know what are the first signs of pneumonia in children, adolescents, and adults. Typically, the first symptoms of lung pneumonia are as follows:
- temperature rise;
- manifestation shortness of breath and coughing;
- chills, fever;
- weakness, fatigue;
- chest pain when trying to take a deep breath;
However, very often the first symptoms of pneumonia in adults, as well as signs of illness in a child, may not be so pronounced - often viral diseases are asymptomatic.
Signs of pneumonia in an adult
As pneumonia manifests itself in adults, it depends on the type of pathogen, the severity of the disease, etc. The characteristic signs of pneumonia in adults, the acute development of the process, its extensiveness and the likelihood of complications during improper therapy are the main reasons for patients to immediately contact specialists. The doctor determines in each case, what are the symptoms of pneumonia in adults: the process goes without temperature or temperature, etc. The prescribed treatment depends on the results of the study.
Symptoms of pneumonia in an adult are manifested in the early days of the disease. The first signs of this disease depend on its pathogen.
Cough- This is the main symptom of pneumonia. As a rule, at first, cough in inflammatory processes in the lungs is obsessive, dry, constantly manifests itself. However, sometimes in more rare cases, in the early days of the disease, cough is mild, rare. Further, in the process of developing the ailment, the cough becomes wetter, while there is a discharge purulent sputum mucosahaving a greenish yellow color. Cough, as well as a runny nose, can occur in the first days of the illness and last several days.
Another symptom of the disease that manifests itself at first - fever. At the very beginning of pneumonia, it can be very high and reach 39-40 degrees. So develops radical pneumonia and other types of pneumonia. However, the temperature (in the case of SARS) can be maintained at low-grade indicators - 37.1-37.5 degrees. But even at this temperature, if the patient has weakness, malaise, cough, the patient must always consult a specialist. Another serious symptom is a repeated rise in temperature during the course of the disease. Another sign of pneumonia is the lack of effectiveness of antipyretic drugs.
It should be taken into account what symptoms in adults without fever can occur in the first days of pneumonia.
If large volumes of lungs are affected, the patient may be disturbed by constant dyspnea, as well as the feeling that he lacks air. With a deep breath, a person feels pain, a similar condition is also noted during coughing. The lung cannot hurt, since it lacks pain receptors. However, it is involved in the pathological process pleura, which leads to the manifestation of pain.
Already in the early days of the disease in humans expressed pallor of the skin. A number of other symptoms are also noted - a sharp deterioration in appetite, weakness, severe fatigue, active sweating, chills.
It should be borne in mind that any disease of viral origin should not bother for longer than 7 days. If one week after the onset of the flu or a cold the patient's condition worsened, this is evidence of the development of inflammation of the lower respiratory tract.
Signs of pneumonia in a child
It is important for parents to know what symptoms of pneumonia in a child should alert them, since in children the signs of pneumonia can have certain characteristics. How pneumonia manifests itself in children depends on the characteristics of the disease and on the age of the child. Pediatric pneumonia can develop if a child has certain symptoms:
An inflammatory process can be suspected if the temperature increase (more than 38 degrees) lasts longer than three days, while it is not possible to bring it down with conventional drugs. The temperature, not rising above 37.5 degrees, in young children should be disturbing. Especially if at the same time there are also a number of signs of intoxication - a high level of sweating, weakness, poor appetite. In a newborn, as well as in infants, there may be no sharp jumps in body temperature during the manifestation of inflammation, since their thermoregulation is still not quite perfect, and the immune system remains immature.
In sick children, breathing is very frequent, superficial. Breasts up to 2 months per minute take 60 breaths per minute for children under 1 year old - 50, those who are already 1 year old - 40. As a rule, with inflammation, the baby randomly tries to lie on one side. Another sign may also be noted: undressing the baby, parents may notice that in the process of breathing from the side where the patient has a lung, the skin is drawn in between the ribs and it lags while breathing. Sometimes the baby's breathing rhythm is violated, its periodic stops occur, frequency and depth change. The youngest children can begin to nod to the beat of breathing, puff out their cheeks, and stretch out their lips. Sometimes foamy discharge appears from the nose and mouth.
The youngest children with pneumonia cry and act up, become lethargic. They sleep poorly, do not want to eat. Often noted vomitingand diarrhea, babies spit up, refuse to take breasts.
