Pneumonia croupiform and focal

Symptoms of bronchopneumonia

Symptoms and outcomes of focal pneumonia differ from the described bitterness of clinical manifestations of lobar (croupous) inflammation of the lung, which is largely due to the peculiarities of pathogenesis and morphological changes in both clinical and morphological variants of pneumonia.

First, with focal pneumonia, the inflammatory process is usually limited to the lobe or segment of the lung. Often, pneumonic foci can merge, capturing a larger proportion of the lobe of the lung or even the entire lobe. In these cases, they speak of discharge focal pneumonia. It is characteristic that, unlike the lobular inflammation of the lungs, the pleura is involved in the inflammatory process only with superficial localization or focal pustular pneumonia.

Secondly, in contrast to lobar (croupier) pneumonia, focal pneumonia, as a rule, is not accompanied by hypersensitivity immediate type; more characteristic are the normal and hyperergic reactions of the body. This feature probably determines not so rapid, gradual formation of an inflammatory focus and significantly less vascular permeability than with croupous inflammation.

Thirdly, in connection with the less pronounced violations of vascular permeability in the focus of inflammation, exudate in focal pneumonia contains only a small amount of fibrin and in most cases has the character of serous or mucopurulent exudate. For the same reason, there are no conditions for a massive yield of red blood cells in the lumen of the alveoli.

Fourth, focal pneumonia almost always has the character of bronchopneumonia, in which the inflammatory process is first involved bronchial mucosa (bronchitis), only after that the inflammation as it passes to the parenchyma of the lung and pneumonia is formed. Hence another important feature: in focal pneumonia, a significant amount of serous or mucopurulent exudate is contained directly in the airway lumen pathways, which contributes to more or less pronounced violations of bronchial patency both at the level of respiratory bronchioles and at the level of larger bronchi.

Finally, fifthly, the relatively slow spread of inflammation within the affected segment leads to the fact that some of its areas are at different stages of the inflammatory process. While in one group of alveoli only hyperemia and edema of the interalveolar walls (stage of hyperemia) are revealed, the other groups of the alveoli are already completely filled with exudate (the stage of curation). Such a variegated morphological picture of the inflammation focus with uneven compaction of the lung tissue, which is very characteristic for bronchopneumonia, is supplemented by the presence of sites of micro-teleclases, caused by violation of patency of mainly small bronchi. Thus, for focal pneumonia as a whole, the staging of inflammation, which is detected in some patients with lobar (croupous) pneumonia, is not typical.

The clinical-morphological variant of focal pneumonia is characterized by the following pathogenetic and morphological features:

1. Relatively small length of the inflammatory focus, which captures 1 or more lobules or segment of the lung. An exception is the discharge pneumonia, which seizes significant parts of the lobe of the lung or even the entire lobe.
2. Focal pneumonia is accompanied by a normal or hyperergic reaction of the body, which determines a slower formation of an inflammatory focus and a moderate violation of vascular permeability.
3. Serous or muco-purulent exudate.
4. Involvement in the inflammatory process of bronchial tubes (bronchitis), which is accompanied by violations of patency of both small and (rarely) larger bronchi.
5. Absence of a clear staging of the inflammatory process, characteristic of croupous pneumonia.

These features of pathogenesis largely determine the clinical manifestations of focal pneumonia (bronchopneumonia). Nevertheless, it should be remembered that the biological properties of the causative agents of pneumonia and some other factors also have a significant effect on the clinical picture of this disease.

Resolve

In contrast to lobar (croupous) pneumonia, the onset of bronchopneumonia is more gradual and prolonged in time. Often focal pneumonia occurs as a complication of acute respiratory viral infection, acute or exacerbation of chronic bronchitis. Within a few days the patient notes an increase in body temperature to 38.0-38.5 ° C, a runny nose, a lacrimation, a cough with a mucous membrane or mucopurulent sputum, malaise and general weakness, which is regarded as a manifestation of acute tracheobronchitis or acute respiratory viral infection.

