Description of croupous pneumonia. fibrinous inflammation

Croupous pneumonia is an inflammatory and allergic lung disease. It is characterized by compaction in one or more lobes of the lung with the formation of exudate (effusion) in the alveoli. As a result, the lung tissue is switched off from gas exchange. It most often affects adults 18–40 years old, and rarely children.

Focal and croupous pneumonia are often confused. But in fact, there are differences: focal occupies lobules, and croupous - lobes consisting of lobules. It turns out that the second one is larger in terms of the affected area.

Pathogens and mechanism of development

Lobar pneumonia can be caused by any microorganism, but the most common cause is pneumonia. Less often - streptococcus, staphylococcus, klebsiella, coli. Mixed flora is also possible.

The incidence is high in the winter-spring period. They get sick more often in cities, the reasons for this phenomenon are a large crowding of the population.

Predisposing factors:

  • local or general hypothermia;
  • deficiency states (avitaminosis, hypovitaminosis, anemia);
  • colds;
  • concomitant pathology;
  • decreased immunity;
  • injury;
  • intoxication;
  • fatigue, stress.

The causes of lobar pneumonia are the penetration of microorganisms into the lung tissue with the subsequent development of the inflammatory process. The pathogenesis of the disease is associated with toxins that the pathogen releases. The toxin spreads to the entire lung tissue, resulting in increased vascular permeability and exudation (effusion) of fibrin and blood cells into the alveoli.

AT different periods diseases the pathogenesis of croupous pneumonia (the mechanism of development of the disease) is different. And this, in turn, depends on the clinical picture.

Development periods

There are only four stages of croupous pneumonia. The division is based on pathological anatomy diseases, i.e. processes that occur at the cellular level.

  • In the first stage (hyperemia and flushing), which lasts approximately 1–3 days, the alveoli expand and fluid (exudate) appears in them due to inflammation.
  • In the next, second stage (red hepatization) with a duration of 3–5 days, the air from the alveoli is displaced by a fibrinous effusion, which contains erythrocytes, epithelial cells and leukocytes.
  • The third stage (gray hepatization) is characterized by the predominance of leukocytes in the exudate.
  • The fourth stage (resolution) occurs on the 7-11th day of illness. In this case, fibrin dissolves.

Clinical picture

Croupous pneumonia usually begins acutely. Its first symptom is a high temperature, the values ​​​​of which reach 39-40 ° C. But there may be a short prodromal period, accompanied by headaches, weakness, lethargy, and gastrointestinal disorders.

Features of the temperature reaction: the patient is trembling, he is cold and cannot warm himself. He has "icy" limbs, blue lips.

Other symptoms of croupous pneumonia gradually join. The patient is worried about acute stabbing pain in the side, which is present on the side of the lesion, and may extend into the abdomen or shoulder. It usually disappears in 2-3 days. If the pain lasts longer, this may indicate pleural empyema.

Cough at first unproductive, then (after 2-3 days) wet with thick viscous sputum. Constant excruciating cough significantly affects the patient's well-being and disturbs his sleep. Sputum in the first days is frothy, scanty, whitish. Further, it becomes a rusty color, with an admixture of blood. In the future, when pneumonia passes into the stage of white hepatization, it becomes cloudy. And when the process is allowed, the sputum becomes more liquid, better coughed up. The presence of blood in this stage can be observed with injuries or heart disease.

Worried about shortness of breath with difficulty breathing and swelling of the wings of the nose. The respiratory rate can be from 25 to 50. The backlog of half of the chest is determined. With pleurisy, breathing is superficial due to pain that occurs with a deep breath.

Violation of gas exchange is manifested by cyanosis, which extends to the limbs, lips, nasolabial triangle.

Appearance of a patient with pneumonia

With croupous pneumonia, one can note the characteristic appearance sick.

  • There is one feature: pathological symptoms usually appear on the side of the lesion. For example, a herpetic rash on the lips, ears, on the wings of the nose and redness of the cheeks are observed only on the left or right. But cyanosis, a feverish gleam in the eyes develop on both sides.
  • The position of the patient is passive on the back.
  • The skin is hot and dry to the touch, cold on the extremities.
  • Breathing at the beginning of the disease is superficial and intermittent. There is swelling of the wings of the nose.
  • Croupous pneumonia in children is characterized by a groan in the exhalation phase.
  • When the foci of compaction begin to spread more and more, breathing becomes deep, with the participation of auxiliary muscles.