A child can develop not only streptococcal, but also SARS. What symptoms may be manifested in this case depends on the pathogen and the course of the course. As a rule, with a disease provoked by chlamydia and mycoplasma, the disease initially develops as a cold. The baby is bothered by a dry cough, sore throat, runny nose. Initially, coughing due to perspiration is possible, later the cough develops into a painful one when the child cries or eats.
It is important to consider that in the presence of a number of factors (air pollution, the action of allergens or chemicals), the baby may develop chronic pneumonia, the symptoms of which appear periodically.
The first symptoms of tuberculosis in adults
Clinic tuberculosisvery similar to the clinical picture of pneumonia. However, the first signs of tuberculosis in adults are sometimes mild, they grow gradually. The following first signs of tuberculosis in children and adults are noted:
- coughin which sputum is excreted, lasting more than three weeks;
- small but long temperature rise;
- loss of appetite, weight loss;
- fatigue, irritability.
If even several of these symptoms occur, you need to immediately go through the research and determine the diagnosis.
Pneumonia in adults, diagnosis
In case of untimely detection of the disease, the consequences in adults with pneumonia can be very serious. In particular, it can develop protracted pneumoniaprovoking serious complications. Also likely destructive form of the disease with purulent processes of the lung tissue. Therefore, timely diagnosis is very important.
The clinic of the disease includes the main syndromes and symptoms characteristic of inflammatory processes. Therefore, a thorough assessment of the symptoms that appear in the patient will help diagnose the disease. The doctor takes into account all the signs of how pneumonia is manifested, trying to note the features of such manifestations.
Temperature in pneumonia
The doctor interrogates and determines what temperature in adult patients, as well as what temperature in children. With pneumonia in both an adult and a child, the temperature is usually high and lasts for several days. However, the doctor takes into account the possibility of an atypical course of the disease, that is, whether an inflammatory disease can occur without temperature. Whether there is a temperature depends on the age of the patient and the characteristics of the inflammatory process. For example, infants may sometimes experience low-grade fever.
What cough is manifested
The doctor interviews the patient to determine how many days this symptom manifests itself, what kind of cough in the child or in the adult patient takes place, whether chest pain is felt. This takes into account that pneumonia without coughing is also possible. If the disease proceeds without a cough, the doctor focuses on other symptoms, taking into account everything about the course of the disease in the survey.
To confirm the disease, a general and blood chemistry. A general laboratory study for inflammation demonstrates a number of changes: leukocytosis, increased ESR, neutrophilia. With the viral form, the doctor takes into account that such pneumonia causes an increase in the number of leukocytes due to lymphocytes.
An x-ray of the chest is performed, sometimes lung diseases in children and adults are determined using computed tomography.
Also, in a hospital, microscopic examination, analysis of urine and sputum culture are practiced (with pneumonia, yellow-green sputum is released).
In the early days of the illness, the doctor may listen fine bubbling rales. Lungs with inflammation are heard with a stethoscope. However, if there are suspicions in a child or an adult of pneumonia, it is important to conduct a full range of studies to ensure timely treatment and to clearly know what to do with this disease.
A specialist must prescribe a treatment for pneumonia. If the patient promptly consults a doctor, then the treatment of pneumonia in an adult and a child is successful. How to treat and how to treat this disease depends on the pathogen that provoked the disease. It is for successful treatment that you need to clearly know how pneumonia begins and how to recognize it.
The doctor prescribes any medications after conducting research, including laboratory (white blood cells, ESR and etc.).
The treatment regimen, duration of treatment, the need to place the patient in a hospital is determined exclusively after diagnosis by a specialist. As a rule, the treatment of the disease lasts 7-10 days. The duration of treatment of bilateral pneumonia in an adult is determined only by the doctor.
Pneumonia treatment can be carried out both in a hospital and at home. However, home treatment, as well as the treatment of pneumonia with the help of folk remedies, requires regular monitoring of the patient's condition: the local doctor and nurse should constantly visit him. Direct indications for placing the patient in a hospital are certain points. This is a pneumonia disease in a child of the first year of life, a severe course of the disease with a number of complications, a disease aggravated by somatic manifestations, and the inability to fully treat a person at home.
