Bilateral pneumonia
The content of the article:
- Causes and risk factors
- Forms
- Stages
- Symptoms of bilateral pneumonia
- Bilateral pneumonia in a child
- Diagnostics
- Treatment of bilateral pneumonia
- Possible complications and consequences
- Forecast
- Prevention
Bilateral pneumonia is an inflammatory lesion of both lungs. First of all, the alveoli and interstitial tissue are affected, then the inflammation spreads to all structural elements of the lung tissue. The mortality rate of the disease reaches 9%; bilateral pneumonia is especially dangerous for children, the elderly and people with weakened immunity.
Bilateral pneumonia on x-ray
Causes and risk factors
The causative agents of bilateral pneumonia are most often gram-positive microorganisms. From 40 to 60% of cases of the disease are caused by pneumococci; less often - staphylococci and streptococci. Sometimes the causative agents of bilateral pneumonia are mycoplasma, chlamydia, viruses, fungi and some gram-negative bacteria - hemophilic bacillus, Friedlander's bacillus, enterobacteriaceae, E. coli, Proteus, Legionella, etc. Cases of mixed infections are often noted.
In primary pneumonia, infection occurs by airborne droplets, but most often there is a secondary infection that has developed against the background of a prolonged inflammatory process in the respiratory system. The primary focus of infection, as a rule, is in the nasopharynx - in the oral cavity, tonsils and paranasal sinuses. Bilateral pneumonia is often a complication of influenza, acute respiratory viral infections, tonsillitis and chronic diseases of the respiratory system, such as sinusitis, frontal sinusitis, tonsillitis, tuberculosis, and especially chronic deforming bronchitis. In the generalized form of the disease, the infection is carried into the lungs with blood flow from the kidneys, pelvic organs and abdominal cavity. In weakened patients, the development of the disease is possible against the background of suppression of the immune system and intensive reproduction of opportunistic microflora.
In most cases, infection with gram-positive bacteria leads to the development of bilateral pneumonia.
Risk factors for developing bilateral pneumonia include:
- congenital anomalies in the structure of the lungs;
- congestive heart failure;
- immunodeficiency states;
- smoking and alcohol abuse;
- removal of tonsils in the anamnesis;
- long-term adherence to bed rest.
In young children, exudative-catarrhal diathesis and a tendency to hyperergic reactions are also considered predisposing factors.
Bilateral pneumonia of non-infectious origin can be provoked by exposure to toxic substances, allergens and ionizing radiation, as well as chest injuries, operations on the chest cavity, foreign bodies entering the bronchi and thromboembolism of small branches of the pulmonary artery.
Forms
With bilateral pneumonia in adults, the lower lobes of the lungs are most often affected; for children, the polysegmental form of the disease is more characteristic. Lower lobe bilateral pneumonia develops against the background of a chronic infectious process, prolonged immunosuppression and systemic diseases, accompanied by congestion in the lower lobes of the lungs, for example, with heart failure. Due to the tendency to rapid progression and the formation of a large amount of infiltrate, polysegmental bilateral pneumonia is characterized by a more severe course and a high risk of developing respiratory failure.
With bilateral pneumonia, more often affecting the lower lungs
Stages
The development of the inflammatory process in bilateral pneumonia in the absence of complications occurs in four stages.
- Hot flush (12–72 hours) - a sharp blood filling of the vessels of the lungs and the formation of fibrinous exudate in the alveoli.
- Red hepatization (from 1 to 3 days) - thickening of the lung tissue with the appearance of red blood cells in the alveolar exudate.
- Gray hepatization (from 2 to 6 days) - decay of erythrocytes and active migration of leukocytes into the alveoli.
- Resolution - restoration of the normal structure of the lung tissue.
Symptoms of bilateral pneumonia
The clinical picture of bilateral pneumonia is determined by the ratio of bronchopulmonary and intoxication symptoms, the intensity of which depends on the type of pathogen, the state of the immune system and the form of the disease.
With the defeat of the lower lobes of the lungs, symptoms of bilateral pneumonia include:
- prolonged subfebrile condition and pronounced daily fluctuations in body temperature with an amplitude of 0.5–1 ° С in case of uncomplicated course of the disease and 1–2 ° С in case of complications;
- general weakness and profuse sweating;
- pallor of the skin and cyanosis of the nasolabial triangle;
- severe chest pain with a clear localization, aggravated by a deep breath, coughing and an inclined position of the body.
Severe chest pain and cough are symptoms of bilateral pneumonia
In the first two days of the disease, the cough remains dry, then mucopurulent sputum appears, which may contain an admixture of blood. The presence of shortness of breath depends on the severity of the inflammatory process: from a feeling of lack of air during exercise to suffocation at rest.
The increasing intoxication of the body with bilateral pneumonia is manifested by neurological and abdominal disorders:
- excitation;
- headaches;
- dizziness;
- sleep disorders;
- confused consciousness up to delirium and hallucinations;
- nausea and vomiting;
- loss of appetite;
- bloating;
- unstable stool.
Polysegmental bilateral pneumonia is characterized by a febrile state with chills and profuse sweating; muscle weakness, shortness of breath, pain in the chest, joints and muscles, frequent coughing fits and the production of large amounts of phlegm. With edema of the bronchial walls, the patient's breathing is accompanied by wheezing, in complicated cases, signs of acute respiratory and heart failure develop rapidly.
