Pneumonia in the resolution stage

Symptoms of croupous pneumonia

Shared pneumococcal pneumonia is characterized by the defeat of a whole lobe (or lung segment) of the lung and mandatory involvement in the inflammatory process of the pleura.

The second distinctive feature of shared (croupous) pneumonia is participation in the pathogenesis of the disease of hypersensitivity reaction immediate type in the respiratory zone of the lungs, which determines the rapid onset of the disease, accompanied by a marked violation of the vascular permeability. This reaction is based on the preliminary sensitization of the macroorganism by the pathogen antigens-pneumococci, as a rule, present in the upper respiratory tract. When the pathogen again enters the respiratory parts of the lung and contacts the allergen with mast cells and located on their surface, an immunoglobulin-anti-immunoglobulin complex is formed by immunoglobulins, which activates the mast cell. As a result, it degranulates with the release of a large number of inflammatory mediators, which initiates an inflammatory process in the lung,

It should be emphasized that the activation of the mast cell and the release of inflammatory mediators can also occur under the action of physical factors (cold, excessive physical exertion, "cold" in the form of acute respiratory viral infection and etc.). If by this time the respiratory sections of the lungs are colonized by Streptococcus pneumoniae, a "violent" hyperergic reaction develops, initiating the inflammatory process in the lung.

However, despite the fact that contact with the pneumococcal antigen leads to the formation of immunoglobulins in many patients pneumococcal pneumonia, the described hyperergic reaction, characteristic of lobar croup pneumonia, few of them. It is assumed that in these cases an important role is played by hereditary predisposition, including the inheritance of some NLA genes. It is not excluded that the expression of these genes is combined with the increased ability of B-lymphocytes to secrete immunoglobulins upon contact with the antigen.

With croupous pneumonia, inflammation starts in one or more foci, and then quickly spreads directly through the lung tissue in the form of an "oil stain mainly through interalveolar pores of Kona. In this case, as a rule, bronchi are not involved in the inflammatory process (with the exception of respiratory bronchioles).

The third important feature of lobar pneumonia is the fibrinous nature of the exudate caused by a marked violation permeability of the vascular wall, associated with immunocomplex damage of the microcirculatory vascular bed of the pulmonary parenchyma. An additional damaging factor is the pneumococcal isolated hyaluronidase and hemolysins. Fibrinogen in contact with damaged lung tissue is converted into fibrin, which forms the basis of the formation of a specific fibrin film, which seems to "lining" the surface of alveolar sacs and, apparently, respiratory bronchioles, without affecting larger bronchi. The film is easily removed, resembling that of diphtheria "croup" Hence, the old name of lobar pneumonia - croupous pneumonia - The term, which is not currently used in scientific medical literature, although it is often used in domestic medical practice.

Important distinctive features of share (croup) pneumonia, which largely determine the clinical picture of the disease, are:

• widespread defeat of the whole lobe (or less commonly - segment) of the lung with mandatory involvement in the inflammatory process of the pleura;
• participation in the pathogenesis of pneumonia of an immediate type of hypersensitivity reaction, which determines a "violent" hyperergic reaction initiating the inflammatory process in the lung;
• fibrinous character of exudate;
• the primary lesion of alveolar tissue and respiratory bronchioles with the preservation of the full patency of larger respiratory tract.

The course of lobar pneumonia

The classical course of lobar pneumonia is characterized by the stage of development of morphological changes in the lungs.

The tidal stage is characterized by a sharp hyperemia of the lung tissue, a violation of microcirculation and vascular permeability. Rapidly developing edema of the alveolar walls, accompanied by a decrease in the elasticity of the lung tissue. A small amount of exudate, which begins to fill the alveoli, for some time is located near the wall, as if "lining" their inner surface. The alveoli themselves still retain their airiness. Usually, at the end of this stage, it is possible to identify the involvement of the pleura in the inflammatory process. The duration of the tide stage does not exceed 1-2 days.

The stage of curation (hepatization) is characterized by the predominance of pronounced exudation and emigration to the inflammatory focus of cellular elements involved in inflammation. In this stage, the alveoli are completely filled with fibrinous exudate, and lose their airiness. Exudate is rich in fibrin, alveolar epithelial cells and leukocytes. At the expressed infringement of a vascular permeability in an exudate the considerable quantity of erythrocytes is found out.

