Croupous pneumonia
The content of the article:
- Causes and risk factors
- Forms of the disease
- Stages of croupous pneumonia
- Symptoms of Croupous Pneumonia
- Features of the course of the disease in children
- Diagnostics
- Treatment of lobar pneumonia
- Possible complications of lobar pneumonia and consequences
- Forecast
- Prevention
Croupous pneumonia is an inflammatory-allergic disease, which is characterized by the compaction of one or several lobes of the lung and the formation of pathological exudate in the alveoli, as a result of which the gas exchange process is disrupted.
The disease is diagnosed in all age groups, however, it is more often recorded in patients aged 18–40 years, in children, lobar pneumonia is rare.
The lungs are a paired respiratory organ, located in the left and right half of the chest cavity, limiting the complex of mediastinal organs. The right lung has three lobes, and the left lung has two. Each of the lobes of the lung, in turn, is formed by segments, the pulmonary tissue inside the segments consists of pyramidal lobules, the apex of which includes the bronchus, which forms in it by sequential division of 18-20 terminal bronchioles, ending in acinus. The acinus consists of respiratory bronchioles, dividing into alveolar passages, their walls are dotted with alveoli, in which gas exchange between atmospheric air and blood occurs.
Source: proinfekcii.ru
Croupous inflammation can capture both individual segments of the lung, and the entire lobe, and sometimes the entire lung.
Causes and risk factors
The causative agents of croupous pneumonia are pneumococci (types I, II, III, IV), staphylococci, streptococci, E. coli and Klebsiella. The main routes of transmission are airborne, hematogenous and lymphogenous.
Risk factors include:
- infectious diseases;
- smoking;
- chest injuries of varying severity;
- immunodeficiency states;
- hypothermia;
- intoxication;
- anemia;
- frequent stressful situations;
- overwork;
- poor nutrition.
Forms of the disease
Depending on the characteristics of the clinical picture, croupous pneumonia is divided into typical and atypical forms.
Among the atypical forms of the disease, in turn, the following forms are distinguished:
- abortive - debuts acutely, lasts 2-3 days, then the symptoms involution;
- areactive - the onset is mild, signs of inflammation appear gradually, the course is sluggish;
- central - inflammation occurs in the deep parts of the lung;
- migratory - the areas of the lung located next to the primary are involved in the inflammatory process;
- massive - characterized by the rapid spread of the inflammatory process to other lobes of the lung;
- typhoid - the pathological process develops gradually, the symptoms resemble typhoid fever;
- appendicular - resembles the clinical picture of appendicitis, inflammation often develops in the lower lobes of the lung;
- meningeal - meningeal symptoms are characteristic.
Stages of croupous pneumonia
There are four stages of lobar pneumonia:
- The stage of hyperemia and tide - the inflammatory process in the alveoli leads to their expansion and the appearance of exudate in them; the beginning of diapedesis of erythrocytes into the lumen of the alveoli; vascular disorders are noted; duration 1–3 days.
- The stage of red hepatization - the diapedesis of erythrocytes increases, the inflammatory exudate is enriched with proteins with the loss of fibrin, due to fibrinous effusion, the affected lung becomes denser, acquires a dark red tint, the capillaries are compressed, which causes malnutrition of the lung tissue; duration 1–3 days.
- Stage of gray hepatization - leukocytes infiltrate the intermediate tissue of the lungs around small veins and capillaries; the affected lung becomes grayish, lasting from 2 to 6 days.
- Resolution stage - the fibrinous exudate gradually liquefies under the action of proteolytic enzymes, which begin to secrete leukocytes, and is excreted from the lung; lasts 2–5 days.
Occasionally, the gray hepatic stage may precede the red hepatic stage.
Symptoms of Croupous Pneumonia
With croupous pneumonia, one lobe of the lung, one or both lungs can be affected. The severity of the disease depends on the extent of the lesion.
The onset of the disease is usually acute. Body temperature rises to 39-40 ˚С, severe chills, general weakness, lethargy, headache, shortness of breath, chest pains occur. Sometimes there is flushing of the cheeks, more pronounced on the side of the lesion, diarrhea or constipation. On the third or fourth day, a cough appears with the separation of rusty sputum characteristic of croupous pneumonia.
With the progression of the pathological process, pain occurs in the side from the side of the lesion. The pain can radiate to the abdomen or shoulder, and usually disappears after a few days. If the pain persists for a longer period, there is a possibility of developing pleural empyema. The chest from the side of the lesion lags somewhat behind in the act of breathing, while the auxiliary muscles are involved in breathing.