Bilateral pneumonia in a child
In view of the erased clinical picture, bilateral pneumonia is especially dangerous for infants. Parents should call an ambulance and insist on hospitalization and an in-depth examination of the child when the following signs appear:
- rejection of the breast;
- lethargy and drowsiness;
- pallor of the skin, turning into cyanosis;
- shallow breathing;
- body temperature above 37 ° C for two days.
Bilateral pneumonia is very dangerous for infants
Within 14 days after suffering a cold or flu, preschoolers and younger schoolchildren may develop bilateral polysegmental pneumonia. The anatomical features of the upper respiratory tract in children under 12 years of age, in particular, the small length of the trachea and compression of the pleural sinuses, along with underdevelopment of lymphoid tissue and low activity of antibacterial immunity, contribute to the rapid spread of the inflammatory process in the lungs.
Diagnostics
A preliminary diagnosis is made by a physician or pulmonologist on the basis of a physical examination, in particular auscultatory picture of bilateral lung lesions. The main manifestations of the inflammatory process in the lungs include:
- hard breathing;
- moist fine bubbly and medium bubbly rales;
- crepitus over the foci of inflammation;
- dullness of percussion sound;
- increased bronchophonia;
- pleural friction noises;
- deaf heart sounds.
In order to clarify the diagnosis, an X-ray of the lungs is performed. When the parenchyma is damaged, the images show darkening of various sizes and localization, displacement of the pleural sheets and expansion of the sinuses, and in the case of the spread of the inflammatory process to the interstitial tissue, an increase in the pulmonary pattern.
The main method for diagnosing bilateral pneumonia is X-ray of the lungs
A general blood test shows an increase in ESR up to 30-50 mm / hour and leukocytosis with an increase in the proportion of stab cells in the leukocyte formula up to 6-30%. Microscopy and bacterial culture of sputum and nasopharyngeal lavages can identify the type of pathogen and determine the sensitivity of this strain to antibacterial and antiviral drugs.
In order to monitor the effectiveness of therapy in the third or fourth week of the disease, a control X-ray of the lungs is performed. After being discharged from the hospital, the patient is registered at the dispensary for a year, undergoing periodic examinations by a pulmonologist. A complete blood count, bacteriological examination of sputum and fluorography are performed twice a year.
Treatment of bilateral pneumonia
The therapeutic strategy for bilateral pneumonia is based on a combination of etiotropic and symptomatic approaches. In addition to specific antibacterial or antiviral therapy, measures are taken to eliminate airway obstruction and increase lung vital volume, stimulate immunity and detoxify the body.
In addition to anti-infectious drugs, the patient is prescribed mucolytic and expectorant drugs, vitamins to strengthen blood vessels, therapeutic inhalations and bronchoscopy. Severe intoxication is relieved by intravenous infusion of glucose-saline solutions. To combat functional impairments, it is indicated to carry out post-syndrome therapy; with severe respiratory failure, oxygen therapy and artificial ventilation are used. Due to the high risk of complications, treatment of bilateral pneumonia is carried out in a hospital.
Therapeutic inhalation is part of the treatment of bilateral pneumonia
After the acute inflammation subsides, physiotherapeutic procedures are shown that accelerate the recovery of lung tissue:
- electrophoresis of calcium chloride, hyaluronidase and potassium iodide;
- Becker currents;
- indkutothermy;
- UHF;
- chest massage;
- ultraviolet irradiation;
- magnetotherapy; etc.
After suffering pneumonia, the patient is recommended to practice breathing exercises and exercise therapy, profile spa treatment, prolonged exposure to the fresh air and a general strengthening diet rich in vitamins, microelements and easily digestible protein.
Possible complications and consequences
Complications of bilateral pneumonia are classified into pulmonary and extrapulmonary. The former include obstructive syndrome, abscess and gangrene of the lung, pleurisy and acute respiratory failure; to the second - acute cardiopulmonary failure, infectious toxic shock, meningitis and meningoencephalitis, myocarditis and endocarditis, glomerulonephritis, anemia, etc. Late start of treatment increases the likelihood of complications.
Forecast
Mild to moderate bilateral pneumonia usually heals in 3-4 weeks. In 70% of cases, complete recovery of lung tissue occurs; less often areas of pneumosclerosis (20%) and connective tissue replacement (7%) are formed. The chance of shrinking or shrinking the affected segment or lobe is 3%. With a protracted and complicated course of the disease, as well as with immunodeficiencies, nosocomial infection, the appearance of purulent and toxic complications and resistance of the pathogen to antibiotic therapy, the prognosis is less favorable.
Prevention
Prevention of pneumonia of all types consists in strengthening immunity, including rational nutrition and hardening the body, as well as combating dust and air pollution, timely treatment of respiratory diseases, rejection of bad habits and rehabilitation of chronic foci of infection. The condition of the oral cavity and the timely treatment of caries are of great importance. It is important for weakened people and often ill children to avoid hypothermia, stress and excessive physical exertion, observe a sparing daily regimen and perform breathing exercises. Recently, vaccination against pneumococcus and Haemophilus influenzae in children and adults at risk has been practiced.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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!