Against this background, it is very difficult to establish the onset of bronchopneumonia. Nevertheless, the ineffectiveness of the therapy conducted for several days, the increase in intoxication, the appearance of dyspnoea and tachycardia or a new "wave" of fever increases suggest that focal pneumonia occurs.

The patient is coughing up and secreting mucopurulent or purulent sputum, body temperature increases to 38.0-39.0 ° C (rarely higher), weakness is increased, the headache worsens appetite.

Pain in the chest, associated with involvement in the inflammatory process of the pleura (dry pleurisy), appear only in a part of patients with a superficial location of the focus or the presence of a drainage focal pneumonia. However, even in these cases, pleural pain usually does not reach the same intensity as observed with lobar pneumonia. Pain increases or appears with deep breathing; its localization corresponds to the defeat of various parietal pleura sites. In some cases (with lesions of the diaphragmatic pleura), there may be abdominal pain associated with breathing.

Physical examination

When examined, the hyperemia of the cheeks is determined, perhaps a small cyanosis of the lips, an increased moisture of the skin. Sometimes there is a significant pallor of the skin, which is explained by pronounced intoxication and reflex increase in the tone of peripheral vessels.

When examining the chest, the lag in the act of breathing on the side of the lesion is revealed only in a part of the patients, mainly in individuals with discharge focal pneumonia.

When percussion over the focus of the lesion, a blunt percussion sound is detected, although for a short duration inflammatory focus or deep location of his lung percussion is not informative.

The greatest diagnostic value is the auscultation of the lungs. Most often, over the area of ​​the lesion, a pronounced weakening of the respiration is determined due to impaired bronchial patency and the presence of a multitude of micro-teleclases in the inflammatory focus. As a result, the sound oscillations formed when air passes through the vocal chord, along the trachea and (partially) the main bronchi, do not reach the surface of the chest, creating the effect of weakening the breath. The presence of violations of bronchial patency explains the fact that even with draining focal bronchopneumonia, the pathological Bronchial respiration is not listened to as often as with lobar inflammation of the lungs.

In rare cases, when bronchopneumonia developed against a background of chronic obstructive bronchitis, and the focus of inflammation is deep, at auscultation, you can listen to hard breathing due to the narrowing of the bronchi located outside the pneumonic focus.

The most vivid and reliable auscultative sign of focal bronchopneumonia is the definition of small bubble moist sonorous (consonant) wheezing. They are heard locally on the area of ​​inflammation and are caused by the presence of inflammatory exudate in the airways. Small-bubbly moist sonorous rales are heard most of the time throughout the inhalation.

Finally, in some cases with the involvement of the pleural pleura in the inflammatory process, you can listen to the noise of friction of the pleura.

The most significant differences between the two clinical and morphological variants of pneumonia are: lobar (croupous) and focal inflammation of the lungs (bronchopneumonia).

Comparative characteristics of lobar (croupous) and focal pneumonia

Symptoms	Fractional pneumonia	Focal bronchopneumonia
Features of pathogenesis
The amount of damage	Share, segment	One or more lobules, segment; multiple foci of inflammation possible
Spread of inflammation	Immediately along the alveolar tissue (Kohn's pores)	Inflammation of the bronchi "passes" to the parenchyma of the lung
The immediate-type hypersensitivity reaction in the respiratory zone of the lungs	Typical	Not typical
Involvement of bronchial inflammation	Not typical	Characteristically
Airway transmission	Not violated	Disrupted, possibly the occurrence of micro-teleclactases
Involvement in the inflammatory process of the pleura	Always	Only with superficial localization of the focus of inflammation or with a drain pneumonia
Stages of development of morphological changes	Typical	Not typical
The nature of the exudate	Fibrinous	Muco-purulent, serous
Clinical Features
Onset of disease	Acute, sudden with chills, fever and chest pain	Gradual, after the period of acute respiratory infections, acute tracheobronchitis or exacerbation of chronic bronchitis
Chest pain ("pleural")	Typical	Rarely, only with superficial localization of the focus of inflammation or with drainage pneumonia
Cough	At first dry, then with the separation of "rusty" sputum	From the very beginning productive, with the separation of muco-purulent sputum
Symptoms of intoxication	Expressed	Less common and less pronounced
Dyspnea	Typical	Possible, but less often
Dullness of percussion sound	In the stage of curing, pronounced blunting of sound	Less pronounced, sometimes absent
Type of breathing during auscultation	In the stage of the tide and the stage of resolution - a weakened vesicular, in the stage of curation - bronchial	Mostly weakened breathing throughout the disease
Adverse respiratory noises	In the stage of the tide and the stage of resolution - crepitation, in the stage of curing - the noise of friction of the pleura	Wet, finely bubbly sonorous rales
The appearance of bronhofonii	Characteristically	Not typical