Diagnostic measures

Diagnosis of lobar pneumonia is based on a thorough examination and various tests. Reliable information about the localization of the lesion is given by voice jitter(bronchophony) - vibration of the chest when pronouncing various sounds. Normally, it is the same for all fields. But due to the fact that the right bronchus has a different anatomy (it is shorter and wider), bronchophony can be increased over the apex of the right lung, and this does not indicate pathology.

To determine bronchophony, palms should be placed on symmetrical areas of the chest and asked to pronounce a word, for example, "artillery". Above the site of croupous pneumonia, voice trembling is increased, and where pleurisy is weakened.

The following signs of croupous pneumonia are a change in percussion sound and auscultatory data. When tapping (percussion), a tympanic pulmonary sound is heard. When listening (auscultation), breathing is weakened, but it is vesicular. Crepitus is heard, which is created at the moment of sticking of the walls of the alveoli during inspiration. As the disease progresses, they begin to be heard bronchial breathing, pleural friction noise, fine bubbling rales appear. In the resolution phase, breathing becomes hard, the intensity of wheezing decreases.

Diagnostics with x-ray possible already in the initial stages of croupous pneumonia, even before the appearance of seals in the lung tissue. Focal symptoms are observed: first, an increase in the pulmonary pattern, then a dense, uniform darkening, which is replaced by spotty shadows. There is also a high standing of the diaphragm on the side of the lesion. Signs of the disease completely disappear 2–3 weeks after clinical recovery.

Laboratory signs of the disease

  • In the peripheral blood, neutrophilic leukocytosis is up to 15–20 * 109 g / l, a decrease in the number of lymphocytes, an increase in monocytes, an increase in ESR up to 70 mm / h.
  • In the biochemical analysis of blood - a change in protein fractions.
  • In the general blood test increased content protein, cylinders and erythrocytes.

Possible Complications

Previously, the disease proceeded severely, for a long time, with frequent complications sometimes ending in death. Now, when it is possible to use antibiotic therapy, it proceeds relatively easily. And in general, the prognosis is favorable. The duration of each stage is also reduced. In general, the patient recovers within 1–2 weeks, and the disappearance of radiological signs occurs at 3–4 weeks of illness.

There are also cases with an erased clinical picture or an atypical course of the disease, especially in children.

But in some cases, with croupous pneumonia, complications develop. For example, with late treatment, high virulence of the pathogen, severe comorbidity ( cardiovascular diseases, depletion of the body, intoxication), etc. In children, this list continues with prematurity, artificial feeding, early age. These factors undoubtedly aggravate the course of the disease.

Possible complications of croupous pneumonia are as follows:

  • Pulmonary - pleurisy, abscess, carnification (germination connective tissue), gangrene.
  • Extrapulmonary - various inflammatory diseases: mediastinum, cardiac membranes, peritoneum, joints, kidneys, membranes and substance of the brain. May develop acute cardiovascular failure, toxic shock, liver failure, psychosis, cerebral edema.

Prognostically for croupous pneumonia, the following are unfavorable: the absence of a leukocyte reaction with an increase in the level of neutrophils, a significant increase in heart rate (more than 120 beats per minute), focal symptoms, severe cyanosis, a decrease in venous and arterial pressure, jaundice, bloating, absence of urine.

Treatment and preventive measures

Prevention consists in the use of masks during epidemics. Avoid crowded teams, as well as hypothermia.

In the focus of infection, treatment with special solutions is carried out. Factors under which microbes die: airing and sunlight.

Individual prevention is vaccination. We have already said that the causative agent of the disease is most often pneumococcus, therefore, it is necessary to be vaccinated against it. Children are routinely vaccinated, and adults - if there is a concomitant pathology.

Treatment of lobar pneumonia is complex and is carried out taking into account the etiology and pathogenesis of the disease.

  • Antibacterial therapy, taking into account the sensitivity of the microorganism.
  • Anti-inflammatory drugs, including hormonal.
  • Symptomatic treatment - antiherpetic drugs, vascular agents, mucolytics, etc.
  • Oxygen therapy.
  • Treatment of complications and concomitant diseases.
  • Physiotherapy.

