Croupous pneumonia treatment and symptoms. fibrinous inflammation

Represents acute inflammation one or more lobes of the lung. Due to the fact that the pleura (the serous membrane of the lung) is often affected, croupous pneumonia is also called pleuropneumonia.
Men are more commonly affected young age perfectly healthy before the disease.

pathogens- most often they are bacteria, namely pneumococcus (Streptococcus Pneumoniae) I, II, III-th types.

How does pneumococcus damage the lungs?

Like any other pneumonia, pleuropneumonia is transmitted by airborne droplets. The causative agent penetrates into the alveoli of the lung by the bronchogenic route and leads to the development of inflammatory response. Exudate is formed at the site of inflammation (fluid, rich in proteins and blood cells- lymphocytes, leukocyte, monocytes), leaking from small blood vessels. Are being created favorable conditions for the growth and reproduction of microorganisms. The exudate spreads through the interalveolar pores and covers the whole lobe of the lung.

In development pathological process distinguish 4 stages:


  • Stage I - characterized by reddening of the lung tissue, impaired capillary patency and an increase in inflammatory edema. In the edematous fluid is determined a large number of microorganisms. The duration of this stage is from 2 to 3 days.
  • Stage II - due to leakage of blood elements (erythrocytes) and plasma proteins into the alveoli and small bronchi, the affected area becomes airless, dense, red. The stage lasts 1-3 days.

  • Stage III - the alveoli are filled with a large number of neutrophils (a kind of leukocytes), acquires a grayish-yellow color. Lasts up to 2 - 6 days.
    • run out
  • Stage IV - gradual dissolution of the protein. With complete resorption of the exudate, the lung becomes soft, but its elasticity is not fully restored. The duration of the stage depends on the prevalence of the process, the therapy, the characteristics of the reactivity of the organism, the aggression of the pathogen, and other reasons.

    • What is lobar pneumonia characterized by?



    • The onset of the disease is sudden, often accompanied by chills, headache.

    • Main complaints:
      - Pain in the chest, which is aggravated by deep breathing and coughing.
      - cough at first dry, then with discharge rusty sputum(after 2-3 days from the onset of the disease).
      - shortness of breath associated with the exclusion of an entire lobe of the lung from the act of breathing.
      - increase in body temperature up to 39 - 400 C.
    • General state:
      - the patient is agitated, sometimes inhibited, delirium is possible, sometimes there is a picture of acute psychosis, especially in persons suffering from alcoholism.


      - the patient takes a forced position - on the sore side. The face is pale, feverish blush on the side of the lesion.

    • Herpetic eruptions at the wings of the nose and at the corners of the mouth, swelling of the wings of the nose when breathing.

    • Breathing fast

      • Changes from other organs


      • The cardiovascular system:
        - cardiopalmus
        - lowering blood pressure, etc.

      • Digestive system:
        - At the beginning of the disease, nausea, vomiting, lack of appetite, and stool retention may disturb
        - Tongue dry and furred, abdomen swollen from flatulence
        - In severe cases, yellowness of the sclera and skin appears, the liver enlarges, becomes painful.

      • Nervous system:
        - changes are observed in all patients and depend on the severity of the course of the disease
        - with a mild course, they are manifested by headache and insomnia
        - in severe cases, agitation, delirium, symptoms of acute psychosis appear
        - sometimes rigidity develops neck muscles- strong and long-term reduction, hypersensitivity skin, clouding of consciousness, severe headache.

The content of the article

This is an acute infectious-allergic disease characterized by an inflammatory lesion of the lung tissue with accumulation of fibrin-rich exudate in the alveoli and a typical cyclic course of both pathomorphological and clinical manifestations.
In recent years, croupous pneumonia in children is less common. Perhaps this is due to the fact that during wide application 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 croupous pneumonia

Pathogen - different types pneumococcus. Morphologically, they are similar to each other, but differ in the degree of virulence and some biological properties. Most often, pneumococcus IV is found. Along with pneumococcus in croupous pneumonia in children, streptococcus is isolated, pathogenic staphylococcus, Friedlander's stick, etc. It is impossible to exclude a combination of microbial and viral infection.

