Lobar pneumonia (lobar pneumonia). What is lobar pneumonia - symptoms and treatment

The content of the article

This is an acute infectious-allergic disease characterized by inflammatory lesion pulmonary tissue with accumulation of fibrin-rich exudate in the alveoli and a typical cyclical course of both pathomorphological and clinical manifestations.
In recent years, lobar pneumonia has become less common in children. This may be due to the fact that during the period of widespread use of antibiotics, mainly penicillin, pneumococcus apparently lost its virulent properties and gave way to pathogenic staphylococcus and gram-negative flora. Croupous pneumonia mainly affects children of preschool and school age, rarely at the age of 1 - 3 years and, as an exception, in the first year of life.

Etiology of lobar pneumonia

Pathogen - Various types pneumococcus. Morphologically they are similar to each other, but differ in the degree of virulence and some biological properties. The most common type is pneumococcus IV. Along with pneumococcus, streptococcus, pathogenic staphylococcus, Friedlander's bacillus, etc. are isolated in lobar pneumonia in children. A combination of microbial and viral infection.

Pathogenesis of lobar pneumonia

Lobar pneumonia develops as a result of exogenous penetration of the pathogen into a previously sensitized organism. Contributing factors:
1) a decrease in the immunological reactivity of the body due to changes in nutrition and living conditions;
2) the influence of previous viral and bacterial infection, especially influenza, pneumococcal and staphylococcal, causing sensitization of the body;
3) meteorological factors contributing to hypothermia;
4) weakening of the body’s resistance to chronic diseases;
5) functional disorders central nervous system;
6) massiveness of infection. An auto-infectious mechanism for the development of the disease cannot be excluded: with sudden cooling or overwork, increased proliferation of pneumococci and their penetration into the lower sections is possible. respiratory tract.
It is most likely that the pathogen enters the lungs aerobronchogenically and spreads through the lymphatic tract and interalveolar crevices. The process in the lung becomes an expression of a hyperergic reaction of the body, sensitized to pneumococcus or other pathogen. Acute inflammatory edema develops in the lung, quickly affecting an entire lobe or a significant part of it.

Pathomorphology of lobar pneumonia

In lobar pneumonia, there are 4 successive stages of pathomorphological changes in the lungs.
The first stage - the high tide stage - is characterized by significant vascular disorders, hyperemia and inflammatory edema in the affected area of ​​the lung tissue. Microscopic examination of the lungs reveals expansion and overflow of blood in the capillaries, small arteries and veins. The cavities of the alveoli are filled with serous exudate mixed with blood and cells alveolar epithelium. Serous or serous-hemorrhagic inflammation develops. The first stage lasts 1 - 3 days.
Subsequently, the diapedesis of erythrocytes increases and the exudate is enriched with proteins with the loss of fibrin - the second stage develops - the stage of red hepatitis, which also lasts 1 - 3 days. The lung becomes denser due to fibrinous effusion, rich in red blood cells and neutrophilic leukocytes. The capillaries are compressed, and the nutrition of the lung tissue is sharply disrupted. The alveoli are filled with a thick mass of fibrin, which penetrates into the interalveolar septa. Fibrin is found in bronchioles and small bronchi, as well as on the pleura. The lung becomes airless, dense, like a liver. On the cut - Brown, graininess is expressed.
The third stage, the stage of gray hepatization, lasting 2–6 days, is characterized by the cessation of erythrocyte diapedesis and the accumulation of leukocytes in the exudate. Leukocytes infiltrate the intermediate tissue of the lungs around the capillaries and small veins. The lung is dense, airless, gray, graininess is expressed.
The fourth stage is the resolution stage. Leukocytes begin to secrete proteolytic enzymes, under the influence of which the fibrinous exudate gradually liquefies, partially resolves or coughs up. The lung tissue becomes airy. The duration of the resolution period depends on the individual reactivity of the body and can last 2 - 5 days. In children, the stages of flushing and erythrocyte infiltration are often followed by a stage of resolution. With lobar pneumonia, degenerative changes in the muscles of the heart, liver, and kidneys are observed, which are restored during the recovery period.

