Focal pneumonia in children

Pneumonia is an acute infectious disease. It manifests itself as a syndrome of respiratory disorders. When carrying out the roentgenogram, infiltrative changes are seen. Most often, focal pneumonia occurs in children, it is characterized by an infectious and inflammatory lesion observed in a limited area of lung tissue.

ICD-10 code

Pneumonia is classified as J12-J18. According to the code for μb 10 there are several forms of the disease. The first of these is out-of-hospital. It occurs at home or after 48 hours after being in the hospital. Its course is favorable, lethal outcomes are extremely rare.

The second form is hospital. It can develop after 48 hours, after the patient has been discharged from the hospital. This category includes patients with ventilator-associated pneumonia. This includes victims with pneumonia, who are on maintenance in nursing homes. The degree of lethality in this case is great.

The third form is aspiration pneumonia. It develops by swallowing a large amount of the contents of the oropharynx, a patient who is unconscious. This is due to violations of the act of swallowing, as well as a weakened cough. Under this category, people with alcohol intoxication, craniocerebral trauma, epilepsy, etc. Fall. Aspiration of gastric contents does not exclude chemical burns.

Causes of focal pneumonia in children

The development of the disease provokes pneumococci and streptococci, as well as viruses, fungi and even physical and chemical factors. The main causes of the formation of focal pneumonia in children lie in the previously transferred disease. This can provoke as an ordinary allergic reaction, affecting the lungs, and a complicated cold.

The mucous membrane of the child's airways is too sensitive. This is due to the large "content" in it of a large number of vessels. That is why pathogenic flora, penetrating into it, causes rapid edema. Thereby disturbing the ventilation of the lungs. It becomes difficult for the ciliated epithelium to remove phlegm from the lungs, this contributes to the creation of a favorable environment for the development of microorganisms.

For focal pneumonia is characterized by the presence of a single lesion. Its area is 1 cm, and this is only a minimum. Often, the problem arises in the background of chlamydia. The main and most dangerous of its complications is pneumonia. All this shows that any diseases, including respiratory infections, need to be eliminated on time.

[1], [2],

Pathogenesis

In focal pneumonia, the inflammatory process is limited to the lobule or segment of the lung. Often, the arisen foci can merge with each other, thereby exacerbating the situation. With a superficial localization of the pleura, it gradually becomes involved in the inflammatory process. The pathogenesis of focal pneumonia is not accompanied by an immediate type of hypersensitivity. This feature does not allow the inflammatory process to flash instantly. Here everything happens gradually and quite slowly, than with violation of vascular permeability.

The escudant in pneumonia contains a small amount of fibrin. Most often, it is serous or mucopurulent. This does not allow creating conditions for the release of red blood cells. Focal pneumonia is always characterized by bronchopneumonia. This condition is characterized by an inflammatory process with damage to the bronchial mucosa. So, much of the escudant is contained in the lumen of the airways. This condition provokes violations of bronchial obstruction.

The disease has a number of distinctive pathogenetic features. So, the inflammatory process captures a small area, within a single lobule or segment. For pneumonia, a normal or hyperergic reaction of the body is characteristic. Eskudant serous or mucoid-purulent. Defeat can spread to the bronchi, which causes their obstruction. There are no clear stages of development of the disease.

Symptoms of focal pneumonia in children

The main symptomatology is catarrhal phenomena. The organism is in a state of general intoxication. In focal pneumonia, children develop certain symptoms, including radiologic changes.

Syndrome of general intoxication may occur in a number of other diseases. It is characterized by signs of toxicosis. The baby changes in behavior, apathy can occur, or on the contrary, increased excitability. Often there are severe disorders of consciousness, appetite decreases, vomiting and tachycardia appear. Vomiting occurs in extremely severe cases. The fever persists for more than 3 days. The syndrome of catarrhal phenomena develops against the background of an acute respiratory infection. In 50% of all cases, it indicates the presence of pneumonia. It all starts with a cough, mostly it's wet.