lobar pneumonia pathogenesis

Croupous 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 organism due to changes in the conditions of nutrition and life;
2) the influence of the 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 when chronic diseases;
5) functional disorders central nervous system;
6) the massiveness of the infection. An autoinfectious mechanism of the development of the disease cannot be ruled out: with a sharp cooling or overwork, increased reproduction of pneumococci and their penetration into the lower respiratory tract is possible.
It is most likely that the pathogen penetrates the lungs aerobronchogenically, spreads through the lymphatic tracts and interalveolar fissures. The process in the lung becomes an expression of a hyperergic reaction of an organism sensitized to pneumococcus or another pathogen. An acute inflammatory edema develops in the lung, quickly capturing a whole lobe or a significant part of it.

Pathomorphology of croupous pneumonia

With croupous pneumonia, 4 successive stages of patho are distinguished. morphological changes in the lungs.
The first stage - the stage of the tide - is characterized by significant vascular disorders, hyperemia and inflammatory edema in the affected area of ​​\u200b\u200bthe lung tissue. Microscopic examination of the lungs reveals the expansion and overflow of capillaries, small arteries and veins with blood. The cavities of the alveoli are filled with serous exudate mixed with blood and alveolar epithelial cells. Serous or serous-hemorrhagic inflammation develops. The first stage lasts 1 - 3 days.
In the future, there is an increase in diapedesis of erythrocytes and an enrichment of the exudate with proteins with fibrin precipitation - the second stage develops - the stage of red hepatization, which also lasts 1-3 days. The lung is compacted due to fibrinous effusion, rich in erythrocytes and neutrophilic leukocytes. The capillaries are compressed, the nutrition of the lung tissue is sharply disturbed. The alveoli are filled with a dense mass of fibrin, which also penetrates into the interalveolar septa. Fibrin is found in bronchioles and small bronchi, as well as on the pleura. The lung at the same time becomes airless, dense, like a liver. On a section - brown color, granularity is expressed.
The third stage - the stage of gray hepatization - lasting 2-6 days, is characterized by the termination of diapedesis of erythrocytes and the accumulation of leukocytes in the exudate. There is an infiltration of leukocytes in the intermediate tissue of the lungs around the capillaries and small veins. The lung on the cut is dense, airless, gray color, granularity 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 is coughed up. lung tissue becomes airy. The duration of the resolution period depends on the individual reactivity of the organism and can last 2-5 days. In children, the resolution phase often follows the flushing and erythrocyte infiltration stages. In croupous pneumonia, there are degenerative changes muscles of the heart, liver, kidneys, which are restored by the recovery period.