Those who are interested in whether they die from pneumonia should know that the greatest number of fatal cases occurs when treating this type of disease at home, without consulting a doctor. It is mandatory to hospitalize children under 1 year old and elderly patients, since what to do with pneumonia in such cases can be determined exclusively by a specialist. In such cases, sometimes it may be necessary intensive care, mechanical ventilation.
Basic care for pneumonia
To treat pneumonia as effective as possible, the patient should be provided with high-quality individual care. This approach is especially important for sick children. It is important to strictly observe bed rest, to ensure the restriction of physical activity. However, this does not mean that a person must constantly lie still - it is important to change position, move. After the patient recovers with severe pneumonia, he should not work hard for another two to three months.
In the process of treating pneumonia at home, particular care must be taken to comply with all requirements, both personal and general hygiene. The nutrition of the patient should provide all the needs of the body that is struggling with the disease. Food should contain enough calories, foods high in a variety of vitamins, natural foods. A very important point in the diet of the patient is the provision of a sufficient amount of drink. The fluid used should be warm and varied: raspberry tea, cranberry juice, mineral water are suitable. From time to time you can drink warm milk with honey and soda.
In acute fever, patients who do not have symptoms of heart failure should drink about 2.5-3 liters of fluid per day.
The treatment of pneumonia in children provides a special approach to feeding. The child needs to be offered to eat often and little by little, while it is advisable to offer him favorite food. The appetite of the child is restored after relieving the acute condition. In the process of nutrition, you need to select dishes with a low content carbohydratesthat provoke fermentation processes in the intestine. Compliance with the drinking regime for children is one of the most important principles for caring for a sick child. You need to drink enough to make up for the loss of fluid due to high temperature and shortness of breath.
Patients with pneumonia should be constantly monitored for bowel function to prevent manifestations. flatulence and constipation. The room in which the patient is staying should be regularly ventilated so that the air is clean. Another important point on the path to recovery is the active coughing up sputum. To make coughing more effective, you can perform some exercises from breathing exercises.
Medication for pneumonia
Pneumonia treatment antibiotics is one of the main directions in the treatment of the disease. It is important that antibiotics be prescribed to the patient on time, that is, it is not necessary to wait for the time when the pathogen is identified. However, the appointment of antibiotics to the patient must be carried out only by the attending physician, in no case should you take the drugs yourself.
If pneumonia is treated outside the hospital, patients are often prescribed penicillins, macrolides and 1st generation cephalosporins. The choice of route of administration of the antibiotic depends on the severity of the disease.
If pneumonia is treated in a hospital, then the patient is prescribed 3rd generation cephalosporins, penicillins with clavulanic acid, fluoroquinolones, aminoglycosides, carbapenems. If the etiology of pneumonia is unknown, then a combination treatment may be prescribed in which two or three different antibiotics are used. The effectiveness of the treatment of this disease with antibiotics can be evaluated after 36-48 hours. If there is an improvement in well-being, the appearance of appetite, as well as the absence of negative dynamics of pneumonia, then the result of therapy can be considered positive.
But treatment of pneumonia with antibiotics also involves taking additional medications. So, those drugs are often used whose effect involves the restoration of the drainage function of the bronchi. These are drugs amyfillin, berodual, atrovent. It is also advisable to take medications that thin the sputum and help improve the expectoration process. Those drugs are also used that stimulate the body's defenses - interferon, immunoglobulin and others. Patients with pneumonia are also shown some methods that increase the nonspecific resistance of the body. In this case, adaptogens are effective - ginseng tincture, eleutherococcus extract, aralia preparations, pantocrine, rhodiola rosea, saparala. They are used in an individual dosage twice or thrice a day. All these drugs have a noticeable effect on the human body. They strengthen the immune system, stimulate the metabolic processes in the body, help strengthen the person’s resistance to many negative influences, as well as the effects of infections. To restore the body's defenses, in some cases, the patient is administered gamma globulinare assigned vitamin complexes (in this case, a sufficient amount of vitamin C, as well as B vitamins, is especially important).
In the process of treating pneumonia in children and adults, antihistamines, anti-inflammatory drugs are used. In severe cases of the disease, the attending physician sometimes considers it appropriate to take corticosteroid hormones. In the presence of specific indications, painkillers, respiratory analeptics, oxygen therapy sessions, etc. are also prescribed.
After the patient's body temperature returns to normal and the symptoms of general intoxication disappear, a number of physiotherapeutic procedures can be used. Often a doctor prescribes Microwave, inductothermy, UHF, wellness massage sessions, electrophoresis and etc.