Lung infection is a typical symptom of the disease. Dyspnea does not always manifest itself, however, wheezing is present. The presence of hematologic changes indicates the presence of focal lesions of the lungs. To confirm the diagnosis, X-rays are performed. Pneumonia is characterized by the presence of homogeneous shadows or inhomogeneous shadows.

First signs

Determine the presence of pneumonia and can be at home, without examining the doctor. So, the condition is characterized by a shortage of air. In this case, the respiratory rate begins to increase, and the skin becomes blue. This condition is the first signs of the disease, it occurs against the background of the defeat of the alveoli and smooth muscles of the bronchial wall.

The kid becomes irritable, constantly crying. Body temperature is between 38-40 degrees. The presence of such symptoms requires immediate treatment in the hospital. The child has a decrease in reflexes. There may be changes in the process of digestion of food, as well as weight loss. A child can refuse food, he often vomits. This indicates the presence of pathological changes in the intestines, which can provoke diseases of the respiratory tract.

Often observed pathology of the cardiovascular system. It can, accompanied by a violation of blood supply in a small circle. Clinical symptoms can intensify. Determine the presence of the disease can be by cyanosis of the skin, as well as swelling of the extremities. Against this background, heart rhythm disturbances develop. The baby can be overly active, or on the contrary, sluggish. Failure to eat, bowel disorder and vomiting are yet another indication of the presence of the disease.

[3], [4], [5], [6], [7], [8]

Effects

Focal pneumonia can lead to serious changes in the cardiovascular system. Often observed tachycardia, an expansion of percussion boundaries and even muffled I tone at the top. Some patients have moderate or low intensity shadows. In this case, their contours are violated. These effects occur against the background of infiltration. But if the acini are affected, then on the roentgenogram the foci of inflammation can not be detected.

The shadow of the lung acquires a significant increase. In the patient's blood, leukocytosis can be detected. The number of white blood cells can be unchanged, even within normal limits, but there is a pronounced leukopenia. The index of ESR increased.

To date, focal pneumonia is not particularly dangerous. It can be eliminated through modern effective antibiotic treatment. Antibacterial therapy gives a positive result and at times reduces the risk of consequences.

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Complications

Focal pneumonia is not capable of leading to the development of serious complications. For today it is perfectly treated. Thus, it is possible to eliminate not only the painful symptomatology, but also the disease as a whole. Modern antibacterial drugs really do wonders.

Despite such an optimistic forecast, it is not worth completely excluding the possibility of consequences. So, in the first place, the cardiovascular system may suffer. Possible development of tachycardia. Can suffer and the circulatory system. What is most interesting, the number of leukocytes remains within normal limits, but nevertheless leukocytosis or leukopenia is found. The indicator of ESR is increased.

If you start a timely treatment, get rid of the symptoms and reduce the risk of further consequences will be easy. Focal pneumonia does not often cause death. There is no need to worry about this.

[12], [13], [14], [15], [16], [17]

Diagnosis of focal pneumonia in children

Recognize the presence of the disease on cough and the presence of signs of acute respiratory disease, pneumonia is characterized by an elevated temperature, which stays firmly for more than 3 days. This requires a differentiation of the process. When diagnosing focal pneumonia, the doctor should examine the lower respiratory tract in children. The disease is characterized by the presence of a shortened percussion sound, shortness of breath and wheezing.

The second stage should differentiate pneumonia with bronchitis. It is characterized by the presence of rapid breathing, especially in cases where the lesion is extensive. This symptom is really significant if there are no signs of obstruction. When diagnosing a specialist, he discovers a shortening of the percussion sound. Above the lesion, small bubbles or crepitations can be seen.

When making a diagnosis, they rely on laboratory data. The presence of leukocytosis may indicate the presence of focal pneumonia. This state is characterized by a definite indicator of leukocytes, fluctuating within the range below 10 · 109 / L. As for ESR, this figure is 30 mm / h, or significantly exceeds it. In some cases, the diagnosis of the delivery of C-reactive protein is prescribed. Its level should be more than 30 mg / l.

