Causes of lobar pneumonia, its symptoms and main methods of therapy. Croupous pneumonia in children

According to medical calculations, croupous pneumonia is an acute or chronic disease of the respiratory system, primarily the lungs, infectious, allergic or congestive genesis. In this case, we are always talking about the inflammatory process in the structure of the lower respiratory tract. When the average person speaks of pneumonia, he is referring to the croupous form of pneumonia.

Previously, the disease was considered a death sentence, fortunately, today the disease is treated quite well. According to statistics, every tenth inhabitant of the planet suffers from lobar pneumonia.

In some cases, the disease proceeds in a latent, sluggish form. Its signs are so meager that patients take 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 occur, as they say, from scratch, the pathogenesis of lobar pneumonia includes two main factors. The first is infection with a dangerous pathogen.

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

Pneumococcus. A small but extremely nasty microorganism. It becomes the culprit in the development of pneumonia in 70% of cases (on average). It is pneumococcus that is the cause of the formation of the disease in the vast majority of clinical situations. It is the main causative agent of croupous pneumonia.
Klebsiella. It occupies a worthy place in the formation of the disease. Most often provokes inflammation in children.
Streptococcus. It can be the culprit of croupous type pneumonia, but this is relatively rare. It causes quite simple forms of pneumonia in terms of cure.
Staphylococcus. Golden and hemolytic.

The first one is considered the most dangerous, because it creates multilayer structures that do not allow to effectively deal with the pathogen even with the most powerful antibacterial agents.

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

Herpes virus.

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

herpes simplex virus (type 1);
type 2 virus (genital herpes, transmitted through unprotected genital and oral-genital contact);
strain of the third type (provokes the formation of shingles and the notorious chicken pox);
herpes of the fourth type (Epstein-Barr virus), cytomegalovirus (causes massive damage to the entire respiratory system).

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

Causes of immunodeficiency

The second factor in the formation of the problem is a decrease in the efficiency of the immune system, when the protective structures of the body are unable to give a worthy rebuff to pathogens. As already mentioned, the same staphylococcus lives in almost everyone. Why doesn't everyone get sick? It's all about immunity. What is the etiology (cause) of the insufficiency of its functioning?

The presence in the body of foci of chronic infectious lesions.
Most often, it is these clinical situations that lead to the formation of chronic infectious pneumonia of the lobar type.

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

Frequent acute respiratory viral infections.

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

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

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

Pathogenesis

The essence of the pathological process is the inflammation of individual foci or all segments of the lung or lungs. Because of what, 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:

Increase in body temperature. In the primary period may be absent. As a rule, it occurs at an early stage of the course of the disease, up to 40 in the acute phase. Hyperthermia may not be throughout the entire period.
Pain behind the sternum. Develop as a result of the inflammatory process. Evidence in favor of pneumonia. Increased during inspiration, may be spontaneous. They are defined by the patients themselves as aching, pulling, dull, shooting.

Respiratory disorders. At the first moment, slight shortness of breath appears - an increase in the number of productive respiratory movements. It is observed even with minor physical exertion. With severe damage, also at rest.
Next comes suffocation- inability to breathe normally. The patient can inhale but is unable to exhale. This is an extremely dangerous condition that can lead to death. In a general sense, this pathology is called secondary respiratory failure.
Cardiac disorders. It usually presents with tachycardia.
Cough . Punching, strong. A small amount of transparent or comes out. In the latter case, we are talking about purulent pneumonia.
Weakness, feeling of body cottoniness, headache and other signs of intoxication of the body.

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

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

Stages of the pathology

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

It is also the tide stage or the initial stage. During this period, there is a cough, swelling of the affected lung, hyperthermia of a minor nature develops. The duration of the first stage is 1-2 days. Of the symptoms, it is characteristic that a huge amount of liquid exudate leaves. This is an extremely dangerous biological fluid, since many pathogens are found in it.
Pathological phenomena are growing. The body temperature rises to 39-40 degrees Celsius, a painful cough begins. Shortness of breath develops. The duration of this stage is, on average, about 2-3 days.
Acute phase. The main symptoms get worse. Purulent sputum appears (not always), phenomena of general intoxication develop. Perhaps the onset of the so-called period of imaginary well-being. 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.
Permission . The symptoms are gradually fading away. There are residual effects (pain, cough, shortness of breath).

The croupous form of pneumonia lasts from 3 to 7 weeks and ends with the complete recovery of the patient in the case of properly prescribed treatment. Otherwise, pneumonia becomes chronic.

Possible Complications

Complications of croupous pneumonia include:

Pulmonary edema.
Melt of lung tissue.
Lymphadenitis.
Meningitis.
Secondary bronchitis.
Pleurisy.
Fatal outcome.