Hospitalization is required. Treatment is carried out according to an individual plan, which is influenced by many factors: the phase in which lobar pneumonia is, etiology, pathogenesis, symptoms, the presence of complications, the general condition of the patient.

Stories from our readers

Croupous pneumonia is an inflammatory and allergic disease of the lungs, characterized by compaction of one or more lobes of the lung, as well as the formation of pathological exudate in the alveoli. As a result, the lung tissue ceases to actively participate in the process of gas exchange. Pathogenic microorganisms cause this dangerous disease.

It is worth noting that many people confuse lobar pneumonia with focal pneumonia. But in fact, these pathologies are different from each other. In the case of progression of focal pneumonia, the x-ray will show that certain lobules of the lung are affected. If croupous pneumonia progresses, then the x-ray will clearly show the defeat of an entire lobe of the lung, which consists of small lobules. All this suggests that the area of ​​the lesion in the croupous type is much larger than in the focal type. Therefore, such a pathology is more severe.

Previously, croupous pneumonia was considered a real verdict. If its symptoms appeared, then in most clinical situations the patient died. But now, thanks to the development of medicine and the availability of highly effective drugs, mortality is almost close to zero. It should be noted that croupous pneumonia in children is rarely diagnosed. Adults are more susceptible age category 18–40 years old.

Etiology

The main reason for the progression of the disease is the pathogenic activity of microorganisms. The causative agents of this type of pneumonia are more often Klebsiella and. But mixed flora is not excluded. They enter the lung tissue in three ways:

  • airborne (the most common route of penetration of pathogenic microflora in focal, lobar and other types of pneumonia);
  • hematogenous;
  • lymphogenous.

Risk factors:

  • hypothermia;
  • intoxication of the body;
  • hypovitaminosis;
  • chest trauma varying degrees gravity;
  • overwork;
  • stress;
  • the presence of comorbidities in acute or chronic stage;
  • decrease in reactivity and sensitization of the body.

Pneumonia begins to develop as soon as the pathogenic microflora has entered the lungs. The pathogenesis of the disease is directly related to the toxins that the pathogen releases. These substances penetrate into the lung tissues, thereby significantly increasing the permeability of the walls of blood vessels, exudation and fibrin into the alveoli. Important is the fact that when different stages disease pathogenesis is different, and the clinic depends on this.

stages

In total, clinicians distinguish 4 stages in the progression of croupous pneumonia. Their total duration is a maximum of 11 days.

1 or high tide stage. Duration is one day. Characteristic features- microbial edema and severe hyperemia of the lobe of the lung affected by microorganisms. If at this stage the edematous fluid is taken for examination, it will be possible to identify in it great amount pathogens. The permeability of capillaries increases, and red blood cells gradually seep into the lumen of the alveoli. The affected part is compacted. X-rays show these changes.

2 or red hepatization stage. It develops on the second day of the progression of the disease. Diapedesis of erythrocytes gradually increases due to plethora and edema. But now not only red blood cells, but also neutrophils seep into the lumen of the alveoli. Fibrin (protein) falls out between cells. Lymphatic vessels, which are localized in the tissues of the organ, expand and overflow with lymph. Regional lymph nodes are enlarged. The affected lobe becomes liver-like in density and acquires a dark red color.

3 or gray hepatization stage. It develops in a patient on the 4-6th day of illness. In the lumen of the alveoli, neutrophils and fibrin filaments accumulate. The concentration of red blood cells that undergo hemolysis decreases, which leads to a decrease in the severity of hyperemia. The share of the lung at this stage increases, becomes heavier, and fibrinous overlays appear on the pleura.

4 or resolution stage. It appears on the 9-11th day of the progression of the disease. The formed fibrinous exudate gradually melts and resolves. The lung is cleared of accumulated fibrin and pathogenic microflora. Exudate from the organ is excreted along with sputum and through the lymphatic drainage of the lung.

Symptoms

Croupous pneumonia begins acutely. Its first symptom is hyperthermia to high numbers. But the prodromal period is also not excluded, in which a person may experience such symptoms:

  • weakness;
  • headache of varying degrees of intensity;
  • lethargy;
  • loss of appetite;
  • gastrointestinal disorders: diarrhea, constipation.

