Focal pneumonia

One of the dangerous types of acute inflammation of the respiratory system is focal pneumonia. Consider the features of the disease, symptoms, signs, methods of treatment and prevention.

This form of infectious and inflammatory process progresses in a limited area of lung tissue, that is, within the lobular lobe.

Focal pneumonia can be a complication of other diseases (bronchitis, tonsillitis, bronchial inflammation) or act as an independent disorder. Since the disease begins with the bronchi, it is often called bronchopneumonia.

[1], [2], [3], [4]

Causes of the focal pneumonia

Since most of the disease is secondary, the main factor that provokes it is the complications of acute respiratory viral infections. The causes of focal pneumonia may be associated with the activation of secondary infections that develop on the background of bronchitis, furunculosis, whooping cough, scarlet fever, otitis and other ailments.

The main infectious agents are - viruses, pneumococci, staphylococci, streptococci. The causative agent can spread lymphogenous, bronchogenic and hematogenous. Inflammation arises on the mucous membrane of the bronchi, and gradually affects the bronchioles, alveoli and lung tissue. Foci of inflammation can be small and large, merge, while they do not go beyond the segment or the lobes.

Causes of focal pneumonia in adults and children:

• Stresses and nervous experiences that drain the body.
• Inadequate nutrition, deficiency of vitamins, minerals.
• Harmful habits (smoking, alcoholism).
• Presence of chronic diseases.
• Infectious lesions of ENT organs.
• Prolonged cooling or overheating in children.
• Insufficient physical development and lack of hardening.

In addition to the above reasons, the disease can occur when the permeability of the vascular wall is impaired. This contributes to the formation of serous and mucopurulent exudate, which accumulates in the lumen of the bronchial tree.

[5], [6], [7]

Risk factors

Smoking, hypothermia, inhalation of toxic substances, stress and alcoholism cause violations of the protective systems of the bronchial tree and provoke the multiplication of harmful microorganisms with penetration to the alveoli and bronchi. The further nature of inflammation depends on the properties of the pathogen, the disturbance of microcirculation in the lesion.

[8], [9], [10], [11], [12], [13], [14]

Pathogenesis

The causative agent of the disease can be any harmful microorganism. Pathogenesis is often associated with pneumococcal infection. The disorder can provoke: streptococci, staphylococcus, anaerobic microbes, protozoa, E. Coli, fungi. As a rule, pathogens penetrate into the lung tissue by a bronchogenic route. Lymphogenous and hematogenous pathways, are characteristic for pneumonia, a prominent complication of the underlying ailment.

Morphology of focal disease:

• A small hearth lesion.
• Violation of patency of large and small bronchi.
• Moderate violation of the degree of vascular permeability.
• Gradually the progression of the inflammatory process.
• Separation of serous or purulent-mucous exudate.
• Absence of marked stages in the pathological process.

Pathological anatomy indicates that in the early stages of inflammation, the pulmonary tissue is edematous, hyperemic, later it becomes dry, gray and compacted.

[15], [16], [17],

Symptoms of the focal pneumonia

The disease is easily recognized by its characteristic symptomatology: chills, dry cough with little sputum, general weakness and pain in the chest.

Characteristic pathology signs can develop gradually or take an acute form. As a rule, the disease begins to progress after catarrh of the upper respiratory tract, against the background of influenza or acute form of bronchitis. It is the secondary nature of the disease that does not allow us to recognize the symptoms.

Pulmonologists distinguish the following symptoms of focal pneumonia:

• Elevated body temperature is 38-39 ° C.
• Painful sensations in the chest.
• Dry cough with sputum.
• Rapid breathing and palpitation, tachycardia.
• Headaches and sweating.
• Reduced appetite and general weakness.
• Chills, fever.

The focal shape is characterized by high fever, but if the disease occurs against the background of a weakened immune system, then subfebrile is maintained. With timely therapy, the temperature persists for 3-5 days. Cough can be both dry and wet, with impurities of pus in the sputum. If the pathogen has become a streptococcal infection, then the above symptoms are accompanied by exudative pleurisy.

[18], [19], [20]

First signs

In pneumonia, an infectious and inflammatory process affects the bronchi and surrounding tissues, several segments of the lungs. The first signs depend on the causative agent of the disease and the protective properties of the patient's immune system. The disease is characterized by a gradual onset, which occurs against the background of an advanced ARVI or bronchitis. In this case, there are symptoms such as: fever, increased weakness and sweating, shortness of breath, cyanosis of the skin, headaches. When coughing, bleeding or mucopurulent sputum may be removed. When listening, note the hard breathing, dry wheezes.