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

Croupous pneumonia is a serious lung disease of an infectious-allergic nature. An inflammatory process occurs in the tissues with the formation of alveolar effusion (increased content of biological fluid). The disease begins with the entry of a microbe into the oropharynx, penetrating into the lower respiratory tract (alveoli, bronchioles). The area affected by lobar pneumonia extends to or an entire lobe. The causative agent penetrates into neighboring organs through the blood and lymphatic vessels.

Croupous pneumonia is difficult, because the area of lung damage is significant. Previously, the disease had a high mortality rate, now modern medicine produces highly effective drugs for its treatment. The age of patients is usually from 18 to 40 years.

Causes of croupous pneumonia

Pneumonia starts with:

pneumococci;
staphylococci and;
coli;
klebsiella.

There are cases of combined flora. Pathogenic microbes enter the lungs in several ways:

Hematogenous - the spread of pathogenic microorganisms through the blood.
Lymphogenic - infection of croupous pneumonia through the lymphatic system.
Airborne - the most common way of getting pathogenic microflora, the main source of infection is a sick person.

Provoking factors:

Lack of vitamins and microelements.
Chest injury.
Nervous experiences and stress.
Weakened immunity due to living conditions and nutrition.
Concomitant diseases in acute or chronic form.
Weakened functionality of the body.
Transferred viral and bacterial infections.

Pathogenic microflora instantly starts the process of development of croupous pneumonia of the lungs. The path of development of the disease by an autoinfectious mechanism is possible. Caused by two reasons:

weakened body (hypothermia and overwork);
mass reproduction of pneumococci in the lower respiratory tract.

The pathogen enters the lungs, fibrin in the alveoli increases, the permeability of the walls of blood vessels increases, and fibrin deposits appear on the pleura. Croupous pneumonia spreads through the lymphatic vessels and interalveolar fissures.

Symptoms of croupous pneumonia

Features of the manifestation of lobar pneumonia - acute signs, it is difficult not to notice. But some symptoms appear before the onset of the disease:

Headaches of any kind.
Gastrointestinal disorders (constipation, diarrhea).

The progressive form of croupous pneumonia is characterized by the following symptoms:

pain . Sharp and stabbing pains in the side of the affected side. The intensity increases, and sometimes discomfort occurs in the shoulder and abdomen. After 2-3 days from infection with lobar pneumonia, the symptom disappears. In case of prolonged pain, pleural empyema should be ruled out.
Cough . At the beginning of the development of croupous pneumonia, the cough is dry, unproductive. A few days later, sputum of a thick consistency appears, at first white foamy, and then stained with blood.
shortness of breath . It is difficult for the patient to inhale, part of the affected lung is involved in the respiratory process incompletely. The number of breaths per minute is from 25 to 50.
Cyanosis . Due to a violation of gas exchange, the body does not receive the necessary oxygen. Cyanosis affects the nasolabial triangle, lips, fingers and toes.
Temperature changes . The body temperature rises, the skin becomes dry and hot, the extremities are cold.
Hyperemia . It is often a symptom of pneumonia.

Stages of croupous pneumonia

The clinic of lobar pneumonia depends on the type of pathogen, the area of the lesion, the stage of the disease and its complications. Pathological changes in the lungs go through 4 stages. The duration of all stages of lobar pneumonia is up to 11 days. The course of the disease in children occurs differently, stage 2 is skipped. During illness, the muscles of the heart, kidneys, and liver change, but after recovery, everything gradually returns to normal.

Stage 1

The disease begins with the stage of the tide, which differs:

violation of the work of blood vessels;
hyperemia;
swelling against the background of the inflammatory process of tissues affected by pathogenic microorganisms.

In the edematous fluid there is an abundant amount of causative agents of croupous pneumonia. Affected lobes are detected with . If you look at the lungs under a microscope, at stage 1, an expansion of capillaries, arteries and veins is detected due to their overflow with blood.

Alveolar cavities are filled with serous exudates with blood particles, alveolar epithelial cells. The process turns into inflammation of the serous or serous-hemorrhagic type. The duration of the stage is up to 3 days.

Stage 2

Red hepatization occurs from the second day of the progression of croupous pneumonia - diapedesis of erythrocytes increases, the exudate is enriched with proteins with fibrin precipitation. The lung tissue becomes dense; at stage 2, the fibrous effusion is saturated with erythrocytes and leukocytes.

The lungs are undernourished due to capillary constriction. Fibrin of a thick consistency fills the alveoli, interalveolar septa, a certain amount enters the small bronchi and bronchioles. Lymph nodes increase in size. The lungs are modified - brown staining occurs, significant compaction and visible granularity.

