Pneumonia in adults, children, newborns: species, first signs, symptoms, causes, pathogens, ways of infection, complications, diagnosis, blood, sputum, x -ray, treatment, antibiotics, consequences, rehabilitation, and respiratory exercises. How much pneumonia is treated, how much to lie in the hospital?

This article describes signs of pneumonia in children and adults, as well as methods of treatment and rehabilitation.

Pneumonia is a group of inflammatory diseases that differ in etiology, pathogenesis and clinical and morphological manifestations. Such diseases are characterized by damage to the alveoli and other distal airways.

• According to the clinical etiology of pneumonia, they are divided into acute and chronic. Light inflammation can be primary and secondary.
• Acute disease - this can be either a separate disease that arose independently and the manifestation of another ailment (influenza pneumonia, plague and so on).
• Secondary pneumonia is a complication of another disease. These types of pneumonia are divided into their types.
• We will consider all of them in this article. Here you will also learn about the signs and symptoms of the disease and how to effectively treat pneumonia.

What is double -sided, focal, shared, Klebsiella, right -hand, left -handed, viral, croupous, aspiration, interstitial, basal, mycoplasmic, destructive, caseous, segmental, nososinophilic, eosinophilic, purulent, pneumocystic, streptococcal and pneumococcal, chlocamous, hybstatical, fungal, fungal, fungal, fungal, fungal, fungal, fungal, fungal, fungal, fungal, fungal, mushrooms newborn pneumonia and how is it dangerous?

Lung inflammation is distinguished by the basis of localization, according to the prevalence and nature of the disease. Thus, it turns out that there are many types of pneumonia. Let's look at them all in order:

• Bilateral pneumonia - This is inflammation, which occurs as a result of infection with complex microorganisms, mainly pneumococcus. This is the most dangerous ailment, since the high probability of the fatal outcome of the patient.
• Focal pneumonia -infectious and inflammatory process in a limited area of \u200b\u200bthe lung (small lung slices). One of the most extensive groups in the structure of various inflammatory diseases. Focal pneumonia often occurs in the operational period and are dangerous to the development of respiratory and heart failure.
• Oblast pneumonia - Acute inflammatory process of one or more lung fabrics and pleura. Complications and danger consist in the development of heart failure, damage to the heart valve, abscess and gangrene of light, parapneumatic pleurisy, purulent arthritis, meningitis and brain abscess.
• Klebsiella - Bacilli stick -shaped. It is in the intestines of each person, but in a small amount. But, if its norms are exceeded, then various diseases may develop, including pneumonia. The danger is the development of sepsis, which can lead to death.
• Right -sided pneumonia - It occurs more often than left -sided inflammation of the lungs. This happens, due to the specific structure of the right bronchus-its size is smaller and it is wider. This type of pneumonia is dangerous to the formation of an abscess, acute respiratory failure and the development of myocarditis, meningitis and infectious toxic shock.
• Left -sided pneumonia - The development of this type of inflammation of the lungs is recorded less often than right -hand pneumonia, but it proceeds more complicated. Microbes penetrated the left main bronchus, which is why blood supply is weakened and normal delivery of drugs is almost impossible. The doctor must understand this to cure the patient. The danger lies in the asymptomatic development of the disease, which can lead to undesirable complications.
• Viral pneumonia - a disease characteristic of children, since in adults it develops no more often than in 10% about the total number of detected diseases of this type. The accumulation of fluid in the aisles of the lung and violation of the respiratory process is dangerous.
• Croupous pneumonia - Infectious disease with acute inflammation in the lung tissue. Separate segments or the share of the lung completely are subjected to defeat. The disease can threaten the lives of both young and older people.
• Aspiration pneumonia - an infection that develops in the area of \u200b\u200bthe bronchial tree. The danger lies in the onset of an extensive sepsis as a result of complications, which can lead to death.
• Interstitial pneumonia -Chronic-transgressing disease. The bags of alveoli and connective tissues in the lung are affected. Such a disease in a neglected state can lead to death. "Cellular lung" can also develop. A complete cure of this ailment is possible, but in a small percentage.
• Procorne pneumonia - inflammation with an atypical location of the focus of infection. It spreads in the bronchus, which leads to difficulty in correct diagnosis. Due to the diagnosis, complications develop, which is then difficult to fight.
• Mycoplasma pneumonia - Inflammation is developing the pathogen Mycoplasma pneumoniae - microorganisms that settle on the mucosa, causing acute damage to not only lungs, but also trachea. A severe form of inflammation of the lungs may develop, which is very difficult to cope with.
• Destructive pneumonia - an infection accompanied by a change in the function of the lungs. Leads to diseases of the heart and blood vessels. Often occurs in premature children.
• Caseous pneumonia - The severe form of this disease, which develops as a result of the complication of certain forms of tuberculosis or is an independent form of clinical pulmonary tuberculosis. Complications-pulmonary bleeding and hemoptysis, infectious toxic shock, occurrence of lung cirrhosis.
• Segmental pneumonia - An infectious type of disease that affects the bronchopulmonary segment: bronchi, alveoli and bronchioles. Complications: the development of respiratory failure, as a result of which the heart beats rapidly, tachycardia develops, blood pressure decreases. Because of this, the likelihood of death increases.
• Nosocomial pneumonia - Infectious disease with lung damage. It develops after a person’s entering a hospital, but not earlier than two days later. Inflammation is dangerous in that bacteria are resistant to most antibiotics. A fatal outcome occurs from 20% to 80% of cases. It all depends on the type of bacteria and various secondary factors.
• Eosinophilic pneumonia -Infectious-allergic disease, in which eosinophils accumulate in the bags of alveoli. These components of our immunity, the number of which increases with inflammation and allergies. Eosinophilia, respiratory failure and pulmonary growth of tissues can develop.
• Purulent pneumonia - A disease in which an abscess and bulls are formed, breaking into the pleural cavity. Complication: pneumosclerosis - pathology with the replacement of the normal tissue of the connective.
• Pneumocystal pneumonia - The disease manifests itself in people with low immunity. It can aggravate constantly, even when it seems that the patient is completely cured.
• Streptococcal and pneumococcal pneumonia - Bacterial disease caused by Streptococcus pneumoniae bacteria. In this type of inflammation of the lungs, the number of deaths is small. Complications rarely occur if you start treatment with antibiotics in a timely manner.
• Chlamydial pneumonia - The inflammatory process of infectious etiology. It occurs as a result of the penetration into the lung tissue of the bacteria Chlamydia and Chlamydophila. Fatal outcomes are possible in old age and are found in 10% of patients. Young patients tolerate the disease well and usually the process ends with a complete recovery.
• Hypostatic pneumonia Or stagnant inflammation of the lungs. The disease is typical for the elderly with limited mobility. The danger in impaired respiratory organs and the onset of death.
• Fungal pneumonia - inflammation caused by pathogenic mushrooms. The fungal flora can be listed from the outside or exist within the body. Danger consists in the development of severe intoxication of the body, which leads to complications.
• Pneumonia of newborns - infection occurs in the process of bearing. The danger to the child is respiratory failure, pneumothorax, pleurisy and abscess.

It is important to start timely treatment for any type of pneumonia. This helps the body quickly cope with the infection, with a minimum percentage of complications.

Causes and pathogens of pneumonia

Pneumonia appears as a result of the virus entering the body. Often the disease can cause bacteria that live in our body. They are activated and propagated with reduced immunity. The main causes and pathogens of pneumonia:

• Klebsiella
• Streptococci group c
• E. coli
• Golden staphylococcus
• Pneumococci
• Friedlander stick
• Hemophilic stick
• Enterobacteria
• Legionella
• Mycoplasma
• Moraksella
• Influenza viruses, herpes, adenovirus, paragraphippe
• Fungal infections and others.

In addition, pneumonia may appear as a result of injury, falling into slight toxic substance, allergens and ionizing radiation.

Pneumonia is infectious for others or not, as is transmitted: ways of infection

A healthy person is almost impossible to become infected with pneumonia.

• In order for the microbes to penetrate the lungs, they need to overcome many obstacles: curved passages of the nasopharynx, mucous membrane of the nose, proud, trachea, bronchi.
• If these barriers are overcome by microorganisms, then the immune system is defended.
• But we should not forget that the patient with pneumonia exhales millions of bacteria into the air, which can cause in another person if not inflammation of the lungs, then pharyngitis, rhinitis or tonsillitis.
• Therefore, we can say for sure that pneumonia is contagious to others to one degree or another and it all depends on the immunity of the person and his general state of the body.
• Bacteria that cause pneumonia, through the air, with food, and even with sexual contact spread.

