DISEASES OF THE RESPIRATORY SYSTEM : LOBAR PNEUMONIA (PNEUMONIA CROUPOSA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Lobar pneumonia – lung disease, which is accompanied by massive bilateral inflammatory involvement of the lung tissue with a pronounced intoxication syndrome and secondary changes of the internal organs.
The causative agent in 95% of cases the pneumococcus Frenkel-Wexelbaum, 2% diplobacillus Friedlander, strepto-aureus.
The pneumococcus is found in 32 varieties. There are I, II, III type and the team which unites the 29 species X-group in which the most important are V, VII and VIII type. Specific effect and virulence of pneumococci is due to a complex polysaccharide in the bacterium. Contributing factors are lowered resistance of the nervous system, which, in particular, may be due to the cooling, especially in unseasoned persons; the role also dusty air, all weakening of the body caused by a lesion of respiratory organs, blood circulation, diseases of metabolism, acute infections, which are also being implemented primarily through the nervous system.
Aerogenic infection penetrates through the bronchi, distributed peribronchial and perivascular lymphatic system, affecting the local nervous apparatus, interstitial tissue, and then the alveoli. Lose covers the whole or a substantial part of it. Microbial toxins damage is primarily vascular and Central nervous system and, to a lesser extent, parenchymal organs. In severe cases there is bacteremia.
The prodrome is rare. Usually begins suddenly spectacular chills, fever up to 39-40º, stitches in the side, painful, dry, and then with rusty sputum cough. On the lips, the nose appears herpes simplex. Breathing learning, there is a cyanotic, subicteric. Over the affected easy first determined blunting tympanic sound, then more intense, but not absolute stupidity. Bronchial breath; auscultated crepitus, finely wheezing later. Bronhofoniya and voice trembling .strengthened. Rentgenologicheski — homogeneous darkening saltwat ingly lobe. Mucus viscous, scanty, often rusty, contains pneumococci. Pulse speeded up, blood pressure is lowered. The second tone on the pulmonary artery is amplified. The liver is enlarged. In the urine increased content of urobilin, a reduced amount of chlorides. In blood leukocytosis, sharply accelerated ROHE, often hyperglycemia. From the nervous system — delirium, agitation, insomnia, alcoholic delirium tremens, acute psychosis.
Temperature type continua (39—40º) is kept untreated cases, 4-15 days; most often it crashes is critical for 5-9 day of the disease. In atypical cases there is a remittent fever. The crisis is preceded by the deterioration of the General condition. During the crisis the temperature falls within 12-24 hours to normal; there is a strong sweating, drop in blood pressure. We can fear the collapse of peripheral circulation due to a drop in vascular tone. Can occur in pulmonary edema. Sometimes there is migration of pulmonary lesions consistent with involvement of multiple lung lobes. In these cases, for pneumonia lobar protracted, often ends by lysis. The course has completely changed since the introduction of sulfonamide therapy. The fever lasts no more than 27 to 36 hours after the start of treatment. Intoxication quickly eliminated, the collapse does not develop. Changes in light are stopped, if treatment is assigned on the first day of the disease. At a later beginning of treatment changes in breathing and wheezing can stay a week or longer.
Pulmonary edema, abscess from decay, exudative or purulent pleurisy, indurate of the lung, pneumococcal lesion of other organs (pericarditis, endocarditis, otitis media, meningitis, arthritis), acute nephritis.
Difficulties for the diagnosis of lobar pneumonia is Central pneumonia, in which no fizikalna symptoms, massive pneumonia, which is characterized by intense stupidity and weakening of the respiration and voice shaking, that resembles a pleural effusion, and asthenic pneumonia with protracted, simulating pulmonary tuberculosis.
Reference points for diagnosis:
Diagnostic value has the determination of type of pneumococcus.
In untreated cases depends on the type of pneumococcus (see above) and the reaction of the host (vascular and nervous system). Rehabilitation begins after 3 — 4 weeks after the fall of the temperature.
Hardening of the body, physical education, gitrepository.