Clinic of lobar pneumonia

The clinical picture of lobar pneumonia in children, as in adults, is characterized by a cyclic course. Three periods of the course of the disease can be distinguished: initial, peak period and recovery.
The onset is acute, the temperature rises to 39 - 40 °C. Chills and pain in the side, typical for adults, are observed very rarely in children; even a cough may be absent in the first days. There is pallor, vomiting, bloating and pain in the abdomen, especially in the right iliac region, which resembles the picture of acute appendicitis. But unlike the latter, with lobar pneumonia there is rapid breathing, some lag in breathing on the affected side chest, relatively free excursions of the abdomen and the absence of rigidity of its wall. If you divert the child's attention, it is possible to perform deep palpation of the abdomen.
In the second variant of the development of lobar pneumonia, a sudden increase in body temperature is accompanied by a severe headache, vomiting, neck rigidity, and sometimes convulsions. At the same time, the thought of meningitis arises. However, rapid breathing, a lag in breathing of the affected half of the chest, as well as a weakening of meningeal phenomena over time and the appearance typical symptoms pneumonia gives reason to exclude meningitis.
More typical course pneumonia is observed in school-age children. The disease begins with high body temperature, chills, chest pain, and cough. Breathing is shallow, frequent (30 - 40 per minute), shiny eyes, blush on the cheek of the affected half. Herpes on the nose and lips. Lethargy, sometimes agitation, delirium, hallucinations. From the first days of the disease, participation in the act of breathing of the auxiliary muscles of the chest and swelling of the wings of the nose are detected. Subsequently, breathing is accompanied by moaning and groaning. The cough becomes painful. There is a lag in breathing of the affected half of the chest. The patient in bed takes forced situation(on the sore side).
Objectively, at the onset of the disease, it is possible to determine the increase in vocal tremors on the affected side. Percussion reveals a dullness of sound with a slight tympanic tint, caused by the accumulation of a small amount of exudate in the alveoli and a decrease in the elastic tension of the lung tissue. When listening, breathing is weakened (swelling of the walls of the alveoli and decreased elasticity). Usually, a gentle initial crepitus (crepitatio indux) is heard for a short time, caused by the walls of the alveoli unraveling when exudate penetrates them. As a result of the beginning compaction of the lungs, bronchophony or bronchial breathing.
In the future, the general condition of the patient becomes even more severe. The severity of the disease depends not only on the degree of hypoxemia and intoxication, but also on dysfunction of a number of organs and systems. Body temperature remains at high levels, becoming constant, although sometimes it can be intermittent or remitting. The period of the height of the disease begins, corresponding to the pathological and anatomical stage of hepatization. Shortness of breath increases, the patient takes a forced half-sitting position in bed. Puffiness and cyanosis of the face, lips, and limbs occur. The tongue and lips become dry. The chest pain goes away over time. Viscous glassy sputum mixed with blood (“rusty”) is coughed up, more often in schoolchildren and rarely in children preschool age. A pleural friction rub (fibrinous deposits) is often heard.
A slight expansion of the boundaries of cardiac dullness is detected, often to the right. Muffled heart sounds are heard, with an accent of the second tone over the pulmonary trunk. The pulse is frequent (120 - 140 per 1 min), weak filling. Blood pressure decreases. Sometimes collapse and other manifestations of circulatory failure occur. Changes are detected on the ECG - a decrease in voltage, an increase in the height of the P and T waves, displacement and shortening of the S - T interval. The abdomen is somewhat swollen, the liver is often enlarged as a result toxic damage hepatocytes and protrudes 2 - 3 cm from under the costal edge, soft, sensitive to palpation. Dyspeptic symptoms (belching, nausea, vomiting, decreased appetite, etc.) are often observed. The tongue is dry and often coated.
When examining blood - leukocytosis (10 - 20 G/l, or 10 - 20 per 10.9 in 1 l) with a shift of the formula to the left. Toxic granularity appears in neutrophils, ESR is increased. Characterized by an increase in the amount of globulins, fibrinogen and prothrombin. Blood clotting is often increased. Water-electrolyte, carbohydrate, protein, and fat metabolism are disrupted, and oxidative processes are reduced. At the height of the disease, a decrease in diuresis, an increase in the relative density of urine, a decrease in the excretion of chlorides and the presence of protein in small quantities are determined. Vitamin content ( ascorbic acid, thiamine, riboflavin) in the blood is reduced. Violation noted gas composition blood (decrease in pa02, increase in arterialization of venous blood).
On the 5th - 9th day of the disease, and when successful treatment and earlier, the body temperature drops (usually critically), and recovery occurs. This period in children progresses with rapid improvement. general condition and disappearance of changes in the lung. The cough becomes moist, the sputum is less viscous and easily separated. The shortness of breath stops. Breathing returns to normal. Herpetic blisters dry out and become crusty. During physical examination, it is almost always possible to hear an abundance of crepitating wheezing (crepitatio redux) as a result of liquefaction of sputum. The wheezing is more sonorous than with initial crepitus.
X-ray examination, predominantly on one side, reveals a typical uniform darkening of the entire lobe of the lung or part of it. In the first 1 - 2 days of the disease, infiltration of the lung root is pronounced, which spreads over time and turns into a uniform shadow.
There are atypical forms of lobar pneumonia.
1. Central - the inflammatory focus is located in the deep parts of the lung, and the data physical research indistinct. Only X-ray examination can clarify the diagnosis.
2. Abortive form- the onset of the disease is acute, violent, duration - 2 - 3 days. This form has recently become the most common, which is apparently explained by significant reduction etiological role of pneumococcus.
3. Massive pneumonia - the inflammatory process quickly spreads to other lobes of the lung. This shape resembles exudative pleurisy, but dullness in the lungs is less extensive and does not increase downward.
4. Areactive pneumonia - develops in children with reduced immunological reactivity. The onset is not acute, signs of inflammation develop gradually. The body temperature is subfebrile, general malaise, and the course is sluggish. Objective research data are scarce.
5. Migrating, or wandering, pneumonia - characterized by a transition per continuitatem inflammatory process to neighboring areas. This form is characterized by a longer course.6. Appendicular form - simulates clinical picture appendicitis and occurs more often when the process is localized in the lower lobes. Despite sharp pain in the abdomen, localized in the ileocecal region, the patient allows deep palpation of the abdomen, if it is possible to divert his attention.
7. Typhoid-like form - resembles typhoid fever. The onset is gradual, with a long febrile period and lytic reduction body temperature.
8. Meningeal form - differs in that from the first hours of the disease pronounced brain symptoms (headache, convulsions, drowsiness, vomiting) are detected. In addition, it is characteristic that there is meningeal symptoms(stiff neck, persistent red demography, Kernig's sign). In such patients, a spinal puncture is performed for both diagnostic and therapeutic purposes. The cerebrospinal fluid is clear and flows out under increased pressure. Cytosis and protein are normal. Brain symptoms develop due to swelling of the brain and impairment cerebral circulation as a result vascular disorders.