Other treatments for pneumonia
Another important stage of the comprehensive treatment of pneumonia is the holding of regular sessions of physiotherapy exercises. Such physical exercises contribute to the activation of circulation of blood and lymphatic fluid in the body, normalize the pulmonary ventilation impaired during the disease. Physiotherapy exercises are prescribed to the patient after the body temperature normalizes or decreases to subfebrile. Initially, gymnastics includes several breathing exercises in a supine position. In addition, it is advisable for the patient to lie several times a day on his healthy side in order to improve aeration. To reduce the adhesion process in the diaphragmatic rib angle, a roller should be placed under the chest and lie on a healthy side. When lying on the back, the formation of adhesions in the area between the diaphragmatic pleura and the posterior wall of the chest decreases.
Then, after a few days, the patient at the stage of recovery is prescribed exercises in a sitting and standing position, which are aimed at increasing the mobility of the chest, and also involve training in diaphragmatic breathing.
After a complete cure, people with pneumonia are advised to go skiing, rowing, playing sports.
To improve the drainage function of the bronchi and ventilation function of the lungs, it is often prescribed inhalation. However, it should be noted that inhalations are carried out after the removal of the most acute condition. For inhalation, special drugs are used, for example bioparox, as well as decoctions of herbs.
With the help of massage, you can significantly improve the process of sputum discharge. In addition, the massage has a bronchodilator effect. Depending on the doctor’s prescription, it is used as classic segmentalso acupressure.
Via can massage can significantly accelerate the process of sputum discharge with a strong cough. To do this, on the skin, pre-lubricated petroleum jelly, a can is superimposed, the capacity of which should be 200 ml. After suctioning the jar, massage movements are carried out from the lower back to the cervical spine. Such a massage should last about ten minutes. After this, the patient is wrapped in a blanket and given him a glass of warm tea. Such a massage can be done every two days.
After removing the acute condition, the patient is also recommended to do paraffin, mud, ozokerite appliques. Some experts also recommend holding sessions. acupuncture. However, this method can not be practiced by people in a state of intoxication, with fever, with heart and respiratory failure.
It is important that the treatment of pneumonia was carried out until the patient is fully recovered: he should not only feel normal, but also indicators of laboratory and radiological studies.
After completing the main course of treatment, patients are often recommended to continue recovery after illness in a sanatorium. As a rule, with a competent approach to treatment, the patient recovers in about three to four weeks.
Treatment of pneumonia with folk remedies
Treatment of pneumonia with folk remedies can also be used if the disease is treated at home and the patient is not in a serious condition. There are a number of recipes for decoctions and tinctures of medicinal herbs that effectively affect the general condition of the patient. Some prescriptions, proven by many years of experience, can be used in parallel with drug treatment. We offer several possible recipes for the treatment of pneumonia with folk remedies.
Take two tablespoons of aloe leaves, chop and mix with one teaspoon of salt. 1 tsp salt. The mixture is taken three times a day before meals, one teaspoon. Calendula tincture, which is taken twenty drops three times a day, is prepared as follows: two tablespoons of calendula flowers are poured with one glass of medical alcohol. Infusion is prepared 15 days in a dark place. Similarly, you can prepare tincture of wormwood herb (for one tablespoon of grass one glass of vodka), which is taken four times a day for one teaspoon.
Another traditional medicine effectively helps get rid of cough. For this, one glass of oats with husk is mixed with one liter of milk. The mixture must be boiled for half an hour, then strain and add two tablespoons of butter, five tablespoons of honey. Before going to bed, the patient should take a glass of funds.
In addition, for the treatment of pneumonia in children and adults, traditional medicine advises taking decoctions of medicinal herbs as a drink. There are many options for collecting herbs that effectively affect the patient's condition with pneumonia.
You should mix one part of knotweed grass, anise fruits, pine buds, dill, thyme grass, licorice root. The collection is poured with cold water, infused for about an hour, after which it must be brought to a boil and cooked for about five minutes. Use a fee of half a glass three times a day.
Another collection of herbs includes one teaspoon of chamomile, calendula, and hypericum flowers. The mixture is poured with two glasses of boiling water, infused for two hours. You need to take the collection for a third of a glass three times a day.