Macroscopically, one or more lesions of the lung are enlarged and uniformly compacted (hence the traditional name for this stage is "curation or "hepatitis"). On the cut, the surface of the lung tissue can be of different colors - from dirty gray to dark red - depending on the severity of vascular permeability disorders. The centers of "gray curing" reflect the prevalence of leukocytes in the exudate, mainly neutrophils. If in Exudate, in addition to peytrophils and fibrin, there is a large number of red blood cells, the focus of inflammation looks like a site of "red curing".

In the past, there was an idea of ​​the mandatory sequential transformation of the areas of "red custody" in the areas of "gray custody". However, it has now been shown that the morphological pattern of lobar pneumonia throughout the entire stage can be represented as gray foci, hack and areas of red custody, or their combination. In other words, with lobar pneumococcal pneumonia, foci of gray and red opacification can occur simultaneously and probably are not related to the time elapsed since the onset of the disease. Such a variegated morphological picture of the lung in the stage of curing is connected, first of all, with the species pneumococcus, which was the causative agent of the disease, its virulence, and also with reactivity macroorganism.

In the stage of curation of the pleura, fibrinous and fibrinous-purulent overlays are found that reflect the involvement of the pleura in the inflammatory process.

The duration of the treatment phase usually does not exceed 5-10 days.

The resolution stage is characterized by a gradual resolution of the inflammatory exudate, an increase in the breakdown of leukocytes, and an increase in the number of macrophages. Alveoli are gradually released from exudate, slowly restoring its airiness. For some time, exudate re-located only pristenochno on the inner surface of the alveoli, and then disappears completely. Suffice for a long time, the edema of the walls of the alveoli and the reduced elasticity of the lung tissue remain.

The described distinct staging of the inflammatory process in case of lobar pneumonia is currently observed quite rarely, that is associated with a change in the biological properties of the pathogen, as well as the effect of timely prescribed antibiotic therapy on the process inflammation.

The classical course of lobar pneumonia is characterized by a successive change of three stages inflammatory process, the morphological manifestations of which are the basis of the entire clinical picture diseases:

1. Stage of the tide:
   • inflammatory hyperemia and edema of interalveolar walls with a decrease in the elasticity of the lung tissue;
   • the parietal location of a relatively small amount of fibrinous exudate,
   • preservation of some airiness of the alveoli in the focus of inflammation.
2. The stage of curation (hepatitis):
   • "Tight" filling of alveoli with fibrinous exudate, compaction of the lobe of the lung;
   • presence in the affected portion of the sites of both gray and red curing;
   • mandatory involvement in the inflammatory process of the pleura.
3. Resolution stage:
   • "Dissolution" and resorption of fibrinous exudate, which for some time is located in the alveoli pristenochno;
   • gradual restoration of airiness of alveoli;
   • long-lasting puffiness of the interalveolar septa and reduced elasticity of the lung tissue.

Resolve

The patient's questioning with the presence of symptoms suspicious of spilling pneumonia should include:

1. An exhaustive analysis of the patient's complaints.
2. Evaluation of the clinical and epidemiological situation in which pneumonia has developed, in particular:
   • possible provoking factors (hypothermia, respiratory viral infections, overwork, alcohol excess, excessive smoking, anesthesia and narcotic "intoxication cerebral trauma or stroke and etc.);
   • long stay in an isolated team, in conditions of crowding (school institutions, nursing homes, prisons and so on);
   • recent trips and accommodation in hotels, including air-conditioned;
   • possible recent contacts with patients with pneumonia, bronchitis, ARVI or "colds as well as contact with animals, birds;
   • stay in hospitals, intensive care units;
   • application for the diagnosis and treatment of endotracheal tube, mechanical ventilation, bronchoscopy, etc .;
   • possible recurrent or episodic aspiration of gastric contents, and the like.
3. Presence of concomitant chronic diseases (bronchopulmonary, cardiovascular, digestive organs, diabetes, blood diseases, immunodeficiency states, allergic reactions, etc.).
4. Presence of risk factors (age, smoking, alcoholism, drug addiction, etc.).

Stage of the tide

It was shown above that the "tide" stage is characterized by a significant increase in body temperature (up to 39-40 ° C and higher), accompanied by chills, increasing symptoms of intoxication, pain in the chest, associated with breathing with the appearance of dry, sometimes painful cough.

Inspection

Patients often occupy a forced position in bed, lie on their backs or on their sore sides, pressing their hands with a section of the chest in which there is maximum pain. This situation somewhat reduces the excursion of sore leaflets and relieves pain.

