Croupous pneumonia: signs, stages, diagnosis and treatment

Croupous pneumonia (Pneumonia crouposa) is an inflammatory-allergic disease in which one or more lobes of the lung thicken, exudate accumulates in the alveoli, against which gas exchange is disturbed. Lobar pneumonia is also called pleuropneumonia, lobar or lobar pneumonia.

All people are susceptible to the disease, regardless of gender and age, but most often croupous pneumonia is diagnosed in people 18-40 years old. It rarely affects children.

With such a pathology, individual segments of the lung, the entire lobe or the entire organ can become inflamed.

ICD 10 code: J18.1 Lobar pneumonia, unspecified.

How does the infection occur?

Lobar pneumonia is caused by pneumococci I-IV types. Less commonly, the disease is caused by Frindler’s diplobacillus. As a rule, inflammation manifests itself acutely, against the background of absolute health and the absence of contact with infected persons. On the basis of which it can be concluded that the causative agents of the infection were previously in the upper respiratory tract, but their reproduction was restrained due to the work of the immune system. Its weakening is one of the leading factors in the development of lobar pneumonia.

From the point of view of modern medicine, croupous pneumonia is considered as an infectious-allergic disease. In the vast majority of cases, the disease develops as a result of infection of the lungs with type I and type II pneumococci. The polysaccharide capsule of pneumococci ensures their virulence, and also provokes a pronounced sensitization of the body.

Conditions that are necessary for the development of croupous pneumonia:

1. Primary penetration of pneumococci into the body and the development of inflammation. At the same time, its focus may not be located in the lung tissue, but have a different localization.

2. Sensitization of the body to pneumococci of a certain type and re-penetration of the infection.

So, croupous pneumonia develops under the condition of secondary infection with pneumococci. An important condition is the fact of re-infection at the peak of the body’s sensitization to microbes of a certain type. They can get into the lungs through the blood, lymph or airborne droplets.

Under all conditions, a violent reaction develops in the body, which is similar to the one that occurs when a foreign protein is introduced. In the lungs, a whole chain of morphological changes is launched, which were described by Laennec (hot flush, red and gray hepatization, resolution). In the alveoli, inflammatory exudate accumulates, a significant proportion of which is fibrin.

Clinical signs

The clinical picture of lobar pneumonia has certain differences from classic pneumonia. These conclusions were made on the basis of a study of the symptoms of 151 young patients.

Patients rarely have herpetic eruptions. Rusty sputum when coughing was separated only in every 3rd patient. There is no pus in the exudate. The disease develops acutely, accompanied by chills, fever, chest pain. Characteristic changes in the blood test are hyperfibrinogenemia and neutrophilic leukocytosis.

The severity of the course of the disease depends on the extent of the lesion, that is, on how much lung tissue was involved in the pathological process.

The main symptoms of croupous pneumonia:

• High body temperature. Fever is accompanied by chills and aching muscles.

• Headache.

• Dyspnea. Inhalation is difficult, the frequency of respiratory movements: 25-50 per minute.

• Chest pain. It is aggravated by inhalation and coughing.

• Redness of the cheeks. The painful blush will be especially intense on the part of the affected lung.

• Cough. At first it is dry, unproductive, but becomes wet from 3-4 days of pneumonia. The appearance of rusty sputum indicates the presence of blood in it.

• Bronchophony (chest talk). This symptom is diagnosed by a doctor, when listening to the patient’s lungs with a phonendoscope. With croupous pneumonia, sound vibrations are amplified, which is due to the compaction of the lung tissue.

• Indigestion. The patient may develop diarrhea or constipation.

• Pain in the side of the lesion. It can give to the stomach or to the shoulder. As a rule, the pain resolves on its own in 3-4 days. If this does not occur, it makes sense to suspect pleural empyema.

• Chest lagging when breathing. This symptom is characteristic of the affected side.

• Cyanosis of the nasolabial triangle.