• Consider the signs of focal inflammation of the respiratory system, depending on the infectious agent:
• Staphylococcus - the disease has an acute onset. Headaches and pains in the chest, hemoptysis, confusion, irregular fever and diurnal temperature fluctuations.
• Gram-negative diplobacillus Fridlendera - most often this pathogen affects patients older than 35 years who abuse alcohol and do not adhere to a healthy diet. The main symptoms: severe fever, shortness of breath, blue skin and mucous membranes, coughing with mucous sputum. Sputum has an unpleasant smell, signs of intoxication are observed.
• Viral defeat - acute onset, high fever (lasts up to 12 days), nosebleeds, hemoptysis, cough, convulsions, fever, shortness of breath.

[21], [22], [23], [24]

Dyspnoea with focal pneumonia

Dyspnea is a respiratory disorder that causes a shortage of air. Dyspnoea with focal pneumonia depends on the stage of the disease. Disturbances of respiration can occur both at rest and after active physical activity. Dyspnea is attributed to the main signs of acute respiratory failure. With this disorder, the respiratory system is unable to fill the needs of tissues and body cells in oxygen, and the compensatory mechanisms are completely depleted. Gradually increases the partial pressure of carbon dioxide and decreases the pressure of oxygen in the blood, accumulates the products of metabolism, which entails respiratory acidosis.

Dyspnea with inflammation of the bronchi and lungs occurs due to the accumulation of inflammatory exudate in the alveoli. This leads to a disruption in the exchange of carbon dioxide and oxygen between the capillaries and the alveoli. There are three forms of respiratory failure:

• Parenchymal - with normal ventilation of blood there is insufficient oxygenation of blood, hypoxemia, normocapnia.
• Ventilation - pulmonary ventilation is reduced, worsened by the perfusion-ventilation process, which leads to the progression of hypercapnia and hypoxia.
• Mixed - a combination of the above forms. It is it that develops in the focal inflammatory process.

Dispno is accompanied by additional pathological symptoms - cyanosis, tachycardia, anxiety, severe bronchial breathing, cardiac rhythm disturbance, tachypnea, arterial hypertension. With pronounced symptoms, the patient is hospitalized and urgently oxygenated.

Dyspnea may also appear after recovery. This complication indicates that the inflammatory process is still progressing, that is, pathogenic microorganisms continue to destroy lung tissue. Lack of medical care or untimely treatment in the hospital can lead to empyema of the pleura, sepsis, adhesive pleurisy and lung abscess.

[25], [26]

Focal pneumonia in children

Diseases of the respiratory system in patients of childhood are always acute and cause a number of complications. Focal pneumonia in children is very common and is characterized by inflammation of lung tissue of small size. Its course is significantly complicated if the inflammatory areas merge. In this case, the focal lesion assumes a draining form, which passes heavily and is predisposed to the destruction of tissues.

The ailment is provoked by various streptococci and pneumococci, bacteria, fungi, viruses and even physical factors. Pneumonia can act as a complication of an allergic reaction or another disease affecting the airways. Disease-causing microorganisms penetrate the mucous membranes and cause their puffiness, provoking congestion of sputum.

Symptoms:

• Subfebrile temperature, which can rise to 39 degrees.
• General weakness, lack of appetite, lethargy, decreased activity.
• Grimaces and shortness of breath.
• Hyperemia of the facial skin and blue skin near the nose.
• After a cough, painful sensations appear in the chest.

All of the above signs are an immediate reason to take your child to a doctor. With timely diagnosis and treatment, the disease can be eliminated with minimal complications.

Focal inflammation of the respiratory system in children is detected using laboratory tests (blood, urine, sputum) and chest X-ray. If the diagnosis has confirmed the presence of the disease, then etiotropic therapy is used for treatment. The child is prescribed drugs of different groups for optimal elimination of infection.

[27], [28], [29], [30]

Stages

Symptomatic of inflammatory lesions of the bronchi and lungs depends on the neglect of the pathological process. Stages of focal pneumonia can classify the ailment by the first signs and condition of lung tissue during X-ray examination. There are such stages:

• The first 1-3 days of illness is the tide stage.
• 4-7 day of ailment - curation, pulmonary tissue changes color.
• From day 7 until complete recovery - the stage of permission.