Stage 3

At this stage (4–6 days) of inflammation in the upper respiratory tract, gray hepatization develops, caused by the cessation of erythrocyte diapedesis and the accumulation of leukocytes in the exudate cavity. Red cells decrease in number, so hyperemia becomes less pronounced. Intermediate tissues of the lung-areas of capillaries and small veins are served by infiltration. The organ becomes even denser, gray inside with pronounced granularity. The stage lasts from 2 to 6 days.

Stage 4

The resolution process (after 9-11 days of infection) is characterized by the release of proteolytic enzymes, under the influence of which the fibrous exudate becomes thinner, begins to dissolve or cough up. The lung is cleansed - fibrin, pathogenic microflora, and exudate come out through sputum and lymphatic drainage. The organ becomes airy. The resolution stage lasts from 2 to 5 days, depending on individual reactivity.

Forms of croupous pneumonia

Forms of croupous pneumonia are distinguished by the size of the focus of inflammation:

. The inflammatory process occurs in one lobe of the lung. The right side is more often affected.
. The lesion covers both lobes of the lung.
. Some cases of the disease have non-standard manifestations.
Central. The inflammatory process develops in the deep tissues of the organs, it is not felt during palpation. An X-ray is required for detection.
abortive . Accompanied by acute symptoms in the first 3 days, then they subside.
massive . The process of lung inflammation spreads rapidly in healthy tissues.
Areactive . The initial form passes without acute symptoms, the course is slow, sluggish.
Wandering . Inflammation of the lungs moves from one area to another and continues for a long time.
appendicular . Acute symptoms with aching pains, as in appendicitis.
typhoid . The disease process is similar in the course of typhoid fever. Slow development with febrile attacks.
Meningeal . The disease develops on the basis of meningitis.

Methods for diagnosing croupous inflammation of the lungs

Croupous pneumonia is manifested by a wide variety of symptoms that cannot be overlooked. But due to the various forms of the course of the disease, which may be similar to other diseases, an accurate diagnosis is required.

Methods for diagnosing the disease include:

The most informative method for determining pneumonia. With it, the presence and area of \u200b\u200bdistribution of the inflammatory process is determined, starting from the first stage. Radiography is performed on patients of any age. The radiograph reveals the following signs:

convex borders of the affected lobe;
darkening of areas of the lungs;
pleural changes.

X-ray shows opacity of the lung

To clarify the diagnosis:

Analyzes. General and biochemical blood tests, bacteriological studies of urine and to exclude other types of pneumonia.

To diagnose croupous inflammation of the lungs, infection of focal confluent pneumonia, which is characterized by a variegation of auscultatory data, and a non-cyclic course, should be excluded. You can distinguish by herpetic eruptions on the lips, nose. proceeds with less pronounced symptoms, but periods of exacerbation can be acute.

Controversial diagnoses are confirmed by puncture. In some cases, additional tests are required:

gas composition of blood;
coagulogram;
ECG, CT, MRI;
spirography.

Methods of treatment of croupous pneumonia

Treatment of the disease is carried out under the constant supervision of a doctor, so the patient is hospitalized in the intensive care unit. Therapeutic measures depend on the expressed symptoms, stage, form, and features of the course of the disease. Therapy is prescribed only after a clarified diagnosis of lobar pneumonia. The most effective treatment includes a set of measures. Pneumonia is treated successfully with a quick diagnosis and strict adherence to the recommendations and prescriptions of the attending physician.

The essence of the method is the normalization of gas exchange using oxygen procedures.

Taking medication . Initially, antibiotic therapy is carried out, broad-spectrum antibiotics are prescribed, and after the diagnosis is clarified based on the results of sputum analysis, the drug is adjusted. Additionally, drugs are prescribed to eliminate symptoms:

mucolytics;
antiherpetic;
anti-inflammatory;
vascular;
soothing.

Physiotherapy. Treatment is carried out by physical influences (quartz, magnetic radiation, electrotherapy with heat).

What is dangerous croupous pneumonia

The disease causes many dangerous complications. Severe cases can be fatal. Consequences are of two types:

Pulmonary. Associated with the work of the respiratory tract.

Carnification (development of lung tissue into connective tissue).
Sepsis of the pulmonary membrane.
Suppuration of the lung.
Gangrene of the lung.
purulent and sweaty.
cirrhosis and abscess.
Effusion empyema of the pleura.

Extrapulmonary. The infection often extends beyond the lung, lobar pneumonia spreads throughout the body, affecting other internal organs.

Meningitis is serous and purulent.
Sepsis.
Shock infectious-toxic.
Kidney inflammation.
Joint problems.
Pericarditis.
Inflammatory process of the heart bag.
Liver failure.