Complications of lobar pneumonia

At modern methods Treatment complications - abscess, gangrene of the lung - are very rare. In case of complications, the general condition deteriorates, chills appear, and the body temperature rises even more. The amount of sputum increases significantly, acquiring a purulent or putrefactive character. If there is a cavity located close to the chest wall, sonorous and even sonorous moist rales are heard. The occurrence of suppurative processes in the lung is facilitated by pulmonary atelectasis, caused by blockage of the bronchi with mucus plugs. On an x-ray, in the presence of an abscess, a cavity with a horizontal level of fluid is visible.
Almost always, lobar pneumonia is accompanied by dry pleurisy with fibrinous deposits. At the end of the disease, serous-fibrous or purulent pleurisy may occur. In this case, weakening of vocal tremors, dullness and weakening of breathing, more intense in the lower parts, are determined. The diagnosis is clarified by X-ray and pleural puncture. Complications from other organs and systems - dry or exudative pericarditis and serous or purulent meningitis.
Very rarely, carnification of the lung is observed - its germination connective tissue and subsequent development of bronchiectasis.

Diagnosis of lobar pneumonia

Recognizing lobar pneumonia in typical cases is not difficult. The diagnosis is made based on characteristic symptoms(acute onset, sudden increase in body temperature, chest pain, cough with sputum, often “rusty”, herpetic rashes on the lips and nose, forced position in bed - half-sitting, shortness of breath, lag in breathing of the affected half of the chest); percussion and auscultation data; blood test results (neutrophilic leukocytosis, granularity of neutrophils); X-ray data (darkening of the entire lobe of the lung or most of it). One should remember the uniqueness of the clinical picture of atypical forms of lobar pneumonia.

Differential diagnosis of lobar pneumonia

When establishing a diagnosis of lobar pneumonia, it is necessary to exclude focal confluent pneumonia, which is characterized by diversity of auscultatory data and lack of cyclicality of the course. Segmental pneumonia is excluded based on the presence of herpetic rashes on the lips and nose in patients with lobar pneumonia, the cyclical course of the disease and X-ray data.
Exudative pleurisy, in contrast to lobar pneumonia, is characterized by the localization of dullness over the lower parts of the chest and the characteristic outline of its upper border. In the area of ​​dullness with pleurisy, breathing is sharply weakened or not audible at all, vocal tremor and bronchophony are not detected. In unclear cases, the diagnosis is established using x-ray examination and test puncture.
In the differential diagnosis of lobar and caseous pneumonia, it is taken into account that caseous pneumonia has been extremely rare in recent years. In addition, caseous pneumonia, unlike lobar pneumonia, develops gradually, without a cyclical course, herpetic rash on the lips and facial hyperemia. Mycobacterium tuberculosis is found in sputum. It is essential to take into account anamnestic data (contact with a patient with tuberculosis, positive tuberculin tests, treatment with antibacterial drugs, etc.).
Lobar pneumonia must be differentiated from the primary complex in the infiltration stage, which, unlike lobar pneumonia, is characterized by persistent radiological changes, positive tuberculin tests, and paucity of auscultatory data when significant radiological changes are detected.
The prognosis is favorable.

Lobar pneumonia is an acute independent disease of infectious-allergic origin, involving pulmonary tissue in an abnormal inflammatory process, affecting the lobes of the lung or a significant part of it, but both small loci of damage are possible, when individual segments are captured, and extensive involvement of several lobes. Lobar pneumonia spreads in one or both lungs at once. Pathogenesis of the development of hypersensitivity reactions immediate type, under the influence of which there is an accumulation of infiltrate in the alveoli and, as a consequence, swelling of the bronchi. Fibrinous fluid—exudate—accumulates in the alveoli, and fibrinous deposits are localized on the pleura (pleuropneumonia). The resulting compactions in the tissue interfere with the normal process of gas exchange.

The peculiarity of a certain cyclicity of pathomorphological changes in the lung tissue, activation of allergenic mechanisms in the upper respiratory tract, variability in terms of the sequence of the symptom complex, form a serious blow, with possible lethality, for the human body.

It is also worth noting that lobar pneumonia is one of the most common variants of etiologically pneumococcal pneumonia, and very rarely another causative agent of lobar pneumonia is the root cause of the occurrence during diagnosis.

Acute lobar pneumonia in the overwhelming majority is localized in the lower lobe and always on the right, connecting the pleura of the lung. But more severe situations are also observed when a person develops bilateral lobar pneumonia, with severe intoxication syndrome and concomitant lesions of other internal organs. The very first symptoms are lightning fast and progress with incredible speed.

Previously, the diagnosis of lobar pneumonia was a real death sentence for sick people. When symptoms appeared, doctors gave a disappointing prognosis, since in most cases the patient died. But now, with the development of medical diagnostics, the development of antibiotics on the pharmaceutical market, the compilation international protocols and recommendations for treatment, mortality is close to zero.

The first leading place in terms of tropism for the disease is occupied by the cohort of the adult population 19-40 years old; lobar pneumonia in children is a rare phenomenon and is mainly affected by preschool children and adolescents; among children 1-3 years of age the incidence is low, and cases of the disease in infants, in the first year of life, and completely sporadic.

Lobar pneumonia: causes

In the occurrence of lobar pneumonia, the prevailing etiopathogenetic factors are: the pathogenic activity of microorganisms and active allergic sensitization of the body.