Consciousness can not be changed, although sometimes different degrees of its violation are observed. Skin wet. There is a hyperemia of the face and an injection of sclera, often more pronounced on the side of the lesion. Since lobar inflammation of the lung is often accompanied by a viral infection on the lips, wings of the nose and ear lobes, herpetic eruptions can be detected.

In severe cases and in individuals with concomitant chronic diseases of the lungs or heart, there is a small cyanosis lips, tip of the nose, earlobes, which is associated with the emerging respiratory insufficiency and disorder blood circulation.

Examination of the respiratory system

If there is severe pain, breathing becomes superficial, mainly because of the patient's desire to reduce the friction of the pleural sheets against each other, causing pain.

Already in this stage of the disease it is possible to identify the lag of the diseased side of the chest in the act of breathing, although the symmetry of the thorax is completely preserved

When palpation is often determined by the local tenderness of the chest, associated with inflammation of the parietal pleura, as well as a slight increase in vocal jitter on the side of the lesion. In the projection of the affected lobe of the lung, blunting (shortening) of the percussion sound with a tamponic shade is determined. Dullness of percussion sound is associated with a small compaction of lung tissue. The timbre of the percussion sound is due to the preservation of some airiness of the alveoli, while a significant decrease in the elasticity of the lung tissue. The latter leads to a substantial depletion of the timbre of percussion sound, characteristic of a healthy lung with normal elasticity of the lung tissue. As a result, the pulmonary sound by the physical characteristics approaches the tympanic.

In auscultation, two auscultatory phenomena are defined in the projection of the affected lung fraction: weakened breathing and crepitation.

It was shown above that in the initial stage of lobar pneumonia (the "tidal" stage) the alveoli only partially retain their airiness, and the inner surface of their walls, as well as the walls of respiratory bronchioles lining the viscous fibrinous exudate, and the walls of the alveoli themselves are swollen and are rigid.

For most of the inspiration, the alveoli and, possibly, the respiratory bronchioles are in a collapsed state, which resembles the picture multiple micro-telelectases, the appearance of which in the projection of the affected lobe of the lung and explains the auscultatory phenomenon of weakening respiration. It is clear that a much higher gradient of pressure in the pleural cavity and upper respiratory tracts is required to straighten the adherent walls of the alveoli than in the norm. This pressure gradient is reached only towards the end of the inspiration. During this period, the walls of the alveoli containing the exudate dissolve, and a specific sound arises that is commonly called crepitacio index (initial crepitation).

Crepitation is very similar to wet fine bubbling rales (fine cracles), but differs in that it occurs only at the height of a deep inspiration and does not change when you cough.

It should also be remembered that crepitation can occur in other pathological conditions, for which a decrease airiness of the alveoli and violation of the patency of respiratory bronchioles, which (together with the alveoli) during the first half of the inspiration in collapsed condition. This situation occurs with compression atelectasis, lung infarction, pneumonitis and other diseases.

The most characteristic physical signs of the initial stage of lobar (croupous) pneumonia (tidal stage) are:

• weakened vesicular breathing in the projection of the affected lobe of the lung, accompanied by crepitatio index;
• in the same projection - dullness of percussion sound with tympanic shade (less constant sign).

The stage of custody

The stage of "custody" (the height of the disease) is characterized by the persistence of high fever, symptoms of intoxication, the appearance of a cough with separation "Rusty" and mucopurulent sputum, an increase in signs of respiratory failure, and in some cases - cardiac and vascular insufficiency.

When examined for several days from the onset of the disease, the patient's forced position on the diseased side may persist, associated with involvement in the inflammatory process of the pleura (dry pleurisy), as well as face hyperemia and injection sclera on the side defeat. With a severe course of the disease, cyanosis increases due to progressive ventilation respiratory failure.

Examination of the respiratory system

Respiration is frequent (up to 25-30 or more per 1 min) and superficial. With a considerable extent of inflammation affecting two or more lobes, the presence of not only tachypnea, but also pronounced difficulty in breathing, in particular inspiratory dyspnea, participation in respiration of the auxiliary musculature, swelling with the breathing of the wings of the nose, and the like.

There is also a distinct lag in the act of breathing of the patient's half of the chest. At this stage of the disease, vocal tremor and bronchophonia are strengthened on the diseased side.

With percussion, pronounced blunting of the percussion sound over the affected area is noted, not reaching, however, to the extent absolutely blunt (femoral) sound, the appearance of which in a patient with lobar pneumonia indicates the formation of exudative pleurisy.