In addition, treatment fees may include other herbs: medicinal sage, coltsfoot, thyme, horsetail, plantain leaves, peppermint, dioica nettle, elecampane tall, black elderberry and other medicinal plants.
In the tea that the patient drinks throughout the day, honey and lemon should be added; periodically it is recommended to drink warm milk with the addition of one teaspoon of butter and honey.
Juice therapy is also used in the treatment of pneumonia - a daily intake of fresh vegetable and fruit juices. Juices of beets, carrots, and spinach are most useful for patients.
Effective in combating the symptoms of pneumonia and tincture of eucalyptus, which is used both externally - for inhalation and rinsing the throat, and inside, 30 drops three times a day.
In order to activate the process of expectoration of sputum, it is recommended to use freshly squeezed cabbage juice mixed with honey. Traditional medicine also recommends the regular use of raisins, figs, almonds.
An effective way to treat pneumonia at home is banks that put on the patient’s back and chest. In addition, compresses and dressings of a warming nature are used.
Antibiotics for pneumonia
In pneumonia, it is advisable to use antibiotics in adults after the disease has been confirmed by at least one diagnostic method.
It should be borne in mind that certain symptoms - for example, rapid breathing in a child at a temperature, coughing during a deep breath in an adult, etc. - are not a reason for immediate use of antibacterial drugs, since the patient could also be ill with another ailment. It is impossible to independently determine whether the patient has four signs or 5 signs of inflammation. To prescribe adequate antibiotic therapy, you should immediately consult a doctor.
Before prescribing antibiotics, it is important to determine the causative agent of the disease - under this condition, therapy will be most appropriate. But in some cases this is not possible, therefore, experts prescribe antibacterial drugs with a wide spectrum of action. They are also used before determining the pathogen to create therapeutic concentrations of active components in the blood.
Pneumonia provoked streptococcus (it can cause streptococcus in the throat of a child, etc.), is treated with broad-spectrum penicillinsare sometimes prescribed Vancomycin in conjunction with aminoglycosides.
Mycoplasmain children as well chlamydial, legionella infectionsrequire the appointment of specialized antibiotics - Clarithromycin, Sumamed. Broad spectrum antibacterial drugs are also advisable.
Bronchopneumonia treated with antibiotics - semisynthetic penicillins, treatment of bronchopneumonia in adults can be carried out at home.
With pulmonary inflammation, a complex of 2-3 antibiotic drugs is sometimes used, especially if the focus of inflammation occupies more than one segment.
Complications of pneumonia
If patients turn to specialists immediately after they become ill, and after that adhere to the prescribed treatment regimen, complications, as a rule, do not develop. The manifestation of complications can be directly associated with the disease, as well as with medication.The likelihood of exacerbation of chronic diseases also increases - heart failure, emphysema and etc.
As a complication, it can develop pleuropneumonia, which is characterized by the involvement in the inflammatory process of one or several lobes of the lungs at once, while an acute and severe course of the disease is noted.
Likely manifestation pleurisy(inflammation of the pleura), which can develop into pleural effusionwhen fluid accumulates in the pleural cavity.
Another dangerous complication is abscess lungswhen pus-filled cavities develop in them. This complication develops in people with chronic diseases.
In addition, pneumonia may be complicated. sepsis of blood, bacteremia.
There is a risk of developing infectious endocarditisbreathing problems.
Sometimes, after suffering pneumonia, the first signs develop asthmain adolescents and children.
Prevention of pneumonia complications
As preventive measures, it is recommended to be vaccinated annually against flu. This is especially true for people at risk (children, the elderly, patients with severe ailments).
It is very important to undergo timely diagnosis and adhere to the treatment regimen prescribed by a specialist for influenza, colds, and prolonged coughing.
Well-known rules of hygiene and a healthy lifestyle should be followed.
As measures for the prevention of pneumonia, it is important to observe general sanitary and hygienic rules, regularly devote time to hardening, and exercise. Remediation of foci of chronic infection is also important. All diseases in which lung damage occurs should be treated immediately and correctly. A healthy adult lifestyle, a competent approach to caring for a child, as well as hardening the baby in the first year of life will help to avoid the disease. There are also some drugs (bronchomunal, IRS-19, ribomunil) that stimulate the protective properties of the body during the period of the highest probability of infection with infectious diseases. They also produce a specific vaccine effect against respiratory pathogens.