The most common causative agent of lobar pneumonia is represented by pneumococci; they are divided into 4 types, with acute lobar pneumonia most often provoked by the first and second types, less often by the third or fourth type (in 95% of Frenkel-Wekselbaum pneumococci). Even more rarely, the root cause is in another flora: staphylococci, streptococci, Friedlander's diplobacillus, Klebsiella, Escherichia (). But we should not exclude the possibility of a combined, mixed flora.

The causative agent of lobar pneumonia penetrates into the lung tissue as follows: it is introduced with inhaled air or through an exogenous route, hematogenous, lymphogenous. The body must be in a weakened state.

Causal risk factors for the development of such a disease as acute lobar pneumonia in children and adults are presented in the following positions:

— Sensitization of the body by viruses and bacteria, which increases the sensitivity of the body and weakens all immune defenses. It is important to take into account the massiveness of the emerging infection.

— Poor food and living conditions.

— Thermal factors: hypothermia, overheating of the body. Lobar pneumonia in children with severe fatigue and, in addition to this, cooling or overheating, is an excellent breeding ground for intensive proliferation of pneumococci.

— A possible mechanism for the development of autoinfections.

— Neuropsychic abnormalities.

— Concomitant diseases in various stages: anemic phenomena, stress load, functional disorders of the nervous system.

— Congestion in the lungs and inflammation of the mucous membranes, with hyperreactivity of development in the respiratory tract, impaired function of bronchial cleansing, high permeability of the alveolar membranes.

— For injuries of varying severity and carrying out abdominal operations chest.

- Heavy and harmful conditions labor.

— Inhalation of toxic hazardous substances.

— Ecologically unfavorable situation.

- Alcoholism, drug addiction, smoking.

— Seasonality: autumn-winter-early spring.

— Hyperergic nature of the disease: recurrent cases account for 30–40%.

Lobar pneumonia: symptoms

Lobar pneumonia begins with the following general manifestations:

— Chills, sweating, there is a sharp rise in temperature up to 40°C, followed by a critical decrease by days 8-11 to 35°C, up to collapse.

— Damage to the nervous system: exhausting, clouded consciousness, insomnia, nervous overexcitation and delirium, stupor, vomiting, signs of irritation of the meninges.

- Substernal pain on the affected side or if bilateral lobar pneumonia has developed. The reaction of the pleura is very pronounced - sharp pain on inhalation and exhalation, with coughing, sneezing, radiating to the back, abdominal area, shoulder, thigh. But, with a deep location of the lesion or in the upper lobe of the lung, there is no pain at all. Pleural pain, when radiating to the area of ​​the right hypochondrium or the right ileocecal angle, can simulate cholecystitis, appendicitis, cholelithiasis, etc.

- The cough is initially dry and painful, then separation in progress glassy, ​​thickly viscous, viscous sputum, for two to three days is accompanied by the release of “rusty” sputum - hemoptysis, this color is due to high content red blood cells With mitral disease or congestion in the ICC, the sputum becomes brightly bloody in color - it is difficult to expectorate, sticky, and sticks to the lips. During the recovery phase, it again changes to an easily expectorable, mucopurulent one.

- Upon examination, you can notice that the person is lying on the affected side, due to severe pleural pain, he spares the affected side when breathing, and there is an unhealthy feverish blush on his face with a cyanotic tint.

- Shortness of breath up to 40/min with the addition of cyanosis of the lips and swelling of the wings of the nose.

— Additional signs: herpes of the lips, yellowness of the skin and mucous membranes, sclera. Lack of appetite and increased thirst, constipation and flatulence, whitish coating on the tongue.

A number of the complications outlined above depend on the initial state of the human body before the disease. Complications of lobar pneumonia that arise are treated exclusively in a hospital setting and with dynamic observation after complete recovery, in order to prevent insidious, masked, instantly recurring recurrent symptoms.

According to medical calculations, lobar pneumonia is an acute or chronic illness organs respiratory system, primarily of the lungs, infectious, allergic or congestive origin. In this case, we are always talking about the inflammatory process in the structure of the lower respiratory tract. When the average person talks about pneumonia, he means the lobar form of pneumonia.

Previously, the disease was considered a death sentence; fortunately, these days the disease can be treated quite well. According to statistics, every tenth inhabitant of the planet suffers from lobar pneumonia.

In some cases, the disease occurs in a latent, sluggish form. Its signs are so scarce that patients mistake their condition for a banal acute respiratory disease. However, the lobar form of pneumonia is extremely dangerous. What should you know about her?

Pneumonia does not arise, as they say, out of nowhere; the pathogenesis of lobar pneumonia includes two main factors. The first is infection with a dangerous pathogen.

The following are the causes of this type of health problem:

• Pneumococcus. A small but extremely unpleasant microorganism. Becomes the culprit in the development of pneumonia in 70% of cases (on average). It is pneumococcus that is the cause of the disease in the vast majority of clinical situations. It is the main causative agent of lobar pneumonia.
• Klebsiella.
• Occupies a worthy place in the formation of the disease. Most often provokes inflammation in children.
• Streptococcus. It may be the culprit of pneumonia of the lobar type, but this is relatively rare. Causes forms of pneumonia that are quite easy to cure.

Staphylococcus. Golden and hemolytic.

The first is considered the most dangerous because it creates multilayer structures that do not allow the pathogen to be effectively combated even with the help of the most powerful antibacterial agents.