During the height of the disease, the pathological Bronchial respiration due to compaction of lung tissue while maintaining patency airways. For backward reasons, crepitation is not heard, since the alveoli are completely filled with fibrinous exudate and airiness is lost. Often, for several days, the noise of friction of the pleura continues to be heard over the affected area, which subsequently disappears.

Against the background of increasing signs of intoxication, the heart rate increases to 110 12 per 1 min. At the top, functional systolic noise can be heard, in some cases, arrhythmia.

In uncomplicated course of lobar pneumonia, the duration of the peak period of the disease usually does not exceed 7-10 days, after which the resolution stage begins.

The most characteristic physical signs of the stage of custody are:

• pathological bronchial breathing in the projection of the affected lobe of the lung and the noise of friction of the pleura;
• pronounced blunting of percussion sound.

Stage of resolution

The stage of resolution in cases of uncomplicated course of the disease is characterized by a decrease in body temperature (lytic or more rare cases - a critical decrease in all manifestations of general toxicity syndrome and respiratory failure, cessation cough.

All pathological findings are revealed in the stage of curing with percussion and auscultation gradually regress. There is a kind of "enlightenment" of blunted percussion sound. Dulling again, like in the first stage, acquires at first a tympanic hue, and then a clear pulmonary sound is restored.

At auscultation, the bronchial shade of breathing weakens, which is associated with a decrease in the compaction of lung tissue. Due to the gradual dissolution of the exudate, the airiness of the alveoli is partially restored. The exudate is located near the wall. Therefore, just as in the first stage of the disease, weakened breathing is determined over the affected part of the lung for some time. At the end of the inhalation, the "breaking" of the alveoli and respiratory bronchioles again occurs, which is the cause of crepitation (crepitacio redux - the ultimate crepitation). Unlike the first stage crepitacio redux becomes sonorous.

As the removal of the exudate and the disappearance of edema of the alveolar walls occur, elasticity and airiness of the lung tissue, vesicular breathing begins to be determined over the lungs, crepitation disappears.

The most characteristic physical signs of the resolution stage are

• dullness of percussion sound with a tympanic tinge, which is gradually replaced with a clear pulmonary sound;
• weakened vesicular breathing, which passes into vesicular breathing;
• the appearance of reduptio redux, with the subsequent disappearance of this auscultatory phenomenon.

It should be emphasized that the described precise staging of clinical manifestations of lobar (croupous) pneumonia is presently relatively rare. In this connection, laboratory and radiographic signs of the disease acquire special significance for diagnosis.

Complaints of the patient for shared pneumonia

All early symptoms of developing lobar pneumonia can be divided into two groups:

1. generalintoxication and
2. bronchopulmonary.

The first of these includes fever, chills, headache, general and muscle weakness, weakness, to the second group - pain in the chest, cough, shortness of breath, separation of sputum, etc.

Fever

In most cases, lobar pneumonia begins acutely, with a sudden increase in body temperature to 39-40 ° C and above, and pain in thorax According to the apt expression of A.L. Myasnikova, sick with croupous pneumonia, remembers the day and the hour when she started disease. The rise in body temperature is usually preceded by a tremendous chill, lasting 3 hours. Further high fever (3, -39 ° C) of a constant character (febris continua) with small daily fluctuations in body temperature, not exceeding, ° C, which is very typical for uncomplicated pneumococcal disease pneumonia. The constant fever can last 7-10 days, but against the background of adequate antibiotic therapy this period is usually reduced to 3-4 days.

If the swings of body temperature during the day exceed 1-2 ° С (laxative, hectic) and are accompanied by chills or cognition with each new an increase in body temperature, one should think about possible purulent-destructive and septic complications - abscessing of pneumonia, development of pleural empyema, sepsis and etc.

In uncomplicated course of lobar pneumonia, the febrile period ends with a lytic (gradual) or (rarely) critical (sudden) drop in body temperature. A critical drop in temperature may be accompanied by symptoms of acute vascular insufficiency.

Among the most important factors determining the nature of the temperature response in pneumonia, at present, mediators of inflammation (prostaglandins, leukotrienes, cytokines, a significant increase in which, observed r the climax of the inflammatory process in the lungs, affects the functional state of thermoregulatory centers.

Thus, the temperature response as a whole not bad reflects the nature and dynamics of the inflammatory process in the lung, as well as the effectiveness of the antibacterial and anti-inflammatory therapy. Nevertheless, it should be remembered that the normalization of body temperature does not in itself mean the completion of the pathological process in the lung. Moreover, in a number of cases, the absence of a temperature response in the formation of lobar pneumonia, especially in elderly or senile patients or weakened patients suffering from severe concomitant diseases. Can have a serious prognostic value, indicating a sharp decrease in the reactivity of the body.