Pathogenic flora travel to our body and can begin to multiply in any organ. The most susceptible to this lungs and bronchi.

Pneumonia in adults: the first initial signs, symptoms, cough, temperature, shortness of breath

The manifestation of symptoms of lung inflammation in adults depends on different reasons:

• Type of pathogen
• Conditions of development of the disease
• The course of the disease
• The prevalence of the inflammatory process

The first initial signs of pneumonia in adults:

• Long cough
• Heat
• Shortness of breath, since breathing failure occurs already in the first hours of the disease
• Discomfort and pain in the bronchi, with coughing, with full breath
• Shinter in the nasolabial triangle
• Weakness
• Fast fatiguability
• Dispensed (not enough air)
• Lethargy, headaches
• Lack of appetite

Sometimes a cough can be insignificant and dry, but soreness with an increase in shortness of breath is manifested. The worst thing is a disease without symptoms or with a minimum number. Such a pathology often occurs in fixed patients. The swelling of the alveoli and the accumulation of fluid in them are formed.

Coughing, temperature, shortness of breath: how much does it last with pneumonia?

By cough and temperature, the severity of the disease and the state of immunity are determined.

• First, the patient has a low temperature, which normalizes in the morning.
• If a person’s immunity is good, then such a temperature can be observed for 10-14 days, which complicates the correct diagnosis. But a competent doctor should pay attention to dry cough and sore throat.
• However, well -being will deteriorate, which causes an increase in temperature (up to 40 degrees and above) and the appearance of cough with thick sputum.

Coughing, temperature, shortness of breath holds with pneumonia for 3-6 weeks. The temperature after the disease can be within 37 degrees for a couple of weeks.

Important: If the body temperature after the disease rises to 38 degrees, then you need to consult a doctor, as this may be evidence of a repeated infection, and the foci of infection may occur again.

Long -term shortness of breath is evidence that a liquid has accumulated in the alveoli, which did not completely withdraw during the course of the disease. Consult a doctor to prevent a repeated infection.

Can there be pneumonia without symptoms, cough, temperature?

Pneumonia without symptoms, cough, temperature often proceeds in young children. Therefore, it is important that the doctor see the root of the problem and correctly diagnosed if the baby constantly cries, he has poor appetite and drowsiness.

It is important for an adult with inflammation of the lungs, which proceeds asymptomatic, it is important to follow his health and consult a doctor in a timely manner. Do not engage in familiar activities, despite the fact that there is no temperature. Ignoring the first signs of the disease (weakness, drowsiness, poor appetite) can lead to the development of severe complications.

Pneumonia in children: the first initial signs, symptoms, cough, temperature, shortness of breath

Pneumonia in children is an insidious disease that can occur without symptoms or with signs similar to other diseases. Parents should be attentive to the behavior of their baby and urgently contact the pediatrician if the first initial signs of the disease appear:

• Lethargy, drowsiness, tearfulness
• Permanent cough
• Body temperature above 38 degrees
• Shortness of shortness of breath
• Lack of appetite
• Tachycardia
• The appearance of a blue in a nasolabial triangle
• Fluffing of the thoracic region
• Weight loss, sometimes body weight reach a critical mark

Both newborn children and older kids can get pneumonia.

Intrauterine pneumonia in newborns: causes

Eliveal inflammation may also appear in newborn children. Clinical manifestations of the disease are accompanied by the first 72 hours after birth. The causes of intrauterine pneumonia in newborns should include the following:

• Bacteria in the genitals in the mother
• Pathology of childbirth
• An abortion and miscarriage
• Inflammatory processes in the placenta

The causative agent penetrates through umbilical blood. The fetus does not breathe lungs and therefore the disease proceeds asymptomatic and manifests itself only at birth, with the first sigh of the crumbs.