Conditions are characterized by severe currents, require immediate treatment. Feeling worse, chills and fever appear. There is more sputum, it has a purulent and putrid odor.

Prevention

The main task of the prevention of lobar pneumonia is to eliminate the provoking factors of infection. It is important to strengthen the immune system through air or water hardening, a healthy diet and physical activity. It is necessary to observe the rules of personal hygiene, give up bad habits. Monitor the state of health, do not start the disease. During epidemics, take precautions. The disease poses a high risk to human health. In order to avoid serious consequences of the disease, you should immediately undergo an examination and begin treatment.

Editor

Daria Tyutyunnik

Doctor, forensic expert

Parents should be aware of the overt and hidden symptoms of pneumonia in order to recognize them in time in their child. A visit to the doctor is required at the first and slightest signs.

The current article is about lobar pneumonia, a type of pneumonia. Consider what it is, as well as the features of the symptoms and treatment.

What it is?

Croupous 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, croupous pneumonia occurs on one side of the lungs, and bilateral pneumonia is rare. The classic form covers one of the lobes of the lung, but this is extremely rare, usually only one or a few segments of the lobe are affected.

Right croupous pneumonia on x-ray

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

stages

Tidal stage. It 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 congestion in the lungs.

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

The stage of gray hepatization. Lasts from 2 to 6 days. The accumulation of fibrin and leukocytes continues, but erythrocytes begin to break down in the exudate. The affected areas become gray-green or gray-brown in color, but remain firm. The exudate becomes fibrinous-purulent.

Resolution stage. Extends over 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 croupous pneumonia in children can rarely be observed. The mixed morphological picture is more often shown.

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

Causes

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

In clinical practice, there are cases when a child has a place to be at the same time. In this case, the primary process is the virus, and then, with reduced immunity, pathogenic microflora joins.

Contributing factors to infection

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

Complaints of the child

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

Symptoms

Croupous pneumonia is characteristic acute onset. The body temperature rises sharply 39-40 degrees. Cough and other respiratory signs may not be present at first.

With croupous inflammation, there is an acute stabbing pain on the side of inflammation of varying intensity, radiating to the abdomen or shoulder. The pain usually goes through 2-3 days, otherwise it is an alarming signal for the development of pleural empyema.

From the very beginning of croupous pneumonia, auxiliary muscles of the chest are connected to the respiratory act of the child. When breathing, the wings of his nose swell, coughing causes pain, he groans, groans and groans, lies on his sore side.

Other symptoms include the following:

Arterial 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 ( 25 to 50 times per minute), superficial with shortness of breath, difficulty in inhaling and with a visual lag of the affected half of the chest.
The skin of the body is dry and hot, while the skin of the hands and feet becomes cold with a bluish tinge. There is also cyanosis of the lips and a blush on the cheek from the side of inflammation.
There are signs of intoxication.
Quite often, you can observe herpetic eruptions in the face and neck.
The stomach is often swollen.
The liver is enlarged.

Reference. Breathing rate 60 and over breaths per minute in babies up to a year is considered rapid. With pneumonia, children aged over 1.5 years old breathe in and out about 50 times in 60 seconds, at the norm up to 30 times.

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

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

Treatment

In the treatment of croupous pneumonia in children, they are used. 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. In severe pneumonia, aminoglycosides or a combination of different groups of drugs may be prescribed.

Often starting antibiotic therapy is prescribed empirically, until information about the causative agent of the disease is obtained. Antibiotics are prescribed for children with severe intoxication and a high temperature that lasts more than 3 days.

Properly selected initial therapy gives an effect within first two days treatment: temperature goes down, pneumonic symptoms do not increase, health improves.

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

In addition to antibiotic therapy, pediatricians prescribe bronchodilators, expectorants and anti-allergic drugs, as well as vitamins.

In severe cases, carry out post-syndrome therapy aimed at maintaining the respiratory function, the work of the heart and blood vessels, an adequate response from the nervous system of the child.

Additional methods of treatment are connected in the recovery stage. The doctor may prescribe physiotherapy and reflexology, and herbal remedies.

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

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

Conclusion

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

Croupous pneumonia is an acute infectious disease in which one or more lobes of the lung is affected, fibrinous effusion appears in the alveoli, and fibrinous overlays appear on the pleura. Croupous pneumonia mainly affects adults. The disease is characterized by a pronounced clinical picture and symptoms of intoxication. Patients with lobar pneumonia are hospitalized in the therapy clinic.

To examine patients at the Yusupov Hospital, doctors use modern equipment from leading European, American and Japanese companies. Pulmonologists use European treatment protocols, individually approach the choice of the method of therapy for each patient. Drugs are administered through the digestive tract, intramuscularly, intravenously and by inhalation. Thanks to complex treatment, the length of stay of patients in the hospital is reduced.