As the pathology progresses, the cynic is supplemented by the following symptoms:

  • pain in the side of the lesion. Has a sharp or piercing character. The degree of intensity is different. May radiate to the shoulder or abdomen. This symptom usually disappears 2-3 days after the onset of the disease. If the pain syndrome persists longer, then this is already an alarming signal - perhaps the patient has developed pleural empyema;
  • cough. On the early stage disease, it is unproductive, but on the 3rd day it becomes wet. During coughing, the patient produces thick sputum. At first she is frothy and has White color, but gradually becomes "rusty" due to the admixture of blood in it;
  • usually the patient is worried about shortness of breath - breathing is difficult. Frequency respiratory movements per minute - from 25 to 50. The affected half of the chest is somewhat behind in the act of breathing;
  • cyanosis. This symptom occurs due to a violation of gas exchange. The tissues of the body do not receive enough oxygen. A sick person has cyanosis of the nasolabial triangle, fingers and toes, lips;
  • skin covering hot and dry, and cold on the extremities;
  • participation of auxiliary muscles in the act of breathing.

Complications

Inflammation of the lungs in any form is fatal dangerous disease, as against its background progress dangerous complications requiring treatment in intensive care.

Complications of croupous pneumonia are as follows:

  • infectious-toxic shock;
  • abscess.

Diagnostics

Croupous pneumonia is not difficult to determine, since its symptoms are quite specific. It is important when the first symptoms appear, which indicate the progression of the disease, to seek qualified medical care.

Most informative method diagnosis is x-ray. It makes it possible to identify the presence and prevalence of the pathological process. X-rays are performed both for adults and children with suspicion of the development of this pathology.

The treatment plan is developed taking into account the stage of the disease, the severity of symptoms, the severity of the course and the general condition of the patient. It should be noted that basic therapy should be started as soon as the diagnosis has been confirmed.

Treatment of croupous pneumonia is only complex. Only then will it be effective. The patient is assigned:

  • oxygen therapy. This method of treatment is necessary for the normalization of gas exchange;
  • antibiotic therapy. First, doctors resort to drugs a wide range actions, but after receiving the results of sputum culture, the drug can be changed;
  • physiotherapy methods of treatment;
  • anti-inflammatory pharmaceuticals;
  • symptomatic treatment. Basic therapy can be supplemented with mucolytics, antiherpetic drugs, vascular medicines And so on.

With croupous pneumonia, an acute inflammatory process extends to the entire lung lobe or affects its individual segments. In this case, the disease in its development goes through successive stages.

If the inflammation covers the entire area of ​​the lung, then this type of disease is also called lobar pneumonia. However, it is quite rare. Most often, with croupous inflammation of the lungs, it is individual segments that are affected.

This form of the disease can occur both in children and in adult patients.

Origin of the disease

The croupous form of pneumonia arises and develops due to the pathogenic effect on the human body of various pathogenic bacteria.

So, the causative agents of the disease can be:

  • Frenkel-Vekselbaum pneumococci;
  • wand Friedlander - Pfeiffer;
  • coli;
  • staphylococci;
  • streptococcus.

Thus, the etiology of lobar pneumonia is directly related to the activity of pathogenic bacteria. However, in the same way, we should talk about a number of concomitant disease factors that significantly increase the likelihood of its development. These include:

  • frequent SARS and colds;
  • chronic diseases of the respiratory system;
  • severe hypothermia of the body;
  • psychological shocks and stresses;
  • inflammatory processes occurring in the respiratory tract;
  • chest riveting injuries;
  • weak immunity.

The root cause of lobar pneumonia should be sought precisely in the combination of the pathogenic effects of bacteria, as well as one or more concomitant factors.

Stages of the disease

In the medical literature, it is customary to distinguish four successive stages or stages that the croupous form of pneumonia goes through in its development.

The first is the tidal phase. It is characterized by a rapid overflow of excess blood lung tissue, which significantly disrupts the patency of blood vessels. Its average duration is 2-3 days.

The second stage of red hepatization. It is characterized by a change in the physiological characteristics of the lung affected by pneumonia. First of all, due to the accumulation of red blood cells, it becomes red. lung weight increases and its significant compaction is noted. During this period, the lung in its density becomes similar to the liver. This is where the term curing comes from. Average duration stage also equals 2-3 days.

The third is the stage of gray hepatization. It is characterized by the fact that a large number of leukocytes begin to accumulate in the lung affected by inflammation, this leads to a change in color. As a rule, gray hepatization occurs on the 5th-6th day of lobar pneumonia. The average duration of the stage is also 1-2 days.

