Bronchopneumonia
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Bronchopneumonia is an acute infectious and inflammatory disease of the lungs with the involvement of all structural elements and the obligatory damage to the alveoli, the development of inflammatory exudation in them (with the release of the liquid part of the blood plasma from the bloodstream into the surrounding tissues, "soaking").
Inflammation of the walls of the bronchioles with bronchopneumonia
Bronchopneumonia is a type of pneumonia in which not only the lung tissue is affected, but also the adjacent structural elements of the bronchial tree. The inflammatory process in this case is focal in nature: it is common within a segment, lobule or acinus.
Bronchopneumonia is not associated with a specific type of pathogen; with progression, it can transform into lobar pneumonia. In the form of an independent disease, it occurs in children and elderly patients, in adulthood it most often becomes a complication of other diseases.
In the structure of the causes of death, pneumonia takes the 4th place after cardiovascular, oncological diseases and injuries.
Synonym: focal pneumonia.
Causes and risk factors
The most common causative agents of community-acquired (emerging in a domestic environment) bronchopneumonia:
- pneumococci (Streptococcus pneumoniae) - lead in the ranking of pathogens, accounting for 70 to 90% of all cases;
- haemophilus influenzae (Haemophilus influenzae);
- mycoplasma (Mycoplasma pneumoniae), 20-30% of patients under 35 are infected with this pathogen;
- chlamydia (Chlamydia pneumoniae);
- legionella (Legionella pneumophila);
- moraxella [Moraxella (Branhamella) Catarralis];
- Klebsiella, Friedlander's stick (Klebsiella pneumoniae);
- E. coli (Escherichia coli);
- Staphylococcus aureus (Staphylococcus aureus);
- hemolytic streptococcus (Streptococcus Haemoliticus).
The most common cause of bronchopneumonia is infection
If pneumonia develops within 48–72 hours after a patient is admitted to a hospital (so-called hospital pneumonia), the main pathogens are often:
- Staphylococcus aureus (Staphylococcus aureus);
- Pseudomonas aeruginosa (Pseudomonas aeruginosa);
- E. coli (Escherichia coli);
- Klebsiella, Friedlander's stick (Klebsiella pneumoniae);
- Proteus (Proteus mirabilis) and other gram-negative microorganisms.
In addition to bacteria, some viruses can cause bronchopneumonia: influenza viruses, parainfluenza, adenovirus, respiratory syncytial and rhinoviruses, some enteroviruses (Coxsackie, ECHO), etc.
A characteristic sign of bronchopneumonia is polyetiology, that is, a combination of several causal factors.
Risk factors for developing bronchopneumonia:
- long experience of smoking;
- elderly and children's age (especially from 3 to 9 months);
- secondary immunodeficiency states;
- alcohol abuse;
- heart failure with congestion in the pulmonary circulation;
- immunosuppressive therapy;
- chronic pathology of the bronchopulmonary zone;
- professional harm;
- unfavorable ecological situation;
- malformations of the respiratory system;
- long bed rest;
- condition after surgery;
- chronic inflammatory processes of the ENT organs.
After the penetration of pathogenic microorganisms into the smallest structures of the bronchial tree and lung tissue, the local immune defense is disturbed, which allows pathogens to provoke inflammatory changes. Against the background of inflammation in the tissues of the bronchi and lungs, microcirculation suffers, which leads to the development of ischemia; processes of lipid peroxidation are activated, local sensitization occurs.
Forms of the disease
Depending on the conditions for the development of the disease, the following forms are distinguished:
- community-acquired (home, outpatient);
- hospital (nosocomial);
- pneumonia against the background of immunodeficiency.
In some classifications, it is proposed to separately consider bronchopneumonia associated with medical intervention.
According to the etiological factor, there are:
- bacterial bronchopneumonia;
- viral;
- atypical.
The focus of bronchopneumonia
According to the severity of bronchopneumonia, they are divided as follows:
- lungs - unexpressed symptoms of intoxication, subfebrile body temperature, pulmonary infiltration within one segment, there are no respiratory failure and hemodynamic disturbances;
- moderate severity - moderately pronounced symptoms of intoxication, an increase in body temperature up to 38 ° C, pulmonary infiltration within 1-2 segments, respiratory rate (respiratory rate) - up to 22 per minute, heart rate (heart rate) - up to 100 beats / min, there are no complications;
- severe - severe symptoms of intoxication, body temperature above 38 ° C, respiratory failure II (III) degree, hemodynamic disturbances (blood pressure less than 90/60 mm Hg, heart rate - more than 100 beats / min, need for vasopressors), leukopenia less than 4 x 10 9 / l or leukocytosis 20 x 10 9 / l with the number of immature neutrophils more than 10%, multilobal, bilateral pneumonic infiltration, rapid progression of the process (increase in the infiltration zone by 50% or more within 48 hours of observation, pleural effusion, abscess formation, urea nitrogen> 10.7 mmol / l, disseminated intravascular coagulation, sepsis, failure of other organs and systems, impaired consciousness, exacerbation of concomitant diseases).