Causes and stages of croupous pneumonia

The causative agent of croupous inflammation of the lungs are pneumococci types I-IV. Sometimes croupous pneumonia is caused by Friedlander's diplobacillus. In the majority, acute pneumonia begins in full health and in the absence of contact with patients with pneumonia. This suggests that the development of croupous pneumonia occurs under the influence of microorganisms in the upper respiratory tract. An important factor provoking the development of pneumonia is a decrease in immunity.

There are 4 stages of development of croupous pneumonia. The stage of the tide is characterized by severe hyperemia of the lung tissue, congestion in the capillaries. Its duration is from 12 hours to 3 days. In the stage of red hepatization, blood cells come out through the walls of capillaries and small veins due to a violation of their tone and permeability, effusion appears in the alveoli. The exudate is rich in fibrin, which coagulates and prevents air from entering the alveoli. The lungs become dense, similar to the liver. The duration of the second stage is from 1 to 3 days.

In the stage of gray hepatization, the exit of erythrocytes through the vascular wall stops. The effusion, in addition to fibrin, contains alveolar epithelium and leukocytes. Due to the abundant content of leukocytes, the affected lung has a characteristic gray-greenish tint. The duration of this stage varies from 2 to 6 days. In the resolution stage, fibrin dissolves and liquefies under the influence of proteolytic enzymes. This stage is the longest.

If the treatment is prescribed in a timely manner and it is effective, the pathological process may lose its characteristic cyclicity and break off at the early stages of development. In violation of the resorption of exudate, complications of croupous pneumonia develop. There may be an overgrowth of connective tissue in the lesion - carnification and cirrhosis of the lung. Sometimes purulent fusion occurs, and pneumonia is complicated by an abscess or gangrene of the lung.

With croupous pneumonia, there are phenomena of dry pleurisy with fibrinous layers and the development of adhesions. In the case of lymphogenous generalization by microorganisms, purulent mediastinitis and pericarditis occur. With the hematogenous pathway of spread of bacteria, metastatic abscesses appear in the brain, purulent meningitis, peritonitis, acute ulcerative or polyposis-ulcerative endocarditis, and purulent arthritis develop.

Symptoms of croupous inflammation of the lungs

Croupous pneumonia has an acute onset. In patients among full health, the body temperature rises to 39 ° C, chills, chest pain appear. In the initial stage of the disease, the cough is dry, then it becomes productive, with the release of "rusty" sputum. Severe shortness of breath is noted, the chest on the side of the lesion lags behind when breathing.

In the initial phase of inflammation during percussion, a dull-tympanic sound is determined above the lesion. During auscultation, hard breathing with an extended exhalation, mild crepitus, and wet and dry rales are heard in a limited area. In the compaction phase with croupous inflammation of the lungs, the following symptoms appear:

a sharp increase in voice trembling, bronchophony during palpation of the chest;
with percussion - a dull sound;
vesicular breathing is not audible, crepitus disappears, pleural friction rub is often heard.

In the resolution phase, voice trembling gradually normalizes, bronchophony disappears, and profuse, sonorous, long-lasting crepitus appears. Sonorous fine bubbling rales are heard, bronchial breathing is gradually replaced by hard, and then vesicular.

In the study of the cardiovascular system, a frequent pulse is determined. In the case of a severe course of croupous pneumonia, it is of weak filling, arrhythmic, arterial pressure is reduced, heart sounds are muffled.

Diagnosis of croupous pneumonia

The pulmonologists of the Yusupov hospital draw up an individual examination plan for a patient with lobar pneumonia, which includes:

sampling blood, urine, sputum;
biochemical analysis of blood (total protein, electrophoresis of blood serum proteins, bilirubin, fibrinogen);
bacteriological culture of sputum for the sensitivity of the flora to antibiotics;
Electrocardiography.

The leading method for diagnosing croupous pneumonia is an X-ray examination of the chest. X-ray of the lungs is performed in two projections. The stage of the tide is characterized by an increase and enrichment of the pulmonary pattern due to hyperemia. Transparency is normal or slightly reduced. The root of the lung on the side of the lesion is somewhat expanded, its shadow is uniform. When the process is localized in the lower lobe, a decrease in excursions of the corresponding dome of the diaphragm is recorded.

In the hepatization stage, radiologists determine an intense decrease in the transparency of the lung tissue, corresponding to the affected area. The size of the affected area of the lungs is normal or slightly enlarged. There is some increase in the intensity of the shadow to the periphery. In the medial parts of the darkening, "stripes of enlightenment" are visible. The root of the lung on the side of the lesion is expanded, its shadow is uniform. The adjacent pleura is compacted.