Chest pain

The second earliest and most characteristic sign of the onset of lobar pneumonia, indicative of involvement in the inflammatory process mainly the lower part of the parietal pleura adjacent to the diaphragm, in which a dense network of painful receptors.

The most characteristic signs of pleural pain is the acute intense nature of pain in the chest, arising and / or amplifying at the height of a deep inspiration. Usually the pain is strictly localized - and the patient can accurately indicate the place of maximum pain. Pain, as a rule, increases when the patient is bent to the healthy side, since this position increases the friction of the inflamed pleura sheets against each other with deep breathing. When a pain syndrome occurs, the patients often breathe superficially, instinctively trying to avoid irritation of the painful receptors of the pleura.

It should be remembered that with lesions of the diaphragmatic pleura, intense acute pain can be localized in various parts of the abdomen, simulating the clinical picture of such diseases like acute cholecystitis, peptic ulcer of the stomach or 12-gut and even acute appendicitis; pain in the left side with pneumonia can simulate acute pancreatitis. In these cases, the presence of high fever and general toxication syndrome further complicates clinical diagnosis. Nevertheless, a careful analysis of the nature of pain in the abdomen and, first of all, a clear connection of pain with In most cases, breathing allows you to suspect that the patient has pleuropneumonia and diagnostic search.

With pleuropneumonia, acute chest pain associated with breathing usually lasts 2-3 days and then disappears. Nevertheless, the increased sensitivity of the skin in the area of ​​the affected pleura may persist for a sufficiently long time, even after the completion of the inflammatory process, increasing with hypothermia, after physical exertion, respiratory diseases, etc. Such an increased pain sensitivity of the pleura can be detected by palpation of the corresponding sites thorax. At the same time, the patient himself with deep breathing often feels a kind of discomfort in this area, although it does not characterize him as intense pain.

In uncomplicated course of lobar pleural pneumonia, chest pain lasts no more than 2-4 days and has the character of typical pleural pain, which is characterized by:

• acute intense character;
• clearly localized pain;
• the occurrence or intensification of pain at the height of a deep inspiration;
• Increased pain when bending the patient to a healthy side.

Cough is the third characteristic sign of pleuropneumonia. As you know, cough occurs when the receptors of the vagus nerve and the upper laryngeal nerve are irritated, located in the pharynx, larynx, trachea, large bronchi and in the pleura. The pathological process, localized only in the parenchyma of the lung or in the small bronchi, is not accompanied by a cough until the sputum enters the larger bronchi.

At the very beginning of the disease (in the 1-2 days of the disease) cough is dry, without separation of sputum. It is associated with involvement in the inflammatory process of the pleura and increased sensitivity of cough receptors. Dry cough often appears with a deep breath, simultaneously with the appearance or intensification of the pain described above in the chest.

After 1-2 days from the onset of the disease, the cough acquires a different character. By this time, the process of exudation begins to grow, and in the alveoli, and then in the terminal and larger bronchi there is a small amount of viscous fibrinous exudate containing a large number of leukocytes and often - erythrocytes. As a result, a cough is accompanied by the release of a small amount of sputum "rusty" color, which reflects the formation in the inflamed lobe of the light areas of "red curing" of lung tissue.

Occasionally, with more pronounced impairment of vascular permeability in the inflammatory focus, sputum or even blood clots may appear in the sputum. In uncomplicated course of lobar pneumonia, uninvited "hemoptysis" or separation of "rusty" sputum continues for a relatively short time (no more than 2-3 days). In the future, sputum usually acquires a mucous or muco-purulent character and is separated in a small amount.

Longer separation of bloody sputum causes differential diagnosis of pleuropneumonia with such diseases and syndromes like tuberculosis, lung cancer, infarction pneumonia, bronchiectatic disease, lung abscess, hemorrhagic tracheobronchitis, and other

In patients with lobar pneumonia, a dry (reflex) cough associated with involvement in the inflammatory process of the pleura appears in the first 1-2 days from the onset of the disease. During the next 2-3 days, a small amount of sputum appears, often "rusty" in color, and in rare cases - veins and clots of blood in the sputum.

Dyspnea

A constant sign of lobar inflammation, although its severity largely depends on the severity of the course of the disease, stage of the inflammatory process, as well as the presence of concomitant diseases of bronchopulmonary and cardiovascular system.