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Analyzes

When diagnosing, doctors pay attention not only to external data. An important role is played by laboratory tests and biochemical indicators. The laboratory blood test is taken from the finger. For the inflammatory process in the body is characterized by an increase in leukocytes or lymphocytes. A special role is played by the index of ESR, in the normal state it should not exceed the norm.

An increased number of leukocytes indicates the presence of bacterial inflammation in the body. With severe intoxication, an increase in rod-shaped forms is observed. Lymphocytes are capable of producing antibodies, the main purpose of which is the destruction of viruses.

You can see the changes in the body according to the index of ESR. It determines the level of the column of erythrocytes at the bottom of the capillary. It is formed within an hour, thanks to subsidence. Normally, the speed is 1-15 mm per hour. With pneumonia, the indicator can increase several times and be 50 mm / hour. ESR is the main marker of the course of pathology.

Biochemical analyzes allow one to assess the effect of the pathological process on other organs and systems of the body. An increase in the level of uric acid indicates the presence of problems in the work of the kidneys. An increase in the level of liver enzymes about the destruction of hepatocytes.

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Instrumental diagnostics

The implementation of diagnostic measures implies a clarification of the nature and specificity of the pathogen, as well as the severity of the inflammatory process. To cope with this task, instrumental diagnostics helps, by means of special techniques.

The most important method in this is a chest X-ray. In the presence of focal lesions in the image, there are distinct types of darkening or shadow. A no less effective way to diagnose the disease is computed tomography. Thanks to it, it becomes possible to detect the infiltration of the lung tissue. As for bronchography, it makes it possible to reveal cavities of decay. Often resorted to a radionuclide study of pulmonary blood flow.

It is impossible to make a diagnosis solely on instrumental research. To complete the picture, you need to obtain the results of laboratory studies. What tools to apply, the doctor decides.

Differential diagnostics

The first step is to examine the patient. For pneumonia is characterized by fever, within 38 degrees, chills and general weakness. At this stage, and resort to the help of differential diagnosis, because you need to identify changes that occur in the circulatory system. The blood test allows you to notice pronounced leukocytosis. In addition to the blood, sputum is also examined, this will help determine the causative agent of the disease.

Other "raw materials" for the study does not give up. At least, at the stage of identifying the disease, this is not necessary. In due course it is surrendered on research of urine. A high level of acid in it indicates the spread of the inflammatory process. Most likely, kidneys are affected. The diagnosis is based on the aggregate data of differential and instrumental studies. This will allow you to notice all the nuances and prescribe an effective treatment that will not allow the development of complications.

[23], [24], [25]

Treatment of focal pneumonia in children

The first thing the child must be hospitalized, the disease is not eliminated on its own. When the diagnosis was accurately delivered, erythropic therapy begins. With some doubts, before starting treatment in a child of focal therapy should make an X-ray.

To date, the disease is eliminated through the antibiotics of the penicillin series. Together with them enzyme inhibitors are often used. Their effectiveness in this case was proved by such drugs as Augmentin and Timentin.

At home, you need to provide the child with normal care. In addition to drugs, you need to eat right, set the drinking regime. The diet should consist of light meals and food. Preference is given to beef, vegetables, fruit and low-fat chicken. A special role is played by the drinking regime. Fever can lead to dehydration of the body. A large amount of liquid allows to excrete phlegm from the body. Children should consume 3 liters of water, give preference to alkaline mineral water, fruit juices and milk.

Observe the bed rest. It is important that the baby's bed and underwear is always clean. After all, with fever, the baby sweats heavily. The room temperature should not exceed 20 degrees. The room should be ventilated, but do not create drafts.

Infants should be given 150 ml of fluid per day per kilogram of body weight. If the baby is breastfed, the amount of fluid used should be monitored by the mother. In a hospital, the missing amount of fluid is administered intravenously.

Medications

Medicamental treatment implies the use of antibiotic therapy. Antibiotics are prescribed immediately after diagnosis. When carrying out antibacterial therapy, it is necessary to take into account the length of stay of the drug in the body. At the beginning of the treatment, a broad spectrum of antibiotics is preferred. Most often appoint Ampicillin, Levomycetin and Tetracycline. If pneumonia was caused by Pseudomonas aeruginosa, preference is given to Nizoral, Nystatin and Metronidazole.