The most significant clinical signs that allow differences, focal bronchopneumonia from lobar pneumonia, are:

• gradual onset of the disease, which develops, as a rule, against the background of acute respiratory viral infection, acute tracheobronchitis, or exacerbation of chronic bronchitis;
• the absence in most cases of acute "pleural" pain in the chest;
• cough with separation of mucopurulent sputum;
• absence in most cases of bronchial respiration;
• presence of moist small-bubbly sonorous rales.

It should be added that the signs listed in the table, which make it possible to distinguish two clinico-morphological variants of pneumonia, belong to the typical classical course of these diseases, which is currently not always observed. This is particularly true for cases of severe hospital pneumonia or pneumonia that have developed in weakened patients and elderly and senile patients

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Croupous pneumonia

Common features of pneumonia

Pneumonia - the name of a group of acute focal infectious inflammatory diseases of the lungs with the defeat of the lower respiratory tract and sweating of inflammatory effusion into respiratory vesicles-alveoli.

The origin of the disease is caused by the ingress of microbes-saprophytes from the oropharynx into the lower respiratory tract - the alveoli and bronchioles. Less often, the spread of pathogens occurs through the lymphatic capillaries or blood vessels from foci of infection in neighboring organs.The causative agents of pneumonia are pneumococci (croupous pneumonia), staphylococci, streptococci and other microbes.

The clinical (external) manifestations of the disease are influenced by many factors:

• properties of the microbe pathogen;
• the nature of the course and stage of the disease;
• structural (morphological) basis of the disease;
• the prevalence of the process in the lungs;
• the presence of complications - pulmonary suppuration, pleurisy or empyema.

Classification of pneumonia

In real life, it is not always possible to accurately determine the causative agent of pneumonia. Therefore, they are usually divided into clinical groups that have similar patterns of flow and the same prognosis.

Modern classification of pneumonia:

• out-of-hospital;
• hospital (hospital-acquired);
• immunodeficiency;
• atypical pneumonia.

Community-acquired pneumonia (domestic, domestic, outpatient), that is, acquired outside the health care institution usually develops in violation of the protective mechanisms of the respiratory system. Often, pneumonia complicates the course of a respiratory viral infection, such as influenza. The main causative agent of community-acquired pneumonia is pneumococcus. The cause of it can also be streptococci or hemophilic rods.

Depending on the volume of organ damage, inflammation of the lungs is divided into the following types:

• croupous pneumonia (pleuropneumonia) - with a lesion of the lobe;
• focal pneumonia (bronchopneumonia) with the defeat of a group of alveoli adjacent to the inflamed bronchus;
• interstitial pneumonia - inflammation of the lung tissue along the bronchi and pulmonary blood vessels.

Croupous pneumonia is only one of the forms of pneumococcal pneumonia, and does not occur with inflammation of the lungs caused by other microbial pathogens.