The fourth stage is called resolution. It is characterized by the breakdown of leukocytes, liquefaction of fibrin and the onset of expectoration of sputum.

It should be noted that such a canonical course of the croupous form of pneumonia is quite rare. Most often this is due to the fact that drug treatment pneumonia, namely the intake of antibiotics cause changes in the course of the disease, which are reflected in the interruption of the inflammatory process in the early stages.

Existing symptoms and signs

With croupous inflammation of the lungs, the patient has the following pathological symptoms:

  • a sharp increase in body temperature to 39-40 degrees;
  • fever and chills;
  • chest pain;
  • shortness of breath and rapid breathing;
  • painful cough;
  • headache;
  • nausea and vomiting;
  • diarrhea and flatulence;
  • strong thirst;
  • poor appetite;
  • the tongue often has a white coating;
  • pressure often rises;
  • insomnia.

It should also be noted that in different patients the same symptoms of lobar pneumonia can manifest themselves absolutely individually in each patient.

Quite often there is an atypical course of croupous pneumonia.

Diagnostic measures

In the usual course of the disease, a qualified doctor, as a rule, simply needs to make the correct diagnosis.

Sometimes it is enough to collect an anamnesis and auscultate (“listen”) to the patient.

An additional attending physician may prescribe a laboratory blood test and x-ray examination.

Therapeutic measures

Treatment of croupous pneumonia is most often complex nature. Correct is of great importance.

The basis of therapeutic measures for the lobar form of pneumonia is drug therapy based on the use of sulfa drugs and antibiotics.

Sulfonamides can be prescribed both non-prolonged and prolonged action. In general, they are a group of artificially synthesized compounds that are used to treat infectious diseases bacterial origin.

At one time, their appearance in the 30s of the last century made it possible to significantly reduce mortality from pneumonia.

Choice suitable antibiotic carried out directly by the attending physician. At the same time, it is based on the bacterium that causes croupous pneumonia.

Drug therapy is supplemented by bed rest for the patient. A bland diet is required. The patient must consume enough vitamins (especially C), as well as plenty of warm and sweet drinks (fruit drinks, teas, compotes).

Possible Complications

At present, with timely and adequate treatment lobar pneumonia qualified specialist the patient, as a rule, is not threatened with serious complications.

Unless we can talk about carnification of the lung - the germination of its connective tissue and the subsequent development of bronchiectasis.

In the case of self-medication, complications are more than possible. Moreover, they can be very heavy. In the worst case, the case can end in an abscess, gangrene of the lung, and even death.

The content of the article

This is an acute infectious-allergic disease characterized by inflammatory lesion lung tissue with accumulation of fibrin-rich exudate in the alveoli and a typical cyclic course of both pathomorphological and clinical manifestations.
AT last years lobar 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 wand, etc. A combination of microbial and viral infection cannot be ruled out.

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 a 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 pathomorphological changes in the lungs are distinguished.
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 the cut - 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. The 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. With croupous pneumonia, degenerative changes in the muscles of the heart, liver, and kidneys are observed, 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 that looks like 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 weakening over time of meningeal phenomena and the appearance typical symptoms pneumoniae give grounds to rule out meningitis.
A more typical course of pneumonia is observed in school-age children. The disease starts with high temperature body, 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. As a result of the beginning compaction of the lungs, bronchophony or bronchial breathing is heard.
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. A viscous, vitreous sputum with an admixture of blood (“rusty”) is coughed up, more often in schoolchildren and rarely in preschool children. 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 toxic injury hepatocytes and protrudes 2-3 cm from under the costal margin, soft, sensitive on 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 in recent times occurs most often, which is apparently due to a significant decrease in the etiological role of pneumococcus.
3. Massive pneumonia - the inflammatory process quickly spreads to other lobes of the lung. This form is reminiscent exudative pleurisy, but the dullness in the lungs is less extensive and does not increase downwards.
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 form - simulates the clinical picture of appendicitis and is more common 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 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 the chest wall, sonorous and even voiced 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 - germination of its connective tissue and the subsequent development of bronchiectasis.

lobar pneumonia diagnosis

Recognition of lobar pneumonia 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); x-ray data (darkening of the entire lobe of the lung or most of it). clinical picture atypical forms lobar pneumonia.