Clinic of croupous 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 of adults in children are very rare, even a cough in the early days may be absent. There is pallor, vomiting, bloating and pain in the abdomen, especially in the right iliac region, which resembles a picture acute appendicitis. But unlike the latter, with croupous pneumonia, rapid breathing is noted, some lag in breathing of the affected side of the chest, relatively free excursions of the abdomen and the absence of rigidity of its wall. If you divert the attention of the child, it is possible to produce a deep palpation of the abdomen.
In the second variant of the development of croupous pneumonia, a severe headache, vomiting, stiff neck, and sometimes convulsions appear in addition to a suddenly elevated body temperature. This brings up the idea of ​​meningitis. However, rapid breathing, lag in breathing of the affected half of the chest, as well as the weakening of meningeal phenomena over time and the appearance of typical symptoms of pneumonia give reason to exclude meningitis.
A more typical course of pneumonia is observed in school-age children. The disease begins with high body temperature, chills, chest pain, cough. Breathing shallow, frequent (30 - 40 per 1 min), shiny eyes, blush on the cheek of the affected half. Herpes on 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. In the future, breathing is accompanied by a groan, groan. The cough becomes painful. There is a delay in breathing of the affected half of the chest. The patient in bed takes a forced position (on the sore side).
Objectively, at the beginning of the disease, it is possible to determine the increase in voice trembling on the affected side. Percussion is determined by dullness of sound with a slight tympanic tinge, due to the accumulation of a small amount of exudate in the alveoli and a decrease in the tension of the elasticity of the lung tissue. When listening, breathing is weakened (swelling of the walls of the alveoli and a decrease in their elasticity). Usually, a gentle initial crepitus (crepitatio indux) is heard within a short time, due to the sticking of the walls of the alveoli when exudate penetrates into them. Due to the incipient 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 the dysfunction of a number of organs and systems. The body temperature is kept at high numbers, taking on a constant character, although sometimes it can have an intermittent or remitting character. There comes a period of the peak of the disease, corresponding to the pathological-anatomical stage of hepatization. Shortness of breath increases, the patient takes a forced half-sitting position in bed. There is puffiness and cyanosis of the face, lips, extremities. The tongue and lips become dry. The pain in the chest eventually stops. Coughing up viscous glassy sputum with an admixture of blood ("rusty"), more often in schoolchildren and rarely in children preschool age. A pleural friction rub (fibrinous layers) is often auscultated.
Unsharp expansion of the boundaries of cardiac dullness is determined, more often to the right. Auscultated muffled heart sounds, accent II tone over the pulmonary trunk. The pulse is frequent (120 - 140 per 1 min), weak filling. Arterial pressure goes down. Sometimes collapse and other manifestations of circulatory failure occur. ECG changes are detected - a decrease in voltage, an increase in the height of the P and T waves, a shift and shortening of the S-T interval. The abdomen is somewhat swollen, the liver is often enlarged as a result of toxic damage to hepatocytes and protrudes 2-3 cm from under the costal margin, soft, sensitive to palpation. Dyspeptic symptoms are often observed (belching, nausea, vomiting, loss of appetite, etc.). Tongue dry, often furred.
In the study of blood - leukocytosis (10 - 20 g / l, or 10 - 20 per 10v9 in 1 l) with a shift of the formula to the left. In neutrophils, toxic granularity appears, ESR is increased. An increase in the amount of globulins, fibrinogen and prothrombin is characteristic. Blood clotting is often increased. Water-electrolyte, carbohydrate, protein, fat metabolism is disturbed, oxidative processes are reduced. At the height of the disease, a decrease in diuresis, an increase relative density urine, reduced excretion of chlorides and the presence of protein in a small amount. The content of vitamins (ascorbic acid, thiamine, riboflavin) in the blood is reduced. There is a violation of the gas composition of the blood (decrease in pa02, increased arterialization of venous blood).
On the 5th - 9th day of the disease, and with successful treatment and earlier, the body temperature drops (more often critically), and recovery occurs. This period in children proceeds with a rapid improvement in the general condition and the disappearance of changes in the lung. The cough becomes wet, the sputum is less viscous and easily separated. The wheezing stops. Breathing is back to normal. Herpetic vesicles dry up and become covered with crusts. During physical examination, it is almost always possible to hear an abundance of crepitant wheezing (crepitatio redux) as a result of sputum thinning. The rales are more sonorous than with initial crepitus.
Radiologically, mainly on the one hand, a typical uniform darkening of the entire lobe of the lung or part of it is determined. In the first 1-2 days of the disease, infiltration of the lung root is expressed, which eventually spreads and turns into a uniform shadow.
There are atypical forms of croupous pneumonia.
1. Central - the inflammatory focus is located in the deep sections of the lung, and the data of the physical examination are indistinct. Only X-ray examination allows to clarify the diagnosis.
2. Abortive form - the onset of the disease is acute, violent, duration - 2 - 3 days. This form has recently been found most often, which is apparently due to a significant decrease in the etiological role of pneumococcus.
3. Massive pneumonia - inflammatory process spreads rapidly to other lobes of the lung. This form resembles exudative pleurisy, but the 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 mild, signs of inflammation develop gradually. Subfebrile body temperature, general malaise, sluggish course. Data objective research meager.
5. Migratory, or wandering, pneumonia - is characterized by the transition per continuitatem of the inflammatory process to neighboring areas. This form is characterized by a longer course.6. Appendicular shape - simulates clinical picture appendicitis and occurs more often when the process is localized in lower lobes. In spite of sharp pain in the abdomen, localized in the ileocecal region, the patient allows deep palpation of the abdomen, if at the same time it is possible to divert his attention.
7. Typhoid-like form - resembles typhoid fever. The onset is gradual, with a prolonged febrile period and a lytic decrease in body temperature.
8. Meningeal form - differs in that from the first hours of the disease, pronounced brain symptoms (headache, convulsions, drowsiness, vomiting) are determined. In addition, the presence of meningeal symptoms (stiff neck, persistent red demographism, Kernig's symptom) is characteristic. Such patients are spinal tap in both diagnostic and medicinal purposes. The cerebrospinal fluid is clear and flows out high blood pressure. Cytosis and protein are normal. Brain symptoms develop due to cerebral edema and impaired cerebral circulation as a result of vascular disorders.