• Despite this, Staphylococcus aureus and viridans, due to its high contagiousness (infectiousness), is present in the body of almost every person (the number of carriers is close to 85-90%, almost like herpes).

Almost everyone is infected with it. According to information from medical sources, the number of carriers is close to 98-100%, since the virus is transmitted through several main routes. The causative agents of lobar pneumonia are the following strains of herpetic agent:

1. virus herpes simplex(type 1);
2. virus of the second type (genital herpes, transmitted through unprotected genital and oral-genital contacts);
3. strain of the third type (provokes the development of herpes zoster and the notorious chicken pox);
4. herpes type 4 ( Epstein-Barr virus), cytomegalovirus (causes massive damage to the entire respiratory system).

These agents are transmitted in four ways: airborne, household contact, hematogenous and lymphogenous.

Causes of immunodeficiency

The second factor causing the problem is a decrease in work efficiency immune system when the body’s protective structures are unable to adequately repel pathogens. As already mentioned, the same staphylococcus lives in almost everyone. But why doesn’t everyone get sick? It's all about immunity. What is the etiology (reason) for the insufficiency of its functioning?

• The presence in the body of foci of chronic infectious lesion.

  Most often, it is precisely such clinical situations that lead to the development of chronic infectious pneumonia of the lobar type.
  

It can be carious teeth, sore joints, tonsillitis, sore throat (sore throat) and other reasons. The immune system directs all its efforts to suppress the spread of infection throughout the body, but pathogens are transported throughout the body via lymphogenous and hematogenous routes, settling in the lungs, gastrointestinal tract, etc.

• Frequent acute respiratory viral infections.

They provoke the development of pneumonia to a slightly lesser extent. The fact is that the fight against frequent acute respiratory diseases depletes the immune defenses. As a result, the development of multiple secondary foci of chronic viral or infectious lesions is observed, including in the lower respiratory tract.

• Vitamin deficiencies. In particular, a lack of vitamin C, which is responsible for the normal production of immunoglobulins. Primarily interferon.
• Chronic non-infectious diseases of inflammatory origin. This includes hepatitis, liver cirrhosis, systemic diseases of the body (including lupus erythematosus).
• A history of problems with endocrine system . In men we are talking about a lack of specific androgen hormones, in women - about estrogen deficiency. In addition, problems with the synthesis of insulin and thyroid hormones affect. The human body is a delicate system. Violation of one function inevitably affects other systems of the body. Including the immune system.
• Frequent stress chronic lack of sleep, psycho-emotional stress of a long-term nature. They cause an increase in the concentration of norepinephrine, adrenaline and cortisol in the bloodstream. These substances mobilize the body, but suppress the functioning of the immune system. The result is clear.
• Development of tumors. Primarily malignant in nature. Such dangerous pathologies cause suppression of the body’s immune system.
• Taking a course of radiation or chemotherapy.
• Taking certain medications. Primarily immunosuppressants.

Inflammation of the lungs can be of an allergic nature, or it can develop due to traumatic damage to the chest organs as a result of bruises (for example, after a bad fall, an accident). In general, we are talking about a similar set of problems.

Pathogenesis

The essence pathological process consists of inflammation of individual foci or all segments of the lung or lungs. Because of this, serous type exudate accumulates in the alveoli.

Symptoms

Symptoms of lobar pneumonia develop gradually over time. An acute onset almost always indicates an unfavorable course of the disease.

In general, we are talking about the following manifestations:

• Increased body temperature. In the primary period it may be absent. As a rule, it occurs early in the course of the disease, up to 40 acute phase. Hyperthermia may not occur throughout the entire period.
• Chest pain. Develop as a result of the inflammatory process. Evidence for pneumonia. They intensify with inhalation and may be spontaneous. They are defined by the patients themselves as aching, pulling, dull, shooting.

• Breathing disorders. At the first moment, slight shortness of breath appears - an increase in the number of productive breathing movements. It is observed even with minor physical exertion. At severe defeat also at rest.
• Next comes suffocation- inability to breathe normally. The patient can inhale, but is unable to exhale. This is extremely dangerous condition, which can lead to fatal outcome. In a general sense, this pathology is called secondary respiratory failure.
• Cardiac disorders. It is usually manifested by tachycardia.
• Cough . Scoring, strong. A small amount of clear or . In the latter case we are talking about purulent pneumonia.
• Weakness, feeling of body weakness, headache and other signs of intoxication of the body.

Symptoms develop gradually (most often). The symptom complex is finally formed on days 5-7 from the onset of the disease. The intensity of symptoms depends on the extent of the process.

In the generalized form, the most intense manifestations develop; if we are talking about lobar pneumonia, the symptoms are not so pronounced.

Stages of the pathology

The stages of lobar pneumonia are few in number. In its development, the disease goes through 4 stages.

1. Aka the tide stage or initial stage. During this period, a cough occurs, swelling of the affected lung, and mild hyperthermia develops. The duration of the first stage is 1-2 days. The typical symptom is that a huge amount of liquid exudate is released. This is extremely dangerous biological fluid, since many pathogens are found in it.
2. Pathological phenomena are increasing. Body temperature rises to 39-40 degrees Celsius, painful cough. Shortness of breath develops. The duration of this stage is, on average, about 2-3 days.
3. Acute phase. The main symptoms get worse. Purulent sputum appears (not always), and symptoms of general intoxication develop. The so-called period of imaginary well-being may begin. This is a moment in time that lasts no more than 1-2 days and is characterized by a sharp, rapid improvement in the condition. The duration of the stage is about 2 weeks.
4. Permission . Symptoms gradually disappear. Residual effects appear (pain, cough, shortness of breath).