Clinic of croupous inflammation of the lungs

Pneumococcal croupous pneumonia has an acute onset: chills, a sharp increase in body temperature to +39 ° C +40 ° C and sweating. Simultaneously there are such symptoms of croupous pneumonia as pronounced general weakness and lethargy. With severe fever and intoxication, there may be signs of central nervous system damage: severe headache, confusion, deafness of the patient, vomiting and other meningeal signs (signs of irritation of the meninges).

Very early from the onset of the disease in the chest on the side of inflammation there are pains. With croupous inflammation of the lungs, the pleural reaction is very pronounced. Pain in the chest is the main complaint of patients and requires the provision of emergency medical care. A distinctive symptom of pleural pain is its connection with breathing and coughing. The intensity of pain sharply increases with inspiration and coughing. In the early days of the disease there is a cough with phlegm, rusty from the admixture of traces of blood. Sometimes there is neobylo hemoptysis.

When examining a patient with croupous pneumonia, the forced position of the patient is revealed: the patient lies on the side of the lesion. On the face of a patient with croupous pneumonia, feverish blush is often observed, brighter on the side of the lesion. Characteristic of the presence of symptoms: dyspnea up to 30-40 respiratory movements per minute, cyanotic lips, swelling of the wings of the nose. Often in the early period of the disease there are herpetic vesicle rashes on the red border of the lips.

When examining the chest, it is usually found that the lag in its affected half is behind in respiratory movements. Due to severe pleural pain, the patient spares the sick side of the chest during breathing.

Percussion of the chest determines the dullness of the percussion sound over the zone of inflammation of the lung. Here, respiration acquires a stiff bronchial hue. At an early stage of croupous pneumonia, a moist crepitating wheeze appears over the focus of inflammation, a sign of exudation in the alveoli. Characteristic manifestations of the heart are the increased heart rate to 100 beats per minute and lowering blood pressure.

The pronounced pleural pain reaction can be combined with reflex pain in the same half of the abdominal cavity, painful when palpation of the upper abdomen. Due to the destruction of red blood cells in the affected lung lobe, slight jaundice of the skin, visible mucous membranes and eyeballs can develop.

Diagnosis of croupous inflammation of the lungs

Croupous inflammation of the lungs is probably the only one of all forms of the disease, when the clinical diagnosis is equated with the etiological (pneumococcal infection). Her clinical, radiologic and laboratory signs are very characteristic, and the diagnosis of croupous pneumonia usually does not cause any special difficulties.

X-ray signs of croupous pneumonia, confirming the diagnosis:

• uniformity of darkening of the lobe or segment of the lung;
• distinct response of the pleural membrane of the lung;
• convex boundaries of the affected fraction.

Laboratory signs of croupous pneumonia:

• a sharp increase in the number of white blood cells in the peripheral blood - neutrophilic leukocytosis> 15 thousand. in 1 cu. mm with the number of young cells> 15%
• toxic granularity in the cytoplasm of leukocytes - white blood cells
• absence of eosinophilic leukocytes in peripheral blood
• increase in the level of fibrinogen protein in blood plasma
• the presence of protein and protein cylinders in the urine, a small amount of excreted urine
• detection in the analysis of sputum lanceolate paired microbe-cocci, colored in violet
• isolation of the pneumococcus culture from the sputum of the patient
• isolation of pneumococcal culture from patient's blood in 15-20% of cases.

Complications of croupous inflammation of the lungs

Inflammation of the lungs is considered a deadly disease due to the high risk of complications. Complications of croupous pneumonia are a number of severe conditions requiring treatment in the intensive care unit.

Conditions complicating the course of croupous pneumonia:

• infectious-toxic shock
• infection of blood with the spread of infection throughout the body - sepsis
• inflammation of the lining of the lung - exudate pleurisy
• empyema of the pleura - purulent pleurisy
• suppuration of the lung - abscess
• pericarditis - inflammation of the cardiac sac.

Croupous pneumonia in children is an indication for treatment in a children's hospital due to the danger of complications.