Differential diagnosis of croupous pneumonia

When establishing the diagnosis of lobar 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 the localization of dullness over the lower parts of the chest and its characteristic outline. upper bound. In the area of ​​dullness with pleurisy, breathing is sharply weakened or not heard at all, voice trembling and bronchophony are not detected. In unclear cases, the diagnosis is established by X-ray examination and test puncture.
At differential diagnosis 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 antibacterial drugs and 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.

With the onset of autumn, the number of calls to medical institutions with complaints of cough and deterioration in general well-being are growing. This is mainly due to a disease such as pneumonia. By its nature, pneumonia is an inflammation. Moreover, the entire tissue of the lungs becomes inflamed, in pathological process all structures are involved, including bronchi and alveoli. Most often, this type of pneumonia affects children and pensioners. Croupous pneumonia in children and the elderly often occurs with complications if treatment is not started in a timely manner. Therefore, it is very important to seek medical help at the slightest suspicion of this disease.

Pneumonia can find its prey in medical institution or outside its walls. In the first case, we will talk about hospital or nosocomial infection. If the patient becomes infected in any other place, then pneumonia will be called out-of-hospital or home. Pneumonia is croupous and focal.

What is lobar pneumonia?

The definition of croupous pneumonia is as follows:

Croupous pneumonia (pleuropneumonia) is an acute inflammatory disease of the lungs, involving all structures of the lung in the inflammatory process, characterized by the presence of intra-alveolar inflammatory exudation and a certain cyclicity of pathomorphological changes in the lungs. Why coarse? Croup - grayish films, consisting of fibrin, which cover areas affected by this type of pneumonia.

It is for croupous pneumonia that the presence of clear stages of the disease, sequentially following each other, is characteristic. Symptoms rapidly increase, then, with correctly prescribed and timely treatment are gradually fading away.

Tidal stage. The average duration is two days. But this period can last from 12 hours to three days. At this stage, there is a pronounced hyperemia (redness) and compaction of the affected area. At the same time, the walls of the capillaries become thinner, and the blood flow is disturbed, some of it enters the alveoli. By the end of the first stage, the respiratory function lungs.

Red hepatization stage. It also lasts from one to three days. At this time, diapedesis of erythrocytes occurs, saying plain language, they exit the walls of the capillaries into the cavity of the alveoli. As a result, blood accumulates in them, which is called effusion. The fluid that is in the lungs (exudate) contains a lot of fibrin. As it folds, it leads to a lack of air in the alveoli and thickening of the lungs, which is called hepatization. It is for this stage that it got its name - hepatization.

The stage of gray hepatization. The second longest of all the stages into which croupous pneumonia is divided. It lasts from two to six days. There is no diapedesis at this stage. In the alveoli, now, in addition to fibrin, epithelium and leukocytes appear. The lungs become gray-greenish in color, due to this the third stage of the disease got its name. This color is due to the presence of a sufficiently large number of leukocytes, which indicates a serious struggle of the body with the causative agent of lobar pneumonia.

Resolution stage. The longest phase, ending with complete recovery and restoration of lung function. The duration is different and depends on the correctness of the treatment, the age of the patient and how strong the body is. At this stage, the fibrin dissolves and the lungs are released. The elastic properties of the lung tissue are restored, and breathing becomes free.

The pathogenesis of lobar pneumonia is that the pathogen penetrates into the upper respiratory tract, then into the lungs. When it enters the lungs, the pathogen multiplies, then causes allergic reaction thereby starting the process of inflammation.

Causes of croupous pneumonia

Age plays important role in the cause of the disease. Since the lungs are still poorly developed in babies, the breathing process is not perfect and not sufficiently adapted to the new world for them, pleuropneumonia quickly spreads and "captures" the lungs of children under the age of 5 years. Also, older people often “become prey” to pneumonia due to the fact that with age the tissues become looser, the lungs become clogged with dust and harmful substances. Not the last place belongs to the decrease in immunity over the years.

In the adult population of working age, the causes contributing to the development of lobar pneumonia are most often:

  1. Hypothermia.
  2. Stress.
  3. Bad habits.
  4. Decreased immunity.

An important factor is the presence in the anamnesis of a previously transferred colds. Whatever the reason, weakening defensive forces organism can lead to croupous pneumonia.