The lobar form of pneumonia lasts from 3 to 7 weeks and ends full recovery patient in case of correctly prescribed treatment. Otherwise, pneumonia becomes chronic.

Possible complications

Complications of lobar pneumonia include:

• Pulmonary edema.
• Melt of lung tissue.
• Lymphadenitis.
• Meningitis.
• Secondary bronchitis.
• Pleurisy.
• Death.

IN severe cases so-called pleuropneumonia develops - an inflammatory process of one (or more) lobes of the lungs involving the pleura (in which pleurisy develops).

Lobar pneumonia in children is almost always caused by pneumococcus, less commonly by diplobacillus and other pathogens. In infants, lobar pneumonia is almost never observed; it occurs somewhat more often in children aged 2 to 5 years, but in its most typical form is observed only in children 5-15 years old. In some cases, the disease is facilitated by rapid and significant cooling or trauma - physical or mental. Lobar pneumonia is characterized by the development of fibrinous inflammation within one lobe of the lung or 2-3 segments of one lobe.

Treatment of lobar pneumonia in children is carried out only in a hospital setting. It requires constant medical supervision and use. modern means conservative therapy. Lobar pneumonia in the decay stage can lead to the death of a sick baby.

Pneumococcal lobar pneumonia stages and symptoms

Pneumococcal lobar pneumonia in children begins to show symptoms almost on the first day. The onset of the disease is usually sudden with high fever (up to 41 degrees Celsius and above), chills, severe toxicosis, which is often accompanied by agitation and delirium. Pulmonary symptoms, expressed in a cough reflex and difficulty breathing, shortness of breath, is delayed, which often complicates diagnosis.

In young children, the equivalent of the prodromal period of intoxication is severe pallor and repeated vomiting. Symptoms of intestinal infection in lobar pneumonia mimic peritonitis or appendicitis. In some children, tension in the muscles of the back of the head occurs before vomiting.

From the very beginning of lobar pneumonia in children, increased breathing is detected up to 50-60 chest movements per minute (a ratio of the frequency of respiratory movements to the heart rate is observed in the ratio of 1 to 3). The child's breathing is accompanied by groans, and a strong paroxysmal, jerking cough appears. Subsequently, there is some lag in breathing of one half of the chest, one-sided redness skin cheeks.

In the first days of the disease, an increase in vocal tremors and sound conduction into the bronchi is visible, which is later joined by bronchial breathing. There is no cough at first. After some time, a dry cough appears, then it is accompanied by sputum production (in older children, rusty in color). When tapping the surface of the chest, there is an area of ​​shortened sound against the background of harsh or weakened breathing.

The lobar form of pneumonia in children is characterized by the spread of the inflammatory process throughout the entire lung lobe. This explains the absence of diffuse wheezing in bronchial tree. On the third day of illness, crepitation (the sound of crunching snow underfoot) can be heard at the height of inspiration, but through frequent and shallow breathing this sound is quite difficult to hear. In some cases, fine bubble-like moist or rales can be heard over the affected area of ​​the lung tissue. As the disease progresses, they may become dry. When crepitus disappears, pleural friction noise may be detected.

The most common complication is pleurisy - dry And exudative. They can develop simultaneously - parapneumonic or after pneumonia (postpneumonic).

Signs of lobar pneumonia in children

Signs of lobar pneumonia in children do not always indicate that this particular disease is developing. The clinical picture of lobar pneumonia can also be observed with large-focal pneumonia, which can be considered as the initial form of lobar pneumonia. The clinical picture of lobar pneumonia is also subdivided at the stage of the disease.

With the beginning of the thinning of the fibrous exudate and the restoration of breathing in the alveoli, the dullness of the pulmonary tone during tapping decreases, normal breathing is restored, shallow bronchial breathing disappears and crepitus begins to be heard again. In the process of resorption of the exudate, bronchial breathing changes to hard, then vesicular, the shortening of the sound tone during tapping, increased vocal tremor and increased bronchial sound disappear. Sometimes, at the stage of rarefaction above the zone of the inflammatory process in the lung lobe, ringing, well-audible small bubble rales appear. From the moment of intoxication, persistent tachycardia is observed, pulse is frequent 120-140 beats per minute, weak filling.

Long-term tachycardia is characteristic of severe lobar pneumonia. At the same time, there is a decrease blood pressure, collapse is possible.

In the blood test, leukocytosis and a shift in the blood count to the left are observed. Toxic granularity appears in neutrophils. The erythrocyte sedimentation rate accelerates to 20-40 mm.

When examining urine at the height of the disease, a decrease in daily volume, an increase in its specific gravity and density, and the presence of a small amount of protein are noted. A week after the onset of the disease, with successful treatment, the body temperature drops critically, less often this happens gradually, and recovery occurs. This period is characterized by a rapid improvement in the patient’s general condition and a reduction in the focus of the inflammatory process in the lungs. The cough becomes moist, shortness of breath disappears, the sputum is less viscous and easier to excrete. Breathing becomes calm, its frequency normalizes. When listening to the lungs, it is almost always possible to hear crispy dry rales as a result of liquefaction of sputum.