Symptoms
In rare cases, the disease develops acutely, but mainly as a complication of acute respiratory (including viral) infections or acute tracheobronchitis.
The main symptoms are:
- cough with mucopurulent sputum (often begins with coughing, which turns into a dry, unproductive cough, sputum appears, as a rule, on the second or third day of the disease);
- an increase in body temperature (often up to subfebrile numbers, in rare cases - up to 38.5-39.5 ° C);
- pain and congestion in the chest, aggravated by deep breathing, coughing (observed only when the focus of inflammation is close to the pleura);
- shortness of breath (up to 25-40 respiratory movements per minute) is an optional symptom, more often worried about children and elderly patients;
- intoxication symptoms (headache, dizziness, apathy, weakness, lethargy, fatigue, decreased or lack of appetite, drowsiness).
Cough, fever, shortness of breath are the main symptoms of bronchopneumonia
In older patients and children, weakened, patients with immunodeficiency states or long-term chronic diseases, the clinical picture may be blurred (without high fever, intense cough and shortness of breath) or, conversely, be characterized by violent rapid symptoms.
Diagnostics
Diagnostic measures for suspected bronchopneumonia:
- complete blood count (leukocytosis with neutrophilic shift to the left, accelerated ESR);
- biochemical blood test (for markers of acute inflammation);
- sputum examination;
- blood gas analysis;
- auscultation (hard breathing is established, fine bubbling wet rales, which can disappear after coughing or deep breathing, crepitation is occasionally determined);
- X-ray examination in frontal and lateral projections [there is a moderate increase in the pulmonary pattern (may be absent with a slight inflammation) and the appearance of fuzzy heterogeneous infiltrative shadows];
- computed tomography (indicated for the root process, severe bronchial obstruction, differential diagnosis with tuberculosis and lung neoplasms).
Bronchopneumonia on X-ray
According to the indications, polypositional fluoroscopy is performed. Control X-ray examination is carried out no earlier than 2-3 weeks with an uncomplicated form of bronchopneumonia.
Treatment
Complex treatment of bronchopneumonia:
- medical and protective regimen (hospitalization or outpatient treatment - depending on the severity, bed rest, restriction of physical activity);
- medical food (diet number 10 or 15) with a large amount of fortified drinks;
- etiotropic treatment (antibacterial, antiviral, antimicrobial drugs);
- pathogenetic treatment, including drugs to restore the drainage function of the bronchi (mucolytics and expectorants), bronchodilators, selective beta-2-adrenomimetics, immunomodulatory therapy, antioxidant drugs;
- detoxifying agents;
- symptomatic treatment (antitussives, pain relievers, anti-inflammatory, antipyretic drugs);
- physiotherapy, exercise therapy, massage, breathing exercises at the stage of convalescence;
- sanatorium treatment, rehabilitation and medical examination of patients.
As part of the complex treatment, expectorants are shown that facilitate the excretion of sputum.
Possible complications and consequences
Bronchopneumonia can be complicated by pulmonary and extrapulmonary pathological conditions.
Pulmonary complications:
- parapneumonic pleurisy;
- empyema of the pleura;
- lung abscess;
- gangrene of the lungs;
- bronchial obstruction syndrome;
- acute respiratory failure.
Extrapulmonary complications:
- acute cor pulmonale;
- infectious toxic shock;
- nonspecific myocarditis, endocarditis;
- meningitis;
- meningoencephalitis;
- DIC syndrome;
- psychosis;
- anemia;
- acute glomerulonephritis;
- toxic hepatitis.
Forecast
With adequate complex therapy, bronchopneumonia has a favorable prognosis. The favorable prognosis decreases in severe disease, severe concomitant pathology, in immunocompromised patients, elderly, debilitated patients, and young children.
Prevention
The main preventive measure is the timely treatment of acute respiratory diseases.
Other preventive recommendations:
- to give up smoking;
- influenza vaccination;
- strengthening the immune system;
- compliance with the rules of personal hygiene (which is especially important during the period of massive spread of ARVI).
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