Complications of croupous pneumonia

At modern methods treatment complications - abscess, gangrene of the lung - are very rare. In the event of a complication, the general condition worsens, chills appear, the body temperature rises even more. Significantly increases the amount of sputum, which acquires a purulent or putrefactive character. In the presence of a cavity located close to chest wall, sonorous and even sonorous moist rales are heard. The occurrence of suppurative processes in the lung is facilitated by atelectasis of the lung, due to blockage of the bronchi by mucous plugs. On x-ray, in the presence of an abscess, a cavity with a horizontal level of fluid is visible.
Almost always croupous pneumonia is accompanied by dry pleurisy with fibrinous layers. At the end of the disease, serous-fibrous or purulent pleurisy may join. This determines the weakening of voice trembling, dullness and weakening of breathing, more intense in the lower sections. The diagnosis is clarified radiographically and with the help of 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.

lobar pneumonia diagnosis

Recognition lobar inflammation lung in typical cases is not difficult. Diagnosis is based on characteristic symptoms(acute onset, sudden increase in body temperature, chest pain, cough with sputum, often "rusty", herpetic eruptions 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 auscultatory data; blood test results (neutrophilic leukocytosis, granularity of neutrophils); data x-ray examination(darkening of the entire lung lobe or most of it). It should be remembered about the originality of the clinical picture of atypical forms of croupous pneumonia.

Differential diagnosis of croupous pneumonia

When establishing the diagnosis of croupous pneumonia, it is necessary to exclude focal confluent pneumonia, which is characterized by the diversity of auscultatory data and the absence of a cyclical course. Segmental pneumonia is excluded on the basis of the presence of herpetic eruptions on the lips and nose in patients with croupous pneumonia, the cyclic course of the disease and X-ray data.
Exudative pleurisy, in contrast to croupous pneumonia, is characterized by localization of dullness over lower divisions chest and its characteristic outline upper bound. In the area of ​​dullness with pleurisy, breathing is sharply weakened or not heard at all, voice jitter and bronchophony are not defined. In unclear cases, the diagnosis is established by 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 croupous, develops gradually, without a cyclic course, herpetic rash on the lips and flushing of the face. 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.).
Croupous pneumonia must be differentiated from the primary complex in the infiltration stage, which, unlike lobar pneumonia, is characterized by persistence of x-ray changes, positive tuberculin tests, and paucity of auscultatory data when significant x-ray changes are detected.
The prognosis is favorable.

Acute croupous pneumonia is a lung disease accompanied by a massive bilateral inflammatory lesion of the lung tissue with a pronounced intoxication syndrome and secondary changes in the internal organs.

Without timely combined treatment, pathology quickly leads to the death of a person due to respiratory, cardiovascular insufficiency and cerebral hypoxia.

The pathogenesis of the croupous form

Lobar pneumonia is most commonly caused by a bacterium called Frindler's wand. Nonetheless, bilateral pneumonia can be called and typical pathogens(staphylococcus, streptococcus, pneumococcus) against the background of reduced immunity.