• Dry skin. In this case, the patient’s body remains hot, and the limbs are cold.

• Shallow breathing with nasal flaring.

• Rapid pulse, muffled heart sounds, arrhythmia.

• Lowering blood pressure.

The main complaints of patients: a sharp deterioration in health, chest pain, headache, feeling of lack of air.

Stages

Croupous pneumonia has several stages of development. The maximum duration of all phases is 10 days or less.

1. The tide stage. Most often, it is resolved within 24 hours. Its characteristics: hyperemia and edema of the affected lung, increased vascular permeability, seepage of red blood cells through them, their entry into the alveoli. The lung tissue is compacted, which can be seen when performing x-rays. Exudate analysis will contain a variety of infectious agents.

2. Red hepatization stage. Develops on the 2nd day of illness. Against the background of edema and plethora of lungs, diapedesis of erythrocytes intensifies. Not only they seep into the alveoli, but also neutrophils. The lymphatic vessels of the lungs dilate and fill with lymph. During this period, the density of the affected area is similar to the density of the liver. Its color becomes dark red. At this stage, there is an increase in lymph nodes.

3. The stage of gray hepatization. It develops on the 4-6th day from the onset of the disease. In the alveoli, there is an accumulation of fibrin and neutrophils. The number of erythrocytes decreases, which leads to a decrease in hyperemia. The affected area of ​​the lung becomes heavy, increases in size, the pleura undergoes fibrosis.

4. Resolution stage. It is observed on the 8-10th day from the onset of the disease. Fibrin begins to dissolve, the lungs are cleared of microbes and their waste products. The exudate leaves the organs along with sputum and drained lymph.

Features of the course of the disease in children

Children rarely have fever and chills, they do not complain of pain in the side.

An atypical course of croupous pneumonia is observed in young children. No cough at the onset of the disease, but other symptoms occur: dry mouth, bloating, nausea and vomiting, abdominal pain, pale skin, rapid breathing, hyperexcitation or lethargy, liver enlargement. Sometimes there is stiff neck, headache, convulsions, delirium and hallucinations. The combination of these symptoms can lead to an incorrect diagnosis (meningitis). As pneumonia progresses, meningeal signs give way to the classic clinical picture of pneumonia.

In children 7-16 years of age, the symptoms do not differ from those that occur in adults. Body temperature stabilizes on days 5-9 from the onset of the disease. At the same time, inflammation in the lungs subsides.

Possible complications and consequences

Complications of croupous pneumonia:

• Effusion pleurisy.

• Gangrene of the lung.

• Purulent pericarditis.

• Purulent mediastinitis.

• Blood poisoning.

• Infectious-toxic shock.

• Abscess of the brain.

• Purulent meningitis.

• Purulent arthritis.

• Heart and respiratory failure.

Weather. If the disease was detected on time, so that the patient received adequate therapy, the prognosis is favorable. It worsens with a belated start of treatment, against the background of the development of complications and problems with the immune system. In this case, a lethal outcome is not excluded.

Diagnostics and tests for croupous pneumonia

Diagnosis of lobar pneumonia begins with the collection of anamnesis. The doctor listens to the patient’s complaints, conducts an examination, outlines a plan for further diagnosis.

Depending on the stage of development of the disease, the results of a physical examination will differ:

1. At the first stage, vesicular respiration is preserved. Percussion sound dull-tympanic, crepitations are heard.

2. At the second stage, the percussion sound is dull, bronchial breathing. The lower edge of the affected lung is limited in movement.

3. The third stage is characterized by those symptoms that are characteristic of the first phase.

The leading instrumental diagnostic method is radiography. If a questionable result is obtained, a CT or MRI may be prescribed.

A prerequisite for complex diagnostics is blood donation for general and biochemical analysis. You will also need the results of a general urinalysis and a LHC sputum culture.

Why is sputum rusty in lobar pneumonia?