In severe cases of the disease, cyanosis of the nasolabial triangle is observed, the skin is dry and hot, while the limbs are cold. The general condition of the patient is severe, rapid breathing is superficial with swelling of the wings of the nose, pulse is frequent, heart sounds are muffled, blood pressure is low, arrhythmia may appear.
Features of the course of the disease in children
Croupous pneumonia in children is not characterized by high fever, severe chills and pain in the side.
In young children, there is no cough in the early days of the disease. Symptoms of croupous pneumonia in them are dry lips and tongue, nausea and vomiting, bloating, abdominal pains reminiscent of those with appendicitis, lack of stiffness of the muscles of the anterior abdominal wall, pallor of the skin, rapid breathing, agitation or lethargy, sometimes an increase in liver size … In some cases, stiff neck muscles, severe headaches, cramps, delirium, hallucinations are observed, and therefore meningitis may be misdiagnosed. As the pathological process develops, the meningeal symptoms disappear, a clinical picture typical for croupous pneumonia appears.
In children aged 7-16 years, the disease is usually typical.
The body temperature returns to normal on the 5th-9th day after the onset of the disease, the inflammatory changes in the lungs disappear rather quickly.
Diagnostics
To make a diagnosis, they collect complaints and anamnesis, physical diagnostics, instrumental and laboratory research.
Source: zdorovie-legkie.ru
During physical diagnostics at stage I of lobar pneumonia, vesicular breathing, dull-tympanic percussion sound, crepitus are noted. Stage II of the disease is characterized by a dull percussion sound, bronchial breathing, and decreased mobility of the lower pulmonary edge on the affected side. At stage III, the signs characteristic of stage I are determined.
One of the most informative instrumental methods for diagnosing croupous pneumonia is X-ray examination. Computed tomography or magnetic resonance imaging may be required to confirm the diagnosis.
Laboratory diagnostics includes a general and biochemical blood test, a general urine test, a bacteriological examination of sputum with an antibioticogram. In the general analysis of blood at the peak of the disease, an increase in the number of leukocytes, a shift in the leukocyte formula to the left, and an increase in the erythrocyte sedimentation rate are determined. Also, the content of globulins, fibrinogen increases, changes in the gas composition of the blood are detected, diuresis decreases, and the specific gravity of urine increases.
Differential diagnosis is carried out with focal drainage, caseous pneumonia.
Treatment of lobar pneumonia
Treatment of croupous pneumonia is carried out in a hospital setting. In severe cases, the patient may need to be admitted to an intensive care unit.
The main drug treatment for croupous pneumonia is to take antibacterial drugs. Before the results of sputum examination are obtained, antibiotics of a wide spectrum of action are prescribed, after the identification of the pathogen and determination of its sensitivity to antibacterial agents, the drug is replaced with the one to which the sensitivity is highest. Additionally, mucolytic drugs, antipyretics are prescribed. In order to normalize gas exchange, oxygen therapy is indicated for patients with lobar pneumonia.
Source: texashealth.org
From 3-4 days from the onset of the disease, inhalation therapy is prescribed (ultrasonic aerosol inhalations of antibacterial agents, etc.), the course of treatment usually ranges from 10 to 15 procedures. Physiotherapy (pulsed ultra-high-frequency therapy, ultraviolet irradiation, magnetotherapy) can be used at the resolution stage.
Possible complications of lobar pneumonia and consequences
Croupous pneumonia can be complicated by the development of effusion pleurisy, gangrene of the lung, purulent pericarditis, purulent mediastinitis, sepsis, infectious-toxic shock, brain abscess, purulent meningitis, purulent arthritis, cardiopulmonary failure.
Forecast
On condition of early diagnosis of the disease and adequate treatment, the prognosis is favorable. In the case of late diagnosis, the development of severe complications of lobar pneumonia (especially in immunocompromised individuals and patients suffering from alcoholism), the prognosis worsens, and a lethal outcome is possible.
Prevention
In order to prevent croupous pneumonia, it is recommended:
- timely and adequate treatment of infectious diseases, especially respiratory diseases;
- refusal of self-medication with antibiotics;
- avoiding chest injuries;
- avoiding hypothermia;
- rational work and rest regime;
- rejection of bad habits;
- balanced diet.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
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!