Symptoms may differ in severity. Consider the main stages of the disorder

1. Light - intoxication of the body is mild. The patient retains normal blood pressure, clear consciousness, subfebrile temperature.
2. The average - intoxication is moderately pronounced, weakness, fever, easy breathing, lowering of blood pressure, sweating are observed.
3. Severe (acute) - severe intoxication, a temperature of 39-40 degrees, severe shortness of breath, cyanosis, heart palpitations, lowering of blood pressure.

[31], [32], [33], [34]

Forms

If the disease takes a chronic form, then there is a sharp progression of all symptoms. The patient complains of a protracted cough, the departure of a large amount of sputum and high body temperature. But it is possible to flow with less severe symptoms, which gradually progresses.

[35], [36], [37]

Acute focal pneumonia

Inflammation of the respiratory system can have several forms, which differ in their course. Acute focal pneumonia is characterized by pronounced symptomatology. The disease occurs against the background of an acute viral infection of the upper respiratory tract. Inflammation begins with the bronchi and passes to the alveoli. The first sign is a sharp rise in temperature, a cough and a chill. At first, the cough is dry, but after 1-2 days it becomes wet with the separation of muco-purulent sputum.

Clinical symptoms directly depend on the depth of the pathological changes and the spread of inflammation. The fever is of the wrong type and lasts up to ten days. The temperature drops gradually, while the subfebrile condition persists for a long period of time. Many patients have bronhophonia and shortening of percussion sound over the zone of lesions. At auscultation, hard breathing is observed, dry wheezes.

X-ray picture is characterized by acute changes in the lungs. The sites of infiltration are combined with unmodified pulmonary tissue. There can be single, large, small multiple and drainage infiltration sites. Pathology can have both a one-sided and two-sided form of inflammation.

[38], [39], [40]

Focal and drain pneumonia

A pathological process that involves several segments or completely a fraction of the lung indicates a drainage form of inflammation. Focal-drain pneumonia is characterized by an increase in signs of respiratory failure and a sharp lag of breathing on the side of the lesion.

On the roentgenogram separate foci of inflammation are visible, which change with microabscesses and emphysematous tissues. In its symptoms, this form is similar to croupous pneumonia. It has a severe course with toxicosis, destruction of lung tissue, cardiac and respiratory insufficiency. Treatment takes place in a hospital with a long course of antibiotics and immunostimulants.

[41], [42], [43]

Community-acquired focal pneumonia

There are several forms of infectious-inflammatory lesions of the respiratory system. Community-acquired focal pneumonia is a disease that occurs on an outpatient basis, that is, at home. Despite a wide choice of antibacterial drugs, the incidence and mortality rate remains high.

The etiology of the disease is associated with the progression of a typical microflora, which affects the upper respiratory tract. Predisposing factors are bronchopulmonary disorders, pathology of ENT organs, smoking, hypothermia, weakened immune system. Clinical manifestations depend on the form and causative agent of the disease.

• Pneumococcal - occurs in 30-50% of all cases of community-acquired form. It begins with a fever, a strong cough with separation of sputum, chills. Without proper treatment leads to such complications as: acute vascular and respiratory failure, parapneumonia pleurisy.
• Streptococcal - occurs after a viral infection, has an acute course and is often complicated by sepsis. The main symptoms: high fever with sudden fluctuations in body temperature, increased sweating, separation of sputum with blood veins. Possible complications: abscessing, exudative pleurisy.
• Staphylococcal - the causative agent is Staphylococcus aureus, which is associated with respiratory viral infections, influenza A and B viruses. It is characterized by peribronchial lesion with the development of multiple and single lung abscesses. The main symptoms: intoxication of the body, fever, shortness of breath, cough with the discharge of purulent sputum.
• Viral - is caused by adenoviruses, influenza A, B viruses. Inflammation begins with pronounced edema of the bronchial mucosa and alveoli. The main complications are thromboses, necrosis, bleeding. From 3-5 days the ailment takes a viral-bacterial form.

[44], [45]

Two-sided focal pneumonia

Long-term intubation anesthesia, artificial ventilation and pathological microbial infections lead to the defeat of both lungs. Two-sided focal pneumonia is accompanied by severe signs of intoxication and severe pain in the chest. This form has the following symptoms:

• High temperature, which is difficult to bring down antipyretics.
• Acute headaches and pain in the chest, which are exacerbated by inhalation.
• Increased sweating and shortness of breath.
• Cough with separation of purulent sputum with blood clots.
• Eruption, pallor and cyanosis of the skin.