The cough reflex provokes the rupture of small blood vessels with the removal of blood into the bronchi. As a result, it oxidizes, turning brown or rusty.

Differences of croupous pneumonia from focal and bronchopneumonia

Differences between croupous and bronchopneumonia:

Differences between croupous and focal pneumonia:

Treatment

Croupous pneumonia is a reason for hospitalization of the patient. At home, the disease is not treated. A prerequisite is the observance of bed rest throughout the stay in the hospital. At the same time, a person must constantly change the position of the body so that sputum does not stagnate and is more easily removed from the lungs. Treatment comes down to taking medications, oxygen therapy and UHF therapy, let’s take a closer look at each.

Medication

All patients are prescribed antibiotics. The drug of choice is benzylpenicillin. If there is no effect after 2 days from the start of therapy, the drug is replaced with Ampicillin, Lincomycin or Erythromycin.

If pneumonia is severe, then the treatment regimen is built on 2-3 drugs that are prescribed simultaneously. The daily dose is increased to the maximum allowable. Antibiotic therapy is continued until complete recovery.

In addition to antibiotics, NSAIDs, mucolytics and bronchodilators are indicated. To remove intoxication, the patient is given droppers with Hemodez. Analgin is used to relieve pain.

Oxygen therapy

Croupous pneumonia leads to respiratory failure, due to which the body suffers from oxygen deficiency. You can relieve the symptoms of hypoxia with the help of oxygen therapy.

Thanks to this procedure, arterial blood is quickly saturated with oxygen to normal values. Flow oxygen therapy is indicated for all patients with hypoxemia. Before it begins, the airways must be cleared of mucus and vomit.

After oxygen therapy, the patient’s state of health returns to normal, shortness of breath disappears, breathing is restored. The person is able to take deep breaths.

UHF therapy

UHF therapy is the heating of tissues with the help of high-frequency electromagnetic radiation. This procedure has proven itself in the complex therapy of croupous pneumonia. A contraindication to UHF is high body temperature.

The passage of UHF therapy allows you to bring recovery closer, since inflammation becomes less intense, swelling is removed from the tissues, blood flow increases, and the production of pathological exudate decreases. Under such conditions, the microbial flora ceases to multiply, and the activity of surviving bacteria decreases.

The course consists of 10-15 procedures, the duration of each of which is 15 minutes.

Diet

Diet plays an important role in the treatment of pneumonia. It helps the body to cope with the disease faster.

Key recommendations:

• The menu should contain foods rich in calcium: milk, cheese, cottage cheese.

• Refuse to consume foods – sources of fast carbohydrates.

• At an early stage of the disease, emphasis is placed on liquid meals. While the patient has a high body temperature, he is offered fruit and vegetable juices, fruit drinks, jelly.

• The diet includes fruits and berries. Citrus fruits, plums and currants are especially useful.

• The daily volume of fluid is at least 2 liters.

• The menu should be enriched with foods that are a source of vitamin A. It is necessary for the lung epithelium for normal recovery. Therefore, the diet includes milk, eggs and liver.

• To normalize the intestinal microflora, the body needs vitamin B, which is found in meat, fish, buckwheat, and bread.

Children with lobar pneumonia often refuse to eat. You don’t need to force feed your baby. He is offered light foods: sauerkraut, pickled cucumbers, meat broth. These dishes are excellent appetite stimulants.

Prevention

The main prevention of pneumococcal infections is the pneumococcal vaccine. It is indicated for young children, as well as for persons from an increased risk group.

Two vaccines are registered in Russia today:

• Prevenar (USA) – you can vaccinate children from 3 months;

• Pneumo 23 (France) – approved for use in children from 2 years of age.

The formed immunity lasts for 5 years, after which re-vaccination is required.

General recommendations for prevention:

• Avoid hypothermia.

• Lead a healthy lifestyle, stop smoking and alcohol.

• Treat chronic diseases.

• They will be hardened.

• Do sport.