In any case, dyspnea with lobar pneumonia is a manifestation of respiratory failure due to three main causes:

• switching off part of the pulmonary parenchyma from pulmonary ventilation;
• increased rigidity of the lungs, which hinders breathing and limits the ventilation of the lungs;
• a decrease in ventilation-perfusion ratios in the affected lung, causing a right-left-handed discharge of venous blood and even the formation of a venous alveolar shunt.

For obvious reasons, the greatest manifestation of dyspnea reaches the stage of custody. In some cases, usually in young patients who do not have concomitant diseases of the lungs and heart, respiratory Insufficiency is manifested only by a small feeling of lack of air and tachypnea arising from physical load.

In severe pneumonia, especially in elderly patients, as well as in persons with concomitant diseases of the bronchi, lungs and cardiovascular system, the emergence of acute respiratory insufficiency. A significant increase in respiratory movements, not only with physical exertion, but also at rest, is accompanied by a painful sense of lack of air and objective signs of respiratory failure - diffuse "gray" cyanosis, participation in respiratory support muscles, tachycardia and m.

The respiratory rate in a patient with pneumonia to 24 in 1 min or more is regarded as a severe course of pneumonia requiring hospitalization in the ICU.

General Intoxication Syndrome

It was mentioned above that one of the main clinical signs of lobar pneumonia is a significant increase in body temperature, accompanied by other manifestations of general toxication syndrome with general weakness, malaise, sweating, headache, confusion (delirium, hallucinations and even loss consciousness).

Often there are also disorders of the function of other organs and systems: a sharp decrease in appetite, severity in epigastric region, unstable stool, flatulence, myalgia, arthralgia, arrhythmias, cardiac and vascular failure.

General weakness is one of the most important manifestations of general toxicity syndrome and in many cases has a prognostic value, to a certain extent reflecting the dynamics of the inflammatory process in lungs. With shared (croupous) pneumonia, general weakness occurs from the first hours of the disease and, rapidly growing, reaches a maximum in 1-2 days.

In severe cases, adynamia appears. Any physical activity causes a painful sense of weakness. Patients with difficulty can raise their hands, sit in bed, even open their eyes. Such severe adynamia is usually accompanied by a pronounced increase in respiration (more than 30 in 1 min), tachycardia (heart rate - 100-120 per 1 min), a decrease in systolic and diastolic blood pressure and, as a rule, has a serious prognostic value, indicating the attachment of a pronounced respiratory and cardiovascular insufficiency.

In this regard, it is important to remember that any increase in body temperature by 1C in patients who have no symptoms intoxication or decreased cardiovascular function, accompanied by an increase in heart rate of only 10-12 strokes per 1 min. Therefore, the occurrence of tachycardia and tachypnea in a patient with lobar pneumonia on a background of normal or slightly elevated body temperature indicates a marked intoxication and has a particularly unfavorable prognostic value.

With less severe intoxication in patients with pneumonia, there are signs of hypodynamia. They can get out of bed, go to the toilet, try to do some work around the house, for example, to make a bed, cook food etc., causes a feeling of weakness and tachycardia.

Often, patients with lobar pneumonia for a long time, even after normalizing body temperature and reducing physical and x-ray signs of the pathological process in the lungs, a pronounced asthenic syndrome is preserved. Performing the usual physical exertion in the past (walking along the street, traveling in transport, cleaning an apartment, etc.) causes rapid fatigue, weakness, a desire to relax. Such a symptomatology indicates the presence in patients with pneumonia, including the recalcalscent latent intoxication, which must be taken into account when appointing individual rehabilitation programs.

The dynamics of the described manifestations of general weakness in a patient with pneumonia can serve as an important additional criterion for the effectiveness of the therapy and regress of the inflammatory process in the lungs. For example, a relatively rapid decrease in general weakness shortly after normalization of body temperature and reduction of fiscal and radiographic signs of pneumonia indicates a favorable course disease. On the contrary, rapid re-growth of general weakness in later terms of the disease or even in the period of convalescence indicates the possible formation of purulent-destructive and other complications. pneumonia, for example exudative pleurisy, pericarditis, hyperinfection, and the like.

Sweating

It also belongs to the number of persistent clinical signs of general toxicosis syndrome in patients with pneumonia. In most cases, sweating has a clear connection with the temperature response and is most pronounced with a decrease in body temperature, especially when its critical incidence.

In other cases, excessive sweating along with asthenic syndrome and subfebrile condition is observed during long after the transferred pneumonia, indicating an insufficient resolution of the inflammatory process.