Treatment is medically administered. The choice of drugs depends on the pathogen and the general health of the patient. Patients are prescribed a complex of antihistamines, anti-inflammatory and immunostimulating agents. For the speedy recovery of the body using physiotherapy procedures.

Focal pneumonia of the right lung

Right-sided inflammatory lung damage develops much more often than the disease on the left side. This is due to the anatomical features of the structure of the respiratory system on the right. The accumulation of bacteria and viruses in the right bronchus is due to its oblique direction. Infection occurs against the background of a decrease in the protective properties of the immune system, which penetrate into the bronchi and begin to multiply. On the roentgenogram, the inflammatory process looks like small foci of shading.

Symptoms:

• Painful sensations on the right side of the chest.
• Cough and separation of viscous sputum.
• In the sputum, blood veins can be traced.
• Severe chills, fever.
• High temperature and increased sweating.
• Pain in the chest when trying to take a deep breath.

The above characteristics are manifested in the classical form of the disease. Formation of foci of infiltration occurs gradually, the disease affects the bronchioles and passes to the alveoli. The disorder has a pronounced polymorphism, that is, on one side there are lesions at different stages of pathological development. Because the symptoms are smeared, the diagnosis process is difficult. Treatment is carried out in a hospital with antibiotics, anti-inflammatory drugs and other means.

[46], [47]

Left-sided focal pneumonia

Small lesions and moderate intoxication with a smoothed symptomatology - indicates a one-sided inflammatory process. Left-sided focal pneumonia is characterized by settling the left side of the chest with forced breathing. During the examination, auscultatory and percussion changes are revealed, indicating a pathology in the lungs. Anatomical and physiological features of the structure of the organ cause difficulties in diagnosing because of the proximity of the heart. Therefore, if there is a suspicion of left-sided lesion, CT and ultrasound are performed.

Symptoms:

• Strong dry cough.
• Painful sensations in the left side.
• Separation of sputum with blood veins.
• A weak fever.
• Change of deterioration and improvement of general condition.

As a rule, the disease occurs against the background of an infection, for example, a bronchitis, ARVI or cold. Depending on the state of the immune system and the activity of the pathogen, the disease can be represented by small foci, part of the segment of the lung or whole lobe. Antimicrobial, anti-inflammatory and antibiotic agents are used for treatment.

Focal lower-lobe pneumonia

Diseases of the bronchopulmonary system adversely affect the functioning of the whole organism. Focal lower-lobe pneumonia can cause serious complications (pulmonary edema, reactive pleurisy), so it needs timely diagnosis and proper treatment.

Most often this form of inflammation is diagnosed in children of childhood. The disease can arise as a result of a systemic disease or a prolonged allergic reaction in the lungs. Malignant pathogens penetrate into the lung tissue from the upper respiratory tract. The further reproduction and distribution of bacteria depends on the state of the immune system. Microbes attack the alveoli and, together with the mucus of the respiratory tract, attack the lower lobes of the lungs.

Symptoms:

• Subfebrile temperature.
• Dry cough with sparse sputum.
• Chills and general weakness.
• Increased sweating.

As a rule, the given form proceeds with an average weight, but at occurrence of complications and neglect of pathological process, can become the reason of a lethal outcome. During the diagnosis, special attention is paid to the radiograph and listening to breathing. For the lower lobar inflammation is characterized by increased surface breathing, wheezing, focal shading. The treatment is performed on an outpatient basis, the patient is prescribed antibiotics, antimicrobials and vitamin preparations to support the immune system.

[48], [49], [50], [51]

Upper-lobar focal pneumonia

This form of the disease of the respiratory system is characterized by a sudden and acute onset. Upper-lobar focal pneumonia causes severe chills and headaches, fever, chest pain. From the first days there is a dry cough, which quickly turns into productive with the sputum discharge. On the lips appear rashes in the form of herpes, cyanosis and hyperemia on the face. Because of the increased level of bilirubin in the blood, on the skin and on the eye sclera, yellow spots are possible. There is shortness of breath, which makes itself felt even in a state of rest.

For diagnosis, use radiography, CT and ultrasound of the respiratory system. In addition, the patient must pass a number of tests, including phlegm to determine the pathogen. Since the upper-lobe form is of bacterial origin, in diagnosis, methods of differentiation with pulmonary tuberculosis are used. Based on the results of the tests, antibacterial therapy is selected. As a rule, with timely treatment, the disease can be cured within 5-7 days.

Complications and consequences

The prolonged course of any disease adversely affects the work of all organs and systems. The consequences of inflammation of the respiratory system can cause pathological changes in the cardiovascular system (tachycardia, cardiac rhythm disturbances). If the focal form takes a croup, then on the roentgenogram it is displayed as a significant increase in the shadow of the roots of the lung. Blood tests show an increase in ESR and leukopenia.

The defeat of the bronchi and lungs is treated for a long time, so there are cases when people who have been ill face such consequences as:

• Bronchial asthma (infectious-allergic form).
• Chronical bronchitis.
• Closed pneumothorax.
• Empyema of the pleura (due to infection in the pleural cavity).
• Abscess of the lung.
• Fibrosis of the lung.
• Infectious allergic myocarditis.
• Acute cardiovascular failure.
• Dysbacteriosis.
• Infectious-toxic shock.

Most often, the disease causes respiratory failure due to the violation of gas exchange in the respiratory system. This leads to diseases, both cardiovascular and respiratory system. With timely treatment and proper diagnosis, negative consequences can be avoided.

[52], [53], [54], [55]

Complications

With focal pneumonia, complications most often occur from the respiratory organs. Complications are pathological processes in any body systems that are not a direct manifestation of inflammation of the bronchi and lungs, but are pathogenetically and etiologically related to it. They are characterized by specific manifestations that determine the course and prognosis of the disease.

Pulmonary complications:

• Empyema of the pleura.
• Multiple destruction of the lungs.
• Edema and gangrene of the lungs.
• Parapneumonic pleurisy.
• Respiratory failure.
• Bronchoobstructive syndrome.

Extrapulmonary complications:

• Sepsis.
• Endocarditis.
• Anemia.
• An acute pulmonary heart.
• Nonspecific myocarditis.
• Psychoses.
• Endocarditis.
• Meningitis.
• Pericarditis.

A severe form of pathology with large lesions and destruction of tissue causes a number of complications associated with exposure to toxins. As a rule, it is acute cardiac, hepatic and respiratory failure, infectious-toxic shock, acid-base balance disorders, thrombohemorrhagic syndrome.

[56], [57], [58], [59], [60]

Diagnostics of the focal pneumonia

To identify pneumonia and determine its type, several methods and procedures are used. Diagnosis is based on symptomatology and, as a rule, is not difficult. There is such a thing as the "gold standard" of diagnostics (developed by AG Chuchalin in 1997), consider it in more detail:

1. Acute onset (fever, fever, chills).
2. Cough with separation of purulent sputum with blood veins.
3. Auscultatory changes over the affected lung (shortening of pulmonary sound).
4. Leukocytosis, leukopenia.
5. Infiltration in the lungs (determined by the X-ray method).

During the examination of the patient, doctors use a diagnostic minimum, which consists of:

• Radiography of the chest (two projections).
• General and biochemical (liver enzymes, urea, electrolytes, creatinine) blood tests.
• Sputum examination to determine the pathogen.
• Serological diagnosis.
• Investigation of arterial blood gases (performed with severe disease).

The diagnosis is made when there is evidence of focal infiltration of pulmonary tissue confirmed by X-ray and at least two clinical symptoms (fever, cough with phlegm, rales, fever, etc.). Absence of infiltration makes the diagnosis uncertain and inaccurate. In this case, the doctor is based on complaints, local symptoms and epidemiological history.

[61], [62]

Analyzes

Diagnosis of the focal form of inflammatory lesions of the respiratory system is a rather complicated process. Analyzes allow to reveal pathological changes in an organism and to confirm the diagnosis.

Laboratory signs of the disease:

• A general clinical blood test - reveals leukocytosis with a shift of the leukocyte formula. If the disease took a croupiform form, then the toxic granularity of leukocytes appears. A severe course is characterized by an increase in ESR, aneosinophilia. If there is no reaction from the blood, this indicates a reduced status of the immune system.
• Biochemical analysis of blood - signs of inflammation are manifested as an increase in the blood of haptoglobin, lactate dehydrogenase, alpha-2 and gamma globulins, sialic acids and the appearance of C-reactive protein.
• The study of the gas composition of the blood - is evident in the severe and complicated course of the disease. For diagnosis, arterial blood is used, in which a decrease in saturation with oxygen, hypoxemia and hypercapnia is revealed.

[63], [64], [65], [66], [67]

Sputum examination

The microbiological examination in case of suspicion of the focal form of pneumonia is very important. Sputum can identify the causative agent of