An inflammatory process occurs in this pathology is not localized, but simultaneously in several areas of one or both lungs. In this case, the infiltrate not only accumulates in the alveoli, but also bronchial edema occurs due to immediate-type hypersensitivity reactions (IHT). They appear due to the similarity of pathogen antigens with some bronchial proteins.

Thus, the pathogenesis of croupous inflammation of the lungs is due to the direct reproduction of Frindler's bacillus in the wall of the alveoli and the occurrence of allergic reactions in respiratory tract.

It should be understood that the main causative agent of croupous pneumonia is highly toxic due to its ability to rapidly destroy tissues. Because of this, the disease progresses rapidly.

The disease is also characterized by a specific x-ray picture, accompanied by the presence of many small shadows in both lungs, which are inflammatory infiltrates.

Symptoms of lobar pneumonia can be classified into 2 categories:

  1. bronchopulmonary;
  2. Intoxication.

Bronchopulmonary symptoms with bilateral pneumonia:

  • Cough;
  • "Rusty" sputum;
  • Increased respiratory rate (tachypnea) and shortness of breath;
  • Pain in the chest.

Cough on the background bilateral inflammation lung is due to irritation of the receptors of the upper laryngeal and vagus nerves. They are localized in the larynx, pharynx, large bronchi and pleura.

It should be understood that the accumulation of sputum in the small bronchi does not lead to the appearance of cough shocks, since there are no specific receptors in this part of the respiratory tract responsible for their occurrence. Only when the inflammatory fluid rises higher will a cough appear.

Such anatomical feature lung plays a negative role for early diagnosis diseases. When performing x-rays at the beginning of the disease, it is clearly seen that there is an inflammatory infiltrate in the alveoli, but the objective state of the person is unchanged.

Only a few hours after the start of reproduction of the pathogen in the respiratory tract, like a "thunder in the blue", all the symptoms of the pathology fall on the person at the same time.

On the first day of illness, the cough is dry. Sputum separation is not observed. On day 2, the patient can observe a “rusty” discharge, which is due to the presence of red blood cells due to damage to the vessels by bacterial toxins. At the same time, the human condition sharply worsens due to intoxication syndromes.

If at this stage a macropreparation is prepared from the lung tissue, then it will be possible to observe the red color of the lung tissue in the affected area. This phenomenon is due to hemorrhages in the alveolar acini.

Respiratory rate on the 3rd day of illness can reach 40 respiratory movements per minute. At the same time, there is tachycardia (increased heart rate) and severe shortness of breath, which does not allow a person to even climb the stairs to the first floor.

A specific feature of lobar pneumonia is the accumulation of fibrinous exudate in the bronchial cavity. It is represented not only by an infiltrative fluid, but by the presence of a protein of the blood coagulation system - fibrin. This protein causes a specific morphological type of the disease - hepatization, since the structure of such a tissue resembles the liver.

Pain in the chest appear when inflammatory changes in the pleural sheets are attached to the pathological process. Often, against the background of pathology, there is an accumulation of fluid in the projection of the costophrenic sinus (exudative pleurisy).

Clinical stages and complications of the disease

The stages of acute croupous pneumonia are distinguished depending on the morphological changes in the lungs:

  • Red hepatization;
  • Gray hepatization (hepatization);
  • Permissions.

red hepatization- the first stage of croupous inflammation of the lungs. It is observed during the appearance of "rusty" sputum.

gray hepatization is formed when large amounts of fibrin accumulate in the lumen of the alveoli, which impedes the process of gas exchange between red blood cells and external air. A macropreparation, which is made from lung tissue at this stage of the pathological process, will show that the alveoli are filled with dense gray contents.

Permission- resorption of infiltrates in the alveoli and exudates in the bronchial wall.

In the stage of red hepatization, a person often has hemoptysis when a large number of vessels are affected. This phenomenon exists for several days, and then the sputum acquires a mucopurulent or purulent character.

If the symptoms persist for a week, it is necessary to exclude such lung diseases as tuberculosis, abscess, hemorrhagic tracheobronchitis.

With an uncomplicated course of the pathology, the process ends with a critical or lytic (gradual) decrease in temperature and the disappearance of pathological symptoms. However, croupous pneumonia rarely resolves completely within a month, although no infiltrative shadows are seen on lung scans.