Disturbances of consciousness, which develop in some patients with lobar pneumonia, are also often associated with general toxication syndrome and indicate the severity of the inflammatory process. Most often they develop in elderly and senile patients, especially with concomitant vascular or other genesis of chronic encephalopathy. In these cases, mental disorders can reach the degree of cerebral coma that simulates the development of ONMC. However, in the clinical picture of the disease, general cerebral neurological symptoms predominate, associated with general intoxication and brain edema.

Another variant of the disturbance of consciousness is delirium and hallucinations, which usually appear on the background of a significant and rapid increase in body temperature at the very beginning of the disease.

The general intestinal syndrome in patients with lobar pneumonia is of great diagnostic and prognostic value, reflecting to a certain extent the severity of the inflammatory process in the lungs. It includes the following clinical manifestations:

• fever with chills;
• general weakness, lack of exercise, or adynamia;
• severe sweating;
• disorders of consciousness (delirium, hallucinations, signs of encephalopathy, cerebral coma with cerebral neurological symptoms);
• violations of the function of other organs and systems (cardiovascular system, gastrointestinal tract, liver and kidneys, the system of endocrine organs, etc.).

Physical examination

The results of a physical investigation of a patient with lobar (pneumatic) pneumonia depend, first of all, on the stage of the development of the disease, the severity of pneumonia and the presence of these or other complications.

ilive.com.ua

Pneumonia in the resolution stage but after a week there is a temperature

Answers:

Svetlana

Probably a cold, because after antibiotics immunity is weakened, it is necessary to drink vitamins and probiotics.

irina lu

always tell the doctor.

zero-phase

Well, hardly a relapse, you already have antibiotics that are sterile. It's probably a viral infection, or the intestines are broken after antibiotics, some rotaviruses or something else ...
the disease is serious, and after such medications everything can be, and the liver and pancreas can be disturbed ...

Nikolai Nibokuvhat

It is compulsory to describe all observations to the child's doctor

Izokh Yulia

call an ambulance, there can be everything.

Zina Zeta

No synthetic antibiotic removes viruses, fungi and parasites. You prichna inflammation is unknown, as well as doctors. Set it on hemoscanner and clean the pathogen. Otherwise, you can bring the disease to a lethal outcome.

Natalia Chernyshova

The doctor's intervention is compulsory. the ambulance.

vladimir cats

can. Immunity is weaned + additional infection. Not at the reception, but to call an ambulance... mother.

ELENA MOLCHANOVA

problems with the lungs of a person torment all life continue treatment

sun.vera

At me after a pneumonia the temperature half a year kept 34-35. It's not the flu, which is quickly cured. I drank Icelandic moss, grass, Konko- (Bad) and herb monastic collections.

How does pneumonia look on X-rays?

Pneumonia on X-rays is characterized by areas of darkening. They indicate the presence of an infiltrate (a swollen inflamed focus) in the lung tissue.

An x-ray photograph can show how much the darkening, its shapes, contours, quantity and location have spread.

Dimensions can be of different sizes. They are divided into

• Small-focal ones, the size of which reaches 3 mm;
• mid-elevation - from 3 to 7 mm;
• Large-focal, reaching 7-12 mm.

Also, blackouts can be total, subtotal, common. Thus, lung X-ray in pneumonia is an integral part of therapy.

Prevalence of pneumonia

Inflammation of the lungs can occur in both adults and children. In children, it is more common, since the respiratory system and immunity are in their developmental stage.

Risk factors:

• hypothermia of the body;
• frequent regurgitation of babies;
• lack of vitamin D;
• prematurity of the child;
• poor nutrition;
• beriberi and anemia;
• decreased immunity;
• bad ecology;
• poor living conditions;
• smoking or smoking parents;
• various congenital malformations and diseases associated with the pulmonary system;
• nervous disorders.

The importance of lung X-rays in pneumonia

An important role in the diagnosis is given to the X-ray, since no other tests can provide reliable information. Before the chest X-ray, the task is not only to determine the lesion focus, but also to create a picture of the morphological variety of pathology. It can be focal, croup, fractional, mixed, draining, etc. The darkening areas on the x-ray are painted in a light color, and the areas of enlightenment in the dark.

What is the stage of resolution of pneumonia on the radiograph?

With the resolution of pneumonia, the following signs will be revealed on the roentgenogram:

1. At the site of inflammation, the pulmonary structure is enriched with small elements.
2. The root expands.
3. Dimensions of the shadow are reduced.
4. Darkening is reduced.