• Ampicillin. The remedy is applied inside, regardless of the food intake. Single dose is 0.5 grams. The maximum dosage should not exceed 3 grams. Take the drug is not worth the children under the age of 3 years. Possible manifestation of allergic reactions, nausea, diarrhea and stomatitis.
• Levomycetin. The remedy is used 30 minutes before meals. Dosage - 0.5 grams, maximum - 3 grams. Take the drug is not necessary for skin diseases, as well as newborns. Side effects: dyspeptic phenomena, hallucinations.
• Tetracycline. The drug is used 4 times a day for one tablet. It is advisable to do this 30-60 minutes before meals. Contraindications: children under 8 years of age, hypersensitivity. Perhaps the development of allergic reactions.
• Nizoral. The drug is used once a day. The duration of treatment depends on the patient's condition. People with severe impaired functions of the liver and kidneys are not allowed to use it. Can lead to dyspepsia.
• Nystatin. The product is used regardless of the food intake. The dose is appointed individually, the treatment period does not exceed 10 days. Use medicament is not possible with hypersensitivity. Negative reactions on the part of the body, in the form of allergies and dyspepsia, are not ruled out.
• Metronidazole. The drug can be taken in the form of tablets or candles. The daily dose does not exceed 2 tablets per day. Suppositories are placed rectally at night, for 10 days. Use the drug is not possible with hypersensitivity. May cause a number of side effects, including a metallic taste in the mouth, nausea, general malaise.

To the widely used antibiotics include: Cefamandol, Mezlocillin and Tobromycin. Duration of treatment should not exceed 15 days.

• Cefamandol. The agent is administered intravenously or intramuscularly. It is enough 50-100 mg per kilogram of weight. The dose is chosen by the attending physician. The remedy should not be used by a newborn. Perhaps the development of nausea, vomiting, skin rashes.
• Mezlocillin. The agent is prescribed in a dose of 75 mg per kilogram of weight. Use the drug can be even a newborn, but with extreme caution. People with hypersensitivity to the components of the drug are at risk. Development of dyspeptic phenomena and allergies is not ruled out.
• Tobromycin. A sensitivity test is required before use. The dose is prescribed exclusively on an individual basis. Use the drug is not recommended for hypersensitivity. Perhaps the appearance of a headache, nausea, general lethargy.

This is not all drugs that are used in the treatment of focal pneumonia. The most common variants were presented above. How to treat and to help, what medication to resort, solves the attending physician.

Alternative treatment

Alternative medicine is famous for its many effective recipes. All of them allow to eliminate the disease without harming the body. But with alternative treatment, it is worth considering one fact: it is not recommended to use it without the knowledge of the doctor. Not always medicinal herbs are able to help in the same way as a quality antibiotic.

The child is recommended to drink hot infusion from the violet grass. It is advisable to use a tincture of magnolia vine, 2 times a day for 30 drops. The most favorable time for this is morning and day. To help the ordinary olive oil is also capable, the main thing is that it should be at room temperature. Coping with the disease will help oatmeal with butter and honey, the main thing that it was very liquid.

It is recommended to take 3 times a day a decoction of aloe leaves along with honey. Prepare a remedy simply, enough to cut a leaf of aloe and mix it with 300 grams of honey. All this is mixed together with half a glass of water and cooked on low heat for 2 hours.

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Herbal Treatment

For the preparation of effective means, it is enough just to get medicinal herbs. Alternative methods of treatment have long been used. Thanks to him you can eliminate any disease, but before choosing a herbal treatment, it is worth consulting with a doctor.