Complications of croupous pneumonia in children are very often observed, which increase the likelihood of bronchial asthma or recurrence of the disease after some time.

Frindler's wand is prone to chronicity, therefore, when immunity is weakened, it can again provoke inflammatory changes in the lungs. As a result, even with a slight increase in temperature in patients with lobar pneumonia, doctors prescribe a second course of antibiotic therapy in order to prevent a relapse of the disease.

In conclusion, I would like to note that the high level of modern medicine has reduced mortality from lobar pneumonia, but it remains quite high. This figure is largely due to the late treatment of patients for qualified medical care.

Principles of treatment

Treatment of acute croupous pneumonia is carried out either in a pulmonological hospital or in intensive care units. It requires the correction of metabolism, intravenous antibiotic therapy, artificial lung ventilation, as well as the normalization of the functioning of other organs and systems.

Treatment of pathology is carried out under constant monitoring of the level of blood gases - oxygen and carbon dioxide using special equipment. At the slightest change in these indicators in negative side doctors carry out inhalation of oxygen.

Antibacterial therapy of the disease is carried out according to a combined scheme using several pharmaceutical groups of antibiotics simultaneously.

Despite the efforts made, often resuscitators fail to save the patient's life. This could have been avoided if the person had applied for qualified help in time. One should not hope for an independent favorable outcome of the pathology, since the causative agent of the disease has a high toxicity. It will quickly cause severe intoxication and brain hypoxia.

Croupous pneumonia is a serious lung disease of an infectious-allergic nature. In the tissues, an inflammatory process occurs with the formation of alveolar effusion ( increased content 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 was high rate mortality, 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 croupous pneumonia - acute symptoms, it's hard 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 occur 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 breathe, part of the affected lung is involved in respiratory process defective. 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.

The alveolar cavities are filled 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 - staining occurs in Brown color, 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. going on lung cleansing- fibrin, pathogenic microflora, exudate comes 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 like in appendicitis.
  • typhoid . The disease process is similar 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:

Most informative method definition of 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.

On the x-ray darkening of the lung

To clarify the diagnosis:

Analyzes. General and biochemical analysis blood, bacteriological examination 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 department intensive care. Therapeutic measures depend on the expressed symptoms, stage, form, 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 held antibiotic therapy antibiotics are prescribed a wide range, and after clarifying the diagnosis 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 lead to lethal outcome. 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 immunity by air or water hardening, healthy eating and physical activity. It is necessary to observe the rules of personal hygiene, refuse 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. To avoid severe consequences disease should be immediately examined and treated.

Croupous pneumonia is an inflammatory-allergic disease, which is characterized by compaction of one or more 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; lobar pneumonia is rare in children.

In case of untimely diagnosis, development severe complications croupous pneumonia (especially in immunocompromised individuals and patients suffering from alcoholism) may be fatal.

Lungs - paired organ breathing, are located in the left and right half of the chest cavity, limiting the complex of mediastinal organs. Right lung consists of three shares, and the left of two. Each of the lobes of the lung, in turn, is formed by segments, the lung tissue inside the segments consists of pyramidal lobules, the apex of which includes a bronchus, which forms 18-20 terminal bronchioles in it by successive division, ending in an acinus. The acinus consists of respiratory bronchioles, dividing into alveolar passages, their walls are dotted with alveoli, in which gas exchange occurs between atmospheric air and blood.

Source: proinfekcii.ru

Croupous inflammation can capture as separate lung segments, and the entire share, and sometimes the lung completely.

Causes and risk factors

The causative agents of lobar pneumonia are pneumococci (I, II, III, IV types), staphylococci, streptococci, coli and Klebsiella. The main routes of infection transmission are airborne, hematogenous and lymphogenous.