Diagnosis of pneumonia: blood test, sputum, x -ray

In medical practice, there is a “gold standard” of diagnosis of pneumonia. Elementary, but at the same time informative indicators are revealed, which make it possible to properly make a diagnosis. Such a diagnosis of pneumonia is carried out:

• A blood test is general and biochemical. Often it is the blood test that helps to detect the disease, but in many patients, it may be normal. This speaks of poor immunity. Therefore, additional diagnosis is prescribed - an analysis of sputum and x -ray.
• Analysis of sputum gives a more complete clinic of the disease. The mucus of yellow or brown is a sign of bacteria in the lungs, namely pneumonia. The mucus of white and gray is a sign of the disease in the nasal sinuses. Sputum of pink color - heart disease, green - infectious diseases. Mucus with blood is a sign of pneumonia that caused fungi of different etiologies. It should be noted that hemoptysis can indicate not only lung diseases, but also stomach and nasopharynx. With this sign, the doctor must prescribe an additional bronchoscopy in order to identify the source of bleeding.
• The radiological picture is visible using x-ray in 2 projections. A picture is taken when the patient stands straight and side. But in the first 72 hours, changes may not be visible, therefore, with a deterioration in the patient’s condition, repeated radiography is made 2-3 days after that.

The doctor must examine in detail the results of laboratory blood tests. With pneumonia there will be such indicators:

• Red blood cells - The norm is or a little less. Children may have an increase in this indicator against the background of dehydration.
• Leukocytes exceeded - more than 9*109/l. But a significant decrease can be observed - below 4*109/l, which indicates a severe course of the disease and disorders in the immune system.
• Segment-nuclear leukocytosis - More than 5%.
• ESR - Significant excess. With lung inflammation, this indicator is more than 30 mm/h with a norm in men-1-10 mm/h, in women-2-15 mm/h, in children-1-8 mm/h.
• Lymphocytosis (exceeding indicators) - indicates the virus in the lungs - citamagalovirus, measles, flu.

Deciphering blood test is made simply and indicators will vary depending on the severity of inflammation. The more pronounced leukocytosis and accelerate ESR, the harder the course of the disease. The child should decrypt the analyzes of the child, as the indicators depend on the age of the baby.

Below the table is normal blood tests of a healthy person. During the recovery after pneumonia, blood indicators should approach this norm.

Treatment of pneumonia: how much is treated, how much to lie in the hospital?

Inflammation in the lungs can be light and moderate. In this case, hospitalization is not required. The duration of treatment of the house is no more than 3 weeks. Treatment of pneumonia depends on the following factors:

• Type of pathogen
• The body's reaction to antibiotics
• The general condition of the patient
• The severity of the disease

It depends on these factors how much the patient will be treated. If the patient has a severe stage of pneumonia, then it will be treated in a hospital. The doctor’s decision depends on such symptoms of the patient:

• Violation of the patient's consciousness. The doctor asks the usual questions that will not cause difficulties in a healthy person.
• The exceeded urea in the blood.
• Low pressure is below 90/40 mm.
• A patient over 65 years old.

If there is at least one factor or symptom, the patient is immediately hospitalized.

Important: The patient should drink a lot of liquids. In addition to water, juices, fruit drinks and tea are recommended. You also need to walk at least in the ward for 20 minutes a day, so that there are no more pressure and stagnation in the lungs.

The doctor is allotted only 4 hours to make a diagnosis and determine the treatment plan. Pneumonia is a serious illness and any delay can cost a patient of life. The main methods of treatment:

• Non -steroidal drugs - NSAID
• Mucolytic drugs
• Expecting syrups and pills
• Anesthetic medicines.

The hospital uses not only drug therapy, but also such procedures are prescribed:

• Breathing exercises
• Physiotherapy
• Back massage

How much pneumonia is treated - terms:

• Treatment with antibacterial therapy ceases about 7 days after the start of the course of treatment.
• Antimicrobial drugs, with inflammation of the slight form of moderate severity, should enter the patient's body for 10 days.
• Treatment of a protracted disease is carried out within 20 days.
• The term of treatment in a hospital is from 7 to 20 days, depending on the condition of the patient.
• If the inflammation of the lungs occurs as a result of infection with a pseudoscan or enterobacteria, then the period of treatment in the hospital can be about 6 weeks. In this case, venous and drip administration of drugs is prescribed.

Important: In most cases, patients recover after 20 days of effective treatment. After that, a person should be observed with the therapist for another six months.

Antibiotics in pneumonia: list, application

Only a doctor should prescribe antibacterial therapy. It makes an accurate diagnosis, and depending on the type of pneumonia, prescribes drugs to the patient. Such antibiotics are used for pneumonia - list:

There are basic rules for prescribing antibiotics:

• Combining several drugs -Usually 2-3 tabletized agents, injections or in the form of droppers.
• First, antibiotics of the first row are prescribed, which must be used until complete recovery. They are prescribed before detecting bacteria-excituator.
• After obtaining the results of laboratory research and other diagnostics, modern antibiotics are prescribed.
• If there is symptoms of atypical pneumonia With pathogens such as chlamydia, legionella and mycoplasma, appropriate drugs are used for treatment that can cope with the specific type of pathogen.
• In the severe stage of pneumoniaIn addition to pills and other medicines, oxygen inhalations with medicine and other similar measures are prescribed.
• Antibiotics can be administered intramuscularly or orally. To achieve a greater effect, in severe disease, the drugs are administered intravenously.

Important: When prescribing antibiotics, attention is drawn to the compatibility of drugs. Only a doctor can know this. Therefore, self -medication for pneumonia is life -threatening!

Are ceftriaxone, bacteriophage Klebsell, Sumamed, azithromycin, amoxiclav, cefotaxim with pneumonia?

As mentioned above, antibiotics with pneumonia are prescribed depending on the pathogen and severity of the course of the disease. Ceftriaxone, bacteriophage Klebsell, Sumamed, azithromycin, amoxiclav, cefotaxim are antibacterial drugs that are effective in pneumonia. But only a doctor should prescribe these drugs separately or in combination.

Complications and consequences of pneumonia in adults and children

With a favorable outcome, the patient is cured on 14-20 days of the disease, depending on severity. But complications may occur when the pathology of nearby organs appears. Problems of a mental nature appear, from the cardiovascular system, as well as respiratory failure. In more detail, all complications were indicated above in the text, in the description of each type of pneumonia.

To eliminate the consequences of pneumonia in adults and children, different procedures are prescribed:

• The most important thing in the treatment of pneumonia is the purpose of antibiotics. After all, it is bacteria that are the cause of the disease and subsequent complications.
• With difficulty breathing, the patient is connected to the apparatus of artificial ventilation.
• With intoxication of the body The saline is used intravenously and other drugs that allow you to quickly cleanse the blood of poisonous substances.
• For blood purification From the activities of microorganisms, hemosorption and hemofiltration are used. Hemodialysis is used for renal failure.
• Increasing immunity - An important way to combat pneumonia. The leukocyte fluid and anti -staphocic solution are transfused.
• Different drugs are used to thin the sputum, reduce body temperature, pain relief, eliminate bleeding and shortness of breath.

After the treatment of pneumonia, complications and consequences experience only a small part of adult patients. It is recommended to lead a healthy lifestyle, the rejection of smoking and drinking alcohol. In children, everything is much more complicated, and secondary pneumonia can occur. Therefore, in the middle and severe stage of the disease, the pediatrician recommends hospitalization to be able to carry out all the necessary procedures for full recovery under the supervision of a doctor.

Rehabilitation after pneumonia, breathing exercises, massage

In the treatment of pneumonia, not only drug therapy is important, but also recovery procedures after cure. Rehabilitation after pneumonia is also a significant stage for any patient who has been ill with such a serious illness. Physiotherapeutic procedures, as well as do breathing exercises and undergo a massage course, will effectively.

Respiratory gymnastics in Strelnikova is very popular. This is a qualified doctor who has developed a complex of breathing exercises - simple, but effective. Inside must be made with his nose - noisy and diligently, as if with all his strength, drawing in the air. The exhalations are arbitrary. Here are the exercises of the respiratory gymnastics in Strelnikova:

1. Exercise "palms". Show your palms, squeeze them with all your strength and at the same time sniff your nose. So you need to make 4 approaches 8 times, that is, only 32 times.
2. "Monfires". Hands at the level of the belt clenched into fists. Make your arms outlets forward, spreading your fingers and at the same time sniff loudly with your nose - 4 approaches 8 times - 32 times.
3. "Pump". Prugge your back, leaning a little forward, but not very low. Make emissions with your hands, as if pumping the pump and at the same time sniff loudly with your nose - 32 times.
4. "Cat". Stand straight, then start squatting a little, turning first in one direction, then in the other. With every turn, sniff with your nose. So you need to do 32 times.
5. "Hug the shoulders". Hands are bent at the elbows, at the level of the shoulders. Hands will only be divorced only in the starting position, then the hands are divorced a little, as if hugging the shoulders. When performing this exercise, always the right hand over the left. You can’t change your hands in places! At every hug, sniff loudly with your nose. Perform the exercise also 32 times.
6.   "Great Pendulum". First, perform the element from below from the exercise “pump”, then at the top from the exercise “hug your shoulders”. With each movement, sniff it noisily with your nose. In total, the upper and lower elements are 32 pieces, that is, you will bend and raise your hands 32 times.
7. "Turning the head to the right and left." The exercise resembles movements, as if you are sniffing the air either in one side, then in the other - where it smells of burning: on the right or on the left? With each turn of the head, sniff loudly with your nose - 32 times.
8. "Chinese blank". Swing your head, tilting it to the right, then to the left. At the same time, do not raise your shoulders - 32 times.
9. "Small pendulum". Sweeping the head up, down, noisily sniffing with his nose - 32 times.
10. "Rolls". The exercise is performed by legs. Stand straight, put one leg forward at a step distance. Now sway, first focus on the front leg, then on the one that stands from behind. With each roll, sniff loudly with your nose - 32 times. Then change your leg and repeat the exercise also 32 times. Attention: you can’t stand half a turn, only directly - follow this.
11. "Front step". Raise one leg, while squatting slightly with the second. From the side it looks like you are dancing Rock-n Roll. With good physical preparation, you can raise the leg high. Do this 32 times.
12. "Rear Step". Bend your leg back, squatting at the same time with the second foot. With each squat, sniff loudly. Repeat 32 times.

You can do breathing gymnastics twice a day - in the morning and evening. After 2-3 days, you will feel relief in terms of breathing, and on the first day it will seem that the nose began to breathe better.

Look at how to correctly perform each exercise in the video. It participates and teaches people correctly to do breathing gymnastics in Strelnikova, her student is Mikhail Nikolaevich Shchetinin.

Video: Strelnikova breathing gymnastics (without extra words and video)

Massage is also very effective with recovery after pneumonia. If there is a slight stagnation in the lungs, then it is massage that will help to finally get rid of this condition during the recovery. It is better if a professional does it.

Is there a vaccination against pneumonia to children, adults?

A vaccine from pneumonia is recommended for young children from 2 years and patients of advanced age-after 65 years. This is due to the fact that at this age, people have reduced immunity and the body is difficult to fight with a pneumococcal infection. There are such vaccinations from pneumonia to children, adults:

Which of these vaccines to make an elderly person is solved only by the doctor.

What is the difference between pneumonia and pneumonia, bronchitis?

Pneumonia is inflammation of the lungs, so there is no difference. But bronchitis differs from pneumonia. To figure out what these differences, you need to know how the person’s respiratory tract is arranged:

• Nose
• Nasopharynx
• Larynx
• Trachea
• Bronchi on the left and right side
• The final bronchi are bronchioles
• There are special bags in the end of the bronchiol in which gas exchange occurs - alveoli

The infection falls through the nose, nasopharynx, passes a larynx, trachea and settles on the bronchi. Such a disease will be called bronchitis. With pneumonia, the infection is in bronchioles and alveoli. It is a consequence of bronchitis. Therefore, recovery at the stage of bronchitis is so important - a disease that is easier and easier to cure.

Is it possible to die from pneumonia?

There are several causes of death from pneumonia:

• Sepsis - blood poisoning. Infection and pathogenic flora enters the bloodstream. In this case, even antibacterial therapy does not always help.
• Infectious toxic shock - Bacteria and toxins are thrown into the blood. The work of the heart, kidneys, the pressure decreases sharply.
• Light abscess - Pus in the lungs. The abscess is eliminated only with the help of surgery.
• Distress syndrome - A sharp decrease in the level of oxygen in the blood and inhibition of the functions of the respiratory system. In this case, only artificial ventilation of the lungs saves.

A death can occur from pneumonia if you do not consult a doctor in a timely manner. Therefore, it is important to monitor your health and with its slightest deterioration, to go to the clinic - to an appointment with the therapist.

No information in this article should be regarded as a replacement for consulting a doctor! Pneumonia is a terrible and serious illness, delay can be worth life. Timely contact doctors and be healthy!

Video: pneumonia: causes and treatment