• Recipe number 1. It should be taken evenly: grass herbs, umbellate centipedes, sage, wormwood and plantain. All the ingredients are crushed and poured in one and a half liters of boiling water. The drug persists throughout the night, filtered in the morning. Drink should be consumed 2-3 times a day, until there is a complete recovery.
• Recipe number 2. In an equal amount, you need to take thyme, spores, dill, anise, licorice root and pine buds. All the ingredients are thoroughly crushed and poured half a liter of boiling water. It also persists all night, and in the morning it is filtered. Take it 2-3 times a day until complete recovery.
• Recipe number 3. Should take leaves or buds of birch, grass of St. John's wort, eucalyptus, string, motherwort and sweetbread. Dilute all this with the roots of marshmallow, elecampane, cyanosis and angelica. To all the bouquet are added mullein flowers. All the ingredients must be crushed in a coffee grinder and pour half a liter of boiling water. During the night the product is infused, then ground and used up to 3 times a day.

Homeopathy

Homeopathic remedies have proved themselves from ancient times. However, not all of them can help. The fact is that they are based on natural components. It is important that a person does not have allergies to certain components. Otherwise, homeopathy will do harm.

There are certain drugs that help fight inflammatory processes in the airways, including pneumonia. Improvements from the reception of these funds are already observed on the second day. If this did not happen, it is worth giving preference to another drug.

Arsenicum album. This drug has a pronounced effect with right-sided pneumonia. Antimonium tartaricum. Applied with the appearance of mucus, as well as gurgling sound from the chest. Bryonia alba. Used at elevated temperature, as well as pain in the chest. Kali carbonicum. It is used for exacerbation, when the baby is very shivering, and his eyelids swell. Lycopodium. Perfectly helps with right-sided pneumonia. Phosphorus. They are used for chest pain, especially when the pain is manifested when the baby lies on the left side. Pulsatilla. Helps to cope with the inflammatory process and calms the child. Sulfur - applicable for burning in the lungs.

Self-administering homeopathic remedies is highly discouraged. It is necessary to do this only under the guidance of an experienced specialist in this field.

Operative treatment

Surgical intervention is extremely rare. It is shown to certain categories of victims. So, operative treatment is widely used only in the event that complications have begun or there is a risk of their development.

In some cases, conservative therapy shows its inefficiency. This happens with an adequate degree of activity. Perhaps this phenomenon with the prevalence of the process, as well as its duration is not less than one year. Defeat can go beyond the lung, and this requires surgical adjustment. At the age of over 7 years, and also with the development of complications, surgical intervention is the only chance to overcome the disease.

Surgical intervention has its contraindications. So, it can not be applied in a vast bilateral process that arose against the background of genetically determined hereditary diseases. Systemic diseases are also contraindications.

Prevention

Preventive measures consist in hardening. A toddler must be taught from an early age to air baths and do wet wiping. This will temper the immune system. Thus, it will increase the ability to withstand bacteria, viruses and colds. Therefore, prevention from an early age is very important.

In most cases, focal pneumonia develops against the background of influenza. Therefore, the first preventive action is the timely elimination of the disease. Do not neglect the methods of strengthening the immunity of the child.

If the baby suffers from protracted diseases, the development of hypostases should be prevented. The child should turn over more often while lying down. Timely elimination of cardiovascular diseases will avoid possible consequences. Finally, the child should be taught not to inhale the air with his mouth. It is necessary to exclude this in winter and autumn. Breathing paths can be slightly covered with a scarf. It is advisable to move slowly, so as not to provoke the acceleration of the rhythm of breathing.

Forecast

If the child has been provided with timely antibacterial therapy, then the further course of the disease will be favorable. After discharge, the child must be placed on dispensary records. This will prevent the development of relapse. After discharge from the hospital, the baby should not visit children's institutions. After all, his body is weakened and there is a risk of re-infection. If you comply with these rules, the forecast will be purely positive.

Do not ignore the rehabilitation period. It is advisable to conduct it in special departments of the hospital or sanatoriums. Daily breathing exercises will be useful. As for nutrition, it is important that it is rational. Rehabilitation with medication should be carried out on individual indications.

Physiotherapy is widely used. The child should put mustard plasters, do ozocerite applications on the chest. A chest massage is performed. If all recommendations are observed implicitly, the forecast will be extremely positive.

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