X-ray examination at the stage of high tide reveals an increase and intensification of the pulmonary pattern of the affected area of ​​the lungs, expansion of the roots of the lungs, and
on the second day of the disease - uniform darkening of the lobe of the affected lung or its segments. At the resolution stage, the x-ray eclipse acquires a heterogeneous spotty character. Usually the process is localized in one lung, but in 5-10% of cases bilateral lesions are possible. Pneumonia is most often observed in the lower lobes of the lung.

Modern features of the course of lobar pneumonia in children: less severe symptoms intoxication, respiratory failure, damage to one or more segments occurs more often than the whole lobe, the duration of the febrile period decreases. In the second week after the onset of antibacterial pneumonia, the temperature may decrease or remain low-grade. With a positive course, pneumonic foci resolve within a month from the onset of the disease. Long-term consequences Pneumonia may appear after 6 months and persist for up to 1 year.

Treatment of lobar pneumonia in children

Treatment of lobar pneumonia in children should begin immediately, immediately after installation preliminary diagnosis. Therapy begins with the appointment of a broad-spectrum antibacterial agent. Subsequently, after testing the sputum for sensitivity to antibiotics, a specific antibacterial agent is prescribed. In the first days of the disease, adequate symptomatic therapy is necessary. Measures should be taken to reduce febrile symptoms, lower body temperature, and relieve attacks of respiratory failure. In particularly severe cases, the child may be connected to an artificial respiration apparatus.

Treatment of lobar pneumonia in children is carried out exclusively in specialized hospitals. Provide at home full treatment and caring for the baby is impossible.

At the stage of resorption of sputum and inflammation, physiotherapeutic procedures, inhalations, and salt mines can be used. In the first days of illness, all procedures accompanied by a warming effect are strictly prohibited. The sick child is provided bed rest, drinking plenty of fluids, sufficient supply of fresh air. In some cases, to reduce symptoms oxygen starvation internal organs use oxygen cushions.

Pathogenetic therapy includes softening herbal decoctions in the first 1-2 days ( Linden blossom), berries (viburnum, raspberries, currants), after 1-2 days, when the cough becomes wet, - decoctions of expectorant herbs (preparations of marshmallow root, licorice, thermopsis herb), preparations of ambroxol hydrochloride, acetylcysteine, bromhexine.

Various forms of lobar pneumonia in children

In physician practice, various forms of lobar pneumonia in children have recently been encountered. They can be either characteristic or have an unclear clinical picture. In some cases, pneumococcal lobar pneumonia in children is disguised as a number of other diseases.

The most common are the following atypical forms of lobar pneumonia:

Central- the source of inflammation is located in the deep parts of the lungs, so the visual examination and listening data are vague; only an X-ray examination will clarify the diagnosis.

Abortive form- the onset of the disease is acute, violent, but the duration of the disease is reduced to 2-3 days.

Massive pneumonia- the inflammatory process quickly spreads to other parts of the lungs. Massive pneumonia resembles exudative pleurisy, but when tapping, the dullness of sound tones with this form is of lower values.

Jet pneumonia- occurs in children with reduced level immunity. Its onset is not acute, signs of inflammation develop gradually, body temperature is subfebrile. General malaise - the course of the disease is sluggish. Objective examination data are insignificant.

Migratory pneumonia- characterized by the transition of the inflammatory process to neighboring areas. This type of pneumonia is characterized by a longer course;

Appendicular form- simulates the clinical picture of acute appendicitis and subsequently peritonitis. But distinguishing these two diseases from each other is quite simple. Despite the acute abdominal pain, which is localized in epigastric region, the patient allows deep palpation of the abdomen, thanks to this it is possible to prevent the picture of appendicitis, and is more common when the process is localized in the lower lobes.

The typhoid form of lobar pneumonia in children resembles typhoid fever. The onset of the disease is gradual with a long febrile period and sharp decline temperature.

The form in the form of meningitis differs in that from the first days of the disease pronounced brain symptoms (headache, convulsions, vomiting, drowsiness) are determined. In addition, it is characteristic that there is specific symptoms meningitis (neck tension, severe photophobia, Kernig's sign). Such patients are prescribed spinal tap, both diagnostic and therapeutic purpose. The cerebrospinal fluid is transparent, flows out under increased pressure, the cellular composition and protein are normal.

Clinical manifestations of lobar pneumonia depend on the period of the disease: initial, peak period, recovery period. The course of lobar pneumonia can be complicated by the development of acute respiratory failure, cardiovascular failure, para- and meta-pneumonic pleurisy, pleural empyema, destruction of lung tissue, abscess and gangrene of the lungs, infectious-toxic shock, intravascular disseminated coagulation syndrome.

Editor

Daria Tyutyunnik

Doctor, forensic expert

Parents should be aware of obvious and hidden symptoms pneumonia in order to recognize them in your child in time. Consultation with a doctor is required at the first and slightest signs.

The current article is about lobar pneumonia, a type of pneumonia. Let's look at what it is, as well as the features of symptoms and treatment.

What it is?

Lobar pneumonia is an acute inflammation of the entire lobe of the lung or a significant part of it. The disease is cyclical and is divided into three periods: onset, peak and recovery. Lasts usually 7-10 days.

Most often, lobar pneumonia occurs on one side of the lungs, and bilateral pneumonia is rare. Classic shape covers one of the lobes of the lung, but this is extremely rare, usually only one or several segments of the lobe are affected.

Right-sided lobar pneumonia on x-ray

Good to know! Croupous pneumonia (parenchymal) rarely occurs in newborns and infants, more often in two- to three-year-old patients, and dominates in preschoolers and schoolchildren.