The etiology of lobar pneumonia is most often bacterial. Most often lobar pneumonia is caused by pneumococcus, streptococcus or staphylococcus aureus. Less commonly, Pfeiffer's bacillus and viruses can cause this disease.

Diagnosis of croupous pneumonia

When seeking medical attention for feeling unwell and the presence of a cough, diagnosis will immediately begin with a detailed history taking. The presence of characteristic symptoms means the likelihood of infection with croupous pneumonia. If the symptoms are clearly expressed, a number of tests are prescribed. But before that, a percussion and auscultatory examination of the lungs is mandatory. These diagnostic methods help to quickly make a preliminary diagnosis. With percussion, or percussion of the chest, the percussion sound is shortened in the tissues of the affected lung. Auscultation, or listening, which is usually done with a phonendoscope, reveals crepitus - a crackling sound and noise.

The next objective research method for croupous pneumonia is an x-ray of the lungs. The picture shows characteristic changes. In the stage of the tide on the side of the lesion, the root of the lung expands and the pulmonary pattern intensifies. Later, a shadow appears in the place where there is an inflammatory process. The very first signs: root expansion and a clearer lung pattern, can persist for a long time.

A mandatory diagnostic method when seeking medical help is general analysis blood. With croupous pneumonia, there will be characteristic changes. Compared to indicators healthy person, the number of leukocytes will be increased and ESR accelerated. Also, the leukoformula shifts to the left. In a biochemical blood test, there will be an increase in seromucoid, glycoproteins, sialic acids, levels of alpha-2 globulins and gamma globulins. Protein, microhematuria and hyaline casts will be observed in the urine.

Additionally, a sputum test may be performed. At the first stage, there will be many erythrocytes and fibrin in it, then leukocytes, and at the resolution stage, dead leukocytes will predominate in it. Along with this, the sputum will definitely contain microorganisms that caused pneumonia. Also additional method diagnostics is spirography, it will determine the decrease in the vital capacity of the lungs and the increase in the minute volume of breathing.

Symptoms

Croupous pneumonia does not begin sluggishly. The beginning is always sudden. The temperature rises sharply, the patient often shakes, so severe chills. Along with this, there is a severe headache. On the side that is affected by inflammation, there is severe pain in the chest. Pain is aggravated by coughing and breathing. Often a person holds their breath and suppresses coughing to reduce pain. Body temperature rises to 39-40 degrees. Against the background of such a strong increase in temperature, nausea appears, and sometimes vomiting. Breathing in croupous pneumonia is difficult, the hepatization stage is characterized by an increase in the number of respiratory movements. On examination, the doctor notes the lag of the affected side in the act of breathing. Pain causes a person to take a position lying on a sore side. With the development of the disease, shortness of breath appears, when breathing, the wings of the nose swell, lips turn blue from a lack of oxygen. A feverish blush is observed on the patient's face, usually more pronounced on the side of the lesion. common symptom of all inflammatory diseases lung is cough. Croupous inflammation lungs is characterized by the presence of a dry cough at the onset of the disease. Then, on the third day, the cough becomes loose, with rusty sputum. Complications of croupous pneumonia with timely treatment are rare. The most common: gangrene of the lung and sepsis.

Treatment

Croupous pneumonia (pleuropneumonia) is currently successfully treated. Mandatory bed rest and proper nutrition, it is recommended to drink more fluids. Depending on the causative agent of the disease, antibacterial or antiviral therapy is prescribed. At the same time, it shows sulfa drugs. It is important to start treatment on time so that there are no complications. Also held symptomatic therapy. For decreasing pain syndrome painkillers are prescribed. Distraction therapy is used - banks, mustard plasters. If pneumonia takes a protracted course, the use of steroid hormones is indicated. AT complex therapy B vitamins are used vitamin C. With a decrease in immunity, the use of immunomodulators is possible.

Prevention

Croupous pneumonia is easier to prevent than to treat. The principles of prevention are the same for most diseases. So, for respiratory diseases, in particular for pneumonia, the most effective prevention is smoking cessation. Along with this, it is worth giving up alcohol and leading a healthy lifestyle. Swimming is a great way to harden the body as a whole and improve the condition of the lungs. During the period when the disease reaches its peak, prophylaxis with immunomodulators is recommended, antiviral drugs and vitamins. To reduce the risk of “getting acquainted” with lobar pneumonia, it is worth minimizing conflict situations and stress.