The resolution stage is characterized by a decrease in the intensity of the shadow of the affected area. The shadow is fragmented, it decreases in size, the lung root is expanded.

Patients with croupous inflammation of the lungs undergo a study of the function of external respiration, according to indications, a pleural puncture is performed. Multislice computed tomography is performed in the following situations:

in the presence of obvious clinical signs of pneumonia and no changes on the radiograph;
if during examination of a patient with suspected croupous inflammation of the lungs, atypical changes are detected (obstructive atelectasis, abscess or pulmonary infarction);
recurrent pneumonia, in which infiltrative changes occur in the same lobe (segment);
prolonged inflammation of the lungs - pneumonia, in which infiltrative changes in the lung tissue are not resolved within 4 weeks.

In the absence of a productive cough, doctors at the Yusupov Hospital perform fiberoptic bronchoscopy, transtracheal aspiration, and transthoracic biopsy. If the patient has a pleural effusion and there are conditions for a safe pleural puncture, a study of the pleural fluid is performed.

Treatment of croupous pneumonia

Patients with lobar pneumonia are hospitalized in the therapy clinic. The rooms have a central ventilation system. Each room is equipped with air conditioning to ensure a comfortable temperature. In severe cases of pneumonia, patients are treated in the intensive care unit, which is equipped with modern heart monitors that allow you to continuously monitor the work of the respiratory and cardiovascular systems, and determine the oxygen content in the blood. If necessary, patients are artificially ventilated with the help of stationary and portable ventilators.

With lobar pneumonia, 2 antibiotics are simultaneously prescribed (benzylpenicillin, ampicillin, amoxicillin clavulanate, cefuroxime, cefotaxime, ceftriaxone). One antibiotic is administered intravenously, the second - intramuscularly. The doctors of the Yusupov hospital carry out a complex treatment of croupous pneumonia, including:

immunoreplacement therapy (intravenous administration of fresh frozen or native plasma, immunoglobulin).
correction of microcirculatory disorders (heparin, reopoliglyukin);
correction of dysproteinemia (albumin, retabolil);
detoxification therapy (saline solutions, 5% glucose solution);
oxygen therapy (oxygen is given through a mask or catheters);
corticosteroid therapy (prednisone, other glucocorticoids).

With severe intoxication, patients with lobar pneumonia are treated by doctors at the Yusupov hospital with plasmapheresis. Antioxidant therapy consists of ingestion of ascorbic acid and rutin. Eufillin, atrovent, berodual have a bronchodilator effect. Expectorant drugs (lazolvan, acetylcysteine) improve the drainage function of the bronchi. Expectorants and bronchodilators in intensive care are administered through a nebulizer.

Physiotherapeutic methods of treatment of croupous pneumonia

For the treatment of patients with croupous inflammation of the lungs, pulmonologists at the Yusupov Hospital widely use physiotherapy procedures. Ultrasonic aerosol inhalation is used to introduce mucolytic antibiotics, heparin into the respiratory tract. Decimeter wave treatment is used almost immediately after the fever has passed.

Impulsive UHF therapy is performed for patients with reduced immunity. Antibacterial drugs are injected into the respiratory system using magnetophoresis. Improves the drainage function of the bronchi massage, physiotherapy exercises and breathing exercises.

If you suspect lobar pneumonia, call the Yusupov hospital, where patients are hospitalized around the clock, 7 days a week. Doctors, without waiting for the results of a bacterial sputum examination, begin antibiotic therapy. Pulmonologists use individual schemes for the treatment of pneumonia with effective, safe drugs.

Bibliography

ICD-10 (International Classification of Diseases)
Yusupov hospital
"Diseases of the Respiratory Organs". Guide ed. acad. RAMN, prof. N.R. Paleeva. M., Medicine, 2000
Respiratory failure and chronic obstructive pulmonary disease. Ed. V.A. Ignatieva and A.N. Kokosova, 2006, 248s.
Ilkovich M.M. etc. Diagnosis of diseases and conditions complicated by the development of spontaneous pneumothorax, 2004.

Prices for the diagnosis of pneumonia

*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, determined by the provisions of Art. 437 of the Civil Code of the Russian Federation. For exact information, please contact the clinic staff or visit our clinic. The list of paid services provided is indicated in the price list of the Yusupov hospital.

Croupous pneumonia is a lesion of the lung tissue and alveoli of an infectious nature. With this pathology, one or more lobes of the lung are compacted, there is a fibrous effusion in the alveoli (accumulation of fluid - exudate), and fibrous overlays form on the pleura. It is more common in adults, less common lobar pneumonia in children. Accompanied by very severe symptoms and requires immediate treatment.

The etiology of lobar pneumonia spreading to one or more lobes is well known. The disease occurs as a result of the activity of pathogenic microflora. The causative agents of lobar pneumonia are pneumococci, streptococci, staphylococci, Klebsiella.