Risk factors include:

  • infectious diseases;
  • smoking;
  • chest trauma varying degrees gravity;
  • frequent stressful situations;
  • overwork;
  • irrational 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 involute;
  • areactive- the onset is not acute, signs of inflammation appear gradually, the course is sluggish;
  • central- inflammation occurs in the deep sections of the lung;
  • migratory- lung areas located near 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- characterized by meningeal symptoms.
Croupous pneumonia may be complicated by the development effusion pleurisy, gangrene of the lung, purulent pericarditis, infectious-toxic shock, purulent meningitis, cardiopulmonary insufficiency.

Stages of croupous pneumonia

There are four stages of croupous pneumonia:

  1. 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; are celebrated vascular disorders; duration 1–3 days.
  2. Red hepatization stage- diapedesis of erythrocytes intensifies, inflammatory exudate is enriched with proteins with fibrin precipitation, due to fibrinous effusion, the affected lung becomes denser, acquires a dark red hue, capillaries are compressed, which causes malnutrition of the lung tissue; duration 1-3 days.
  3. Gray hepatization stage- leukocytes infiltrate the intermediate lung tissue around small veins and capillaries; the affected lung acquires a grayish tint, the duration is from 2 to 6 days.
  4. Resolution stage- fibrinous exudate gradually liquefies under the action of proteolytic enzymes, which begin to secrete leukocytes, and is removed from the lung; lasts 2-5 days.

Rarely, the gray hepatization stage may precede the red hepatization stage.

Symptoms of croupous pneumonia

Lobar pneumonia can affect one lobe of the lung, one or both lungs. The severity of the course 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, there are severe chills, general weakness, lethargy, headache, shortness of breath, chest pain. 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 early diagnosis of the disease and adequate treatment, the prognosis is favorable.

With the progression of the pathological process, pain occurs in the side of the lesion. The pain may radiate to the abdomen or shoulder and usually disappears after a few days. If pain persists for a longer period, there is a possibility of developing pleural empyema. The chest on the side of the lesion lags somewhat behind in the act of breathing, while the auxiliary muscles participate 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, breathing is rapid and superficial with swelling of the wings of the nose, the pulse is frequent, heart sounds are muffled, arterial pressure reduced, arrhythmia may appear.

Features of the course of the disease in children

Croupous pneumonia in children is not characteristic high fever, severe chills and pain in the side.

In children younger age in the first days of the disease, there is no cough. Symptoms of croupous pneumonia in them are dryness of the lips and tongue, nausea and vomiting, bloating, abdominal pain resembling those of 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 the size of the liver. In some cases, stiff neck muscles, severe headaches, convulsions, delirium, hallucinations are observed, and therefore meningitis can be misdiagnosed. As the pathological process develops, meningeal symptoms disappear, and a clinical picture typical of croupous pneumonia appears.

The disease is diagnosed in all age groups, however, it is more often recorded in patients aged 18–40 years; lobar pneumonia is rare in children.

In children aged 7–16 years, the disease usually proceeds typically.

Body temperature returns to normal on the 5-9th day from the onset of the disease, inflammatory changes in the lungs disappear quite quickly.

Diagnostics

To make a diagnosis, complaints and anamnesis are collected, physical diagnostics, instrumental and laboratory examinations are carried out.

Source: zdorovie-legkie.ru

In the course of physical diagnosis at stage I of croupous pneumonia, vesicular respiration is preserved, blunted-tympanic percussion sound, crepitus. Stage II of the disease is characterized by a dull percussion sound, bronchial breathing, reduced mobility of the lower lung edge on the side of the lesion. At stage III, the signs characteristic of stage I are determined. The content of globulins and fibrinogen also increases, changes in the gas composition of the blood are detected, diuresis decreases, and specific gravity urine.

Differential diagnosis is carried out with focal confluent, caseous pneumonia.

Treatment of croupous pneumonia

Treatment of lobar pneumonia is carried out in a hospital. In severe cases, the patient may need to be admitted to an intensive care unit.

The main routes of infection transmission are airborne, hematogenous and lymphogenous.

Main drug treatment croupous pneumonia consists in taking antibacterial drugs. Until the results of the sputum examination are obtained, broad-spectrum antibiotics are prescribed, after the pathogen has been identified and 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, patients with croupous pneumonia are shown oxygen therapy.