Principles of treatment of croupous inflammation of the lungs

The main rule of successful treatment of any pneumonia is the correct choice of antibiotic. The cause of croupous inflammation of the lungs is pneumococcus - a microbe that is sensitive to penicillin. Therefore, benzylpenicillin or its derivatives are most often used as the first drug. Fortunately, in Russia pneumococcus in most regions of the country retains high sensitivity to penicillin and amoxicillin.

If the patient has risk factors for the probable resistance of the pathogen to penicillin, then drugs from the group of "protected" penicillins are used. Most often it is amoxicillin / clavulanate. If the starting schedule of treatment is ineffective within 72 hours, the antibiotic is changed to a drug from another group.

Additional means for the treatment of croupous inflammation of the lungs can be expectorants, bronchodilators medicines, inhalation of an oxygen-air mixture, infusion of medicinal solutions intravenously. The choice of additional medicines is made by the attending physician, based on the severity of the symptoms and the patient's condition.

Given the severity of the symptoms and the danger of complications, treatment of croupous pneumonia is best performed in a hospital, that is, in a hospital.

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What are the symptoms of pneumonia?

Today there are many kinds of pneumonia. It is very important to determine the symptoms of pneumonia to find the right treatment for a particular type of disease and to prevent complications. We will take a closer look at the symptoms of pneumonia and croupous pneumonia.

What are the symptoms of pneumonia and croupous pneumonia?

Symptoms of the disease in croupous pneumonia. The disease occurs usually after overwork or overcooling. Very rapid onset of the disease: a sharp increase in temperature, weakness, headache. Also, the disease is characterized by pain in the chest with a full breath, shortness of breath, skin tightening in the intercostal spaces during inspiration, especially in the foci that are affected by pneumonia. Already on the 4th-5th day rusty sputum appears, coughing attacks. Croupous pneumonia usually lasts two weeks. If the disease acquires a severe degree, then a number of serious complications arise: sepsis, heart disease, abscess. Sometimes, in the absence of treatment, there is a fatal outcome.

Diagnosis of symptoms of pneumonia and croupous pneumonia

Diagnosis of the disease is carried out on the basis of symptoms in pneumonia:

1. (cough, fever, rusty sputum, chest pains),

2. Clinical studies of the patient (analyzes with percussion and pulmonary aspiration),

3. and also with the help of aerography of the lungs, on which a massive darkening of the lobe or both lungs is seen simultaneously.

When the diagnosis is made - croupous pneumonia, it is necessary to contact a medical institution.

What are the symptoms of inflammation of the lungs of the focal type?

Symptoms of focal pneumonia. The disease occurs against a background of chronic or acute bronchitis, less often against the background of other respiratory diseases. The onset of the disease is not as rapid as in croupous, the temperature is not high, the patient has a weakness, but many patients often endure the disease "on their feet." The disease is characterized by a sparse discharge of sputum and persistent cough. Dyspnea and chest pain are almost not observed. With proper treatment, the disease lasts for several weeks. Some complications in focal pneumonia are also observed: lung penetration into the pleural cavity (emphysema) and abscess.

Diagnosis is carried out on the determination of the symptoms of the disease, in clinical examinations of the patient and X-ray examination of the patient's lungs. At a roentgen of lungs the outlined area of ​​consolidation of a lung tissue is found out, the sizes can be various. In some cases uncomplicated focal pneumonia is treated at home.

What are the symptoms of atypical pneumonia?

Symptoms of atypical pneumonia primarily depend on the causative agent of the disease (legionella, mycoplasma, chlamydia). Chlamydia and mycoplasmal pneumonia are most often observed in children. Symptoms of atypical pneumonia: sore throat, chest pain, runny nose, lymphadenopathy, meningitis, muscle pain. Legionella pneumonia is characterized by chest pains, dry cough, diarrhea, kidney damage, joint pain, slow pulse. The course of the disease is very difficult, there may be complications of the kidneys, heart, brain. Diagnosis of inflammation of the lungs of this type is carried out by methods of immunological, microbiological and radiological examinations.

AstroMeridian.ru

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