In most cases, the infection is transmitted by airborne droplets. Together with small dust particles, microorganisms enter the human body. Hematogenous and lymphogenous routes of transmission are also possible. Inflammation begins in the lungs.

Primary damage occurs in the endothelium, mucociliary clearance of cells is disturbed. The activity of macrophages and interferon is inhibited. The immune defense is reduced, so the body cannot fight the infection. Gradually developing pathology

Frequent hypothermia is one of the risk factors

Risk factors

If a favorable environment is observed in the human body, the microorganisms that have entered it will begin to multiply rapidly, which will lead to the defeat of one or more lobes of the lung. Risk factors include:

Frequent hypothermia. This leads to a decrease in immunity, so the body cannot fight the infection that has penetrated into it.
Intoxication. Due to poisoning, the body is weakened, so it is susceptible to infectious lesions.
Avitaminosis and hypovitaminosis. In both cases, the metabolism is disturbed, the work of all systems and organs worsens.
Chest injury. As a result, the integrity of the lung tissue may be impaired.
Overwork and frequent stress.
Associated lung diseases. Chronic and acute pathologies have the same negative effect.

In the presence of the above factors, you need to be careful about your health. If discomfort appears in the lungs, it is necessary to undergo an examination so as not to start the development of the pathological process.

Stages of pathology

There are three stages of croupous pneumonia. They differ in severity and accompanying symptoms.

high tide

There is a very abrupt and sudden onset. It can last from several hours to 3-4 days. A person notes severe headaches, fever to average levels, painful breathing, coughing. There may be a lagging of one half of the chest in breathing, where the focus is located. Crepitus is heard.

Red hepatization stage

An effusion forms in the alveoli, the lungs thicken, and their structure becomes similar to the liver. Dry cough gives way to rusty sputum, which is a characteristic sign of croupous pneumonia. On percussion, tympanitis is heard.

Gray hepatization stage

The general condition worsens, psychosis occurs. Purulent sputum appears when coughing. Bronchial breathing is heard. On percussion, a dull sound is heard.

Resolution stage

The temperature drops, a productive cough with copious sputum appears. On percussion, tympanitis is heard, crepitus returns.

Clinical manifestations

The symptoms of croupous pneumonia are as follows:

general weakness;
symptoms of intoxication;
loss of appetite;
intestinal disorders leading to constipation or diarrhea;
severe pain in the lung area (usually it hurts only on one side);
cough with a lot of rust-colored sputum;
cyanosis of the skin, it becomes very hot.

They also depend on the severity of the disease. With a mild degree, the temperature rises to 38 degrees, the heartbeat is up to ninety beats per minute, blood pressure is not lower than normal. Shortness of breath occurs on exertion. The affected area is small.

With moderate severity, the manifestations of the disease are more pronounced. The temperature is up to 39 degrees, the heartbeat is up to one hundred beats per minute, the blood pressure is moderately reduced. Shortness of breath occurs at rest. There is a massive infiltration of the lungs.

A very severe degree is accompanied by a temperature of up to 40 degrees, the heartbeat is above a hundred beats per minute, blood pressure is sharply lowered. There is cyanosis and extensive infiltration of the lungs.

If you experience any of the above symptoms, you should immediately consult a doctor.

Features of pathology in childhood

The causes of lobar pneumonia in children are the same as in adults. The disease develops as a result of the activity of pathogenic microorganisms. A child can pick up an infection from adults or children. Therefore, if someone in the family is sick, it is better to protect the baby from him. If cases of lobar pneumonia have been recorded in the kindergarten, you should refuse to visit it for some time.

Characteristic of croupous pneumonia in babies is the occurrence of herpes on the lips, wings of the nose, neck and ears. In particular, it is expressed at the initial stage of the disease. At the site of the lesion, the skin becomes swollen, red, itchy and sore.

If there is croupous pneumonia in an infant, he may become moody, constantly crying. This condition is similar to when a baby is teething.

X-ray examination is the main method for diagnosing lobar pneumonia

Diagnostics

The disease is difficult to diagnose. It is necessary to carry out differential diagnostics from focal pneumonia, pulmonary infarction and some other diseases. An x-ray examination is mandatory, which is the most effective.

The doctor must listen to the patient's complaints. Symptoms of other lung pathologies may vary. With focal pneumonia, there is no acute onset, the temperature does not rise, there is no rusty sputum. A dull lung sound is heard on auscultation.

With tuberculous caseous pneumonia, the upper lobe of the lung is most often affected. On the X-ray, foci are clearly visible, and in the sputum there are Mycobacterium tuberculosis.