Stages

Tide stage. Lasts up to 1 day, less often – up to 3. The lung tissue is hyperemic, the permeability of the pulmonary vessels increases, the alveoli are filled with fibrin exudate, which leads to venous stagnation in the lungs.

Red liver stage. Lasts from 1 to 3 days. Red blood cells accumulate massively in the lumen of the alveoli, and fibrin filaments fall out between the cells. Thus, the exudate becomes fibrinous-hemorrhagic, its coagulation leads to airlessness of the alveoli and the lung tissue thickens (hepatization process).

Stage of gray hepatization. Lasts from 2 to 6 days. The accumulation of fibrin and leukocytes continues, but red blood cells begin to be destroyed in the exudate. The affected areas become gray-green or gray-brown in color, but remain dense. The exudate becomes fibrinous-purulent.

Resolution stage. It lasts for several days. Protolytic enzymes of neutrophils and macrophages break down and liquefy fibrin. The exudate is resorbed and the lumen of the alveoli is gradually restored.

A strict sequence of stages in lobar pneumonia in children can rarely be observed. More often a mixed morphological picture appears.

Important! For most infants and young children, the clinic differs from that described above. Newborns do not cough because they do not yet have this reflex. Babies are passive, inhibited, and do not gain weight.

Causes

The main cause of the disease is penetration into lung tissue pneumococcus. Less commonly, lobar pneumonia can be caused by diplobacillus or other pathogenic microorganisms (staphyllo- and streptococci).

IN clinical practice There are cases when a child has both. IN in this case the primary process is a virus, and then, with reduced immunity, pathogenic microflora joins.

Factors contributing to infection

• decreased immunity;
• deterioration of the diet and living environment;
• previous viral or bacterial infection;
• excessive cooling;
• chronic diseases;
• disorders of the central nervous system.

Child's complaints

• for nausea, vomiting, belching;
• chills or sweating;
• abdominal pain;
• headache;
• chest pain;
• , shortness of breath;
• dry mouth.

Symptoms

Lobar pneumonia is characterized acute onset. Body temperature rises sharply to 39-40 degrees. There may not be a cough or other respiratory symptoms at first.

With lobar inflammation, acute stabbing pain on the inflammation side varying intensity, radiating to the abdomen or shoulder. As a rule, the pain goes away through 2-3 days, otherwise it is alarm signal development of pleural empyema.

From the very beginning of lobar pneumonia, the auxiliary muscles of the chest are connected to the child’s respiratory act. When he breathes, the wings of his nose swell, his cough causes pain, he grunts, groans and groans, and lies on his sore side.

Other symptoms include the following:

• Blood pressure decreases.
• Cough in first 2 days The disease is unproductive, then with the release of white foamy sputum, later it becomes viscous, containing bloody streaks.
• sick child frequent ( from 25 to 50 times per minute), superficial with shortness of breath, difficulty in inhaling and with visual lag of the affected half of the chest.
• The skin of the body is dry and hot, and the skin of the arms and legs becomes cold with a bluish tint. Cyanosis of the lips and blush on the cheek due to inflammation are also noted.
• Signs of intoxication appear.
• Quite often you can observe herpetic rashes in the face and neck.
• The stomach is often bloated.
• The liver enlarges.

Reference. Breathing rate 60 or more breaths per minute in babies under one year old is considered rapid. With pneumonia, children aged over 1.5 years inhale and exhale about 50 times in 60 seconds, at normal up to 30 times.

At the height of the disease, pathologically blood composition changes:

• increase in the number of leukocytes (the formula shifts to the left),
• increase in the number of globulins,
• increased amount of fibrinogen.
• a decrease in the amount of urine, but at the same time its density increases.

Treatment

It is used in the treatment of lobar pneumonia in children. Currently, more than 200 antibiotics are known, manufactured by various companies and sold under 600 names. As a rule, doctors use protected penicillins (Augmentin, amoxiclav, etc.) or cephalosporin antibiotics of the 2nd and 3rd generations (cefoperazone, cephalexin, ceftriaxone, cefuroxime).

If necessary, macrolides (azithromycin, erythromycin, revamycin) are used. For severe pneumonia, aminoglycosides may be prescribed or a combination of various groups drugs.

Often, initial antibiotic therapy is prescribed experimentally, before obtaining information about the causative agent of the disease. Antibiotics are prescribed to children with severe intoxication and high temperature, which holds more than 3 days.

Properly selected initial therapy produces an effect within first two days treatment: temperature decreases, pneumonic symptoms do not increase, well-being improves.

If there is no effect, an alternative treatment regimen is prescribed - antibiotic is replaced.

Except antibacterial therapy Pediatricians prescribe bronchodilators, expectorants and antiallergic drugs, as well as vitamins.

In severe cases, carry out syndromic therapy aimed at maintaining respiratory function, work of the heart and blood vessels, adequate reaction from the child’s nervous system.

Additional treatment methods are added during the recovery stage. The doctor may prescribe physiotherapy, reflexology, and herbal remedies.

Immunomodulators are prescribed by an immunologist after recovery, if necessary.

At effective treatment at the stage of disease resolution 5-7 day the temperature drops and its values ​​return to normal, shortness of breath subsides, herpes dries up, pathological changes in the lungs disappear and the child gets better.

Conclusion

After pneumonia, children, especially early age, should be observed by a pediatrician, and if there is a pediatric pulmonologist, by him. For a speedy recovery, the child needs hygienic measures and adequate physiotherapy.