Such signs of resolving pneumonia can be observed for several months until the human body recovers.With inflammation of the lungs, the recovery period lasts slowly.

How do the complications of pneumonia look on the pictures? Complications after pneumonia also have their characteristics on the roentgenogram. For example, an abscess is detected by the appearance of cavities of the disintegration of lung tissue, which merge with each other. Exudative pleurisy is determined in the pictures due to the dimming of the lower pulmonary field. X-ray diagnosis of pneumonia can give the most accurate results of the disease.

Pneumonia in children

Most often the disease affects the child's body. The etiology of pneumonia is divided into:

• bacterial;
• virus;
• mycoplasmal;
• rickettsial;
• fungal;
• allergic;
• caused by invasion of helminths.

Symptoms of pneumonia in children are associated with the form of the disease and the course of the disease. The main ones are:

1. Increased body temperature.
2. Fast fatiguability.
3. Headache.
4. Discomfort in the lungs or under the shoulder blades.
5. Cough.
6. General intoxication of the body.

When listening, bronchophonia, mild breathing, crepitation are noted.

The pulmonary structure on the X-ray appears enhanced. A blood test can show an increase in white blood cells and ESR.

Complications of pneumonia include purulent formations that can be outside the lungs and cause otitis media, pyelonephritis, pericarditis, inflammation in the heart, which is rare, meningitis and other

Possible complications in the lungs:

1. Abscess of the lung.
2. Inflammation of the outer shell of the organ - pleurisy.
3. The accumulation of gases or air in the pleura - pneumothorax.

To prevent such complications, it is necessary to start treatment with antibiotics in time.

Treatment of pneumonia in children

If the disease is severe, treatment is carried out in a hospital. Children under one year of age are subject to immediate hospitalization.

The treatment is of a complex nature and includes the following procedures:

• prescribes etiotropic drugs;
• if there is a respiratory insufficiency, oxygenotherapy is carried out;
• prescribe drugs to improve bronchial conductivity;
• means are used to improve the transport of blood;
• therapy aimed at improving tissue respiration;
• the appointment of funds to improve metabolic processes in the body.

During illness the child should eat due to the age, however the food should be sparing and saturated with vitamins and minerals. In view of the fact that the child constantly coughs, foods that irritate the pharynx should be excluded from the diet. The child should drink a lot of fluids. These can be broths of dogrose, currant currants, jelly and compotes. In the period of treatment, antibiotic therapy is mandatory.

Prognosis of recovery

If treatment was started in a timely manner, then the prognosis for recovery is favorable. In general, complete recovery comes a month after the disease.

If antibiotics are started on time, which lasts from 7 to 14 days, the inflammation resolves in 2-4 weeks. This can be confirmed by X-rays.

In severe pneumonia, antibiotics are prescribed for two weeks or more. Degeneration of the focus of inflammation in this case can last for 1-2 months.

If you do not seek medical help on time, there may be complications that have been described above. In childhood, when there is insufficient treatment, the likelihood of a lethal outcome is high.

After discharge from the hospital, children are registered in a polyclinic, where a regular examination by a pulmonologist and an otolaryngologist is performed.

In addition, the doctor prescribes physiotherapy and exercise therapy with respiratory gymnastics. This contributes to the rapid recovery of the body. If there is such a possibility, then it is recommended to undergo a recovery period in specialized sanatoriums. Well helps herbal medicine using medicinal plants such as altea root, chamomile, sage, elephant, mother-and-stepmother. At home, treatment with mustard plasters, foot baths, inhalations with alkalis and herbs, compresses and iodine mesh on the chest area is applied. A chest massage is also prescribed.

Prevention of disease

The primary prevention of pneumonia is the healthy lifestyle of parents, especially the mother who is carrying the child.After the birth of the baby should be its timely and full-fledged feeding, in the future - tempering activities.

Secondary prevention is aimed at the following actions:

1. Prevent and treat respiratory diseases.
2. At the initial stage of the disease it is desirable to immediately hospitalize the child.
3. Timely should be treated with hypotrophy, rickets and improve immunity.
4. Do not let chronic inflammation occur.

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With the correct treatment of uncomplicated pneumonia, a favorable outcome of the disease is possible. If the child is ill, do not self-medicate, immediately seek medical attention. X-ray diagnosis of pneumonia will accurately determine the diagnosis of the child, which will help in the future in his treatment. X-ray picture can indicate the exact area of ​​inflammation, the extent of lung damage and its degree.

respiratoria.ru

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