Pulmonary infarction is accompanied by hemoptysis, chills and general malaise may be absent. The x-ray shows a wedge-shaped shadow that appears and disappears.

Treatment

Treatment of croupous pneumonia of the lung is necessarily carried out in a hospital. The patient must comply with bed rest during the entire period of illness. He needs to regularly change the position of the body, which contributes to a better discharge of sputum. The disease can be treated with the help of medications, oxygen therapy and UHF therapy.

Medical

Drug therapy combines the use of broad-spectrum antibacterial drugs. The causative agent must be sensitive to the antibiotic used. Benzylpenicillin is prescribed first. If within 2 days of its use there is no effect, it may be necessary to replace the drug. Pneumococci are sensitive to Ampicillin, Lincomycin, Erythromycin.

If the disease is severe, the doctor may prescribe 2-3 drugs at the same time. The daily dose of each should be high enough. Cancellation of their reception is possible only if all signs of the disease disappear.

It also requires the appointment of non-steroidal anti-inflammatory and mucolytic drugs in combination with bronchodilators. If there is a pronounced intoxication of the body, Hemodez is administered intravenously daily by means of a dropper. If the patient complains of severe pain, Analgin is required to relieve discomfort.

oxygen therapy

This is a procedure in which oxygen is used for therapeutic purposes. With croupous pneumonia, the breathing process is disturbed. Therefore, not enough oxygen enters the body. As a result, the blood is poorly saturated with it, which can lead to cell death.

With the help of oxygen therapy, you can quickly saturate the arterial blood with oxygen to normal. The indication for its implementation is hypoxemia. It is required to carry out the procedure in a streaming way. Beforehand, the specialist must make sure that the patient's airways are cleared of mucus and vomit. Otherwise, the permeability of oxygen will be impaired.

After the procedure, the patient's well-being improves. Shortness of breath gradually disappears, breathing is restored, becomes deeper.

This is the heating of tissues by an electromagnetic field with a very high frequency. During the procedure, pulsed or continuous current can be used. UHF helps well with acute croupous pneumonia. However, it is impossible to carry out the procedure at a high temperature - it should drop to normal levels.

This method eliminates inflammation and speeds up the healing process. Puffiness of tissues decreases, local blood flow increases, sputum secretion decreases. Pathogenic microorganisms stop multiplying, they become less active. The course of treatment is approximately 10-12 procedures, each of which lasts up to 15 minutes.

The role of nutrition and adherence in treatment

With croupous pneumonia, you need to eat right. This will help the body recover faster and cope with the disease.

Calcium-rich foods are very useful - milk, cottage cheese, any kind of cheese. The amount of easily digestible carbohydrates is recommended to be reduced.

If a high temperature is observed in the first days of the disease, it is advisable to give preference to liquid food - vegetable and fruit juices, fruit drinks, jelly. Also useful are fresh fruits and berries, especially citrus fruits, currants, plums. It is important to drink plenty of fluids - at least 2 liters per day.

Particular attention should be paid to foods containing vitamin A. It has a positive effect on the epithelium of the respiratory tract. Vitamin A is found in dairy products, eggs, liver.

Antibacterial drugs used for pneumonia disrupt the gastric microflora. Therefore, in order to restore it, foods containing B vitamins should be included in the diet. These include boiled meat, fish, white bread, buckwheat porridge.

When croupous pneumonia occurs in children, appetite stimulation may be necessary. Babies often refuse to eat with such a disease. In this case, you can give the child sauerkraut, salted cucumbers, acidified meat broth. These foods are great for boosting your appetite.

Complications

Complications of lobar pneumonia are divided into pulmonary and extrapulmonary. The former include: empyema, abscess, acute respiratory failure. Extrapulmonary manifest as myocarditis, nephritis, sepsis, pericarditis. All these conditions are quite dangerous, so they should not be allowed to occur. Treatment of pneumonia should begin when the first pathological signs occur.

Prevention

Prevention of the disease includes strengthening the body, hardening it, quitting smoking. You need to lead an active lifestyle, if possible go in for sports, run in the morning. After 65 years of age, mandatory vaccination with pneumococcal vaccine.

To prevent lobar pneumonia in children, it is necessary to strengthen children's immunity. With the baby you need to walk more, monitor his nutrition, include fresh vegetables and fruits in the diet. It is also necessary to exclude hypothermia of the child's body. The child needs to ensure proper sleep and rest for at least 8 hours a day. If the baby gets sick, it is necessary to carry out timely therapy.

Thus, this is a rather dangerous pathology that can lead to a variety of complications. Croupous pneumonia is especially difficult in children, whose immunity is still quite weak. Therefore, it is necessary to treat it in time, and for its prevention it is recommended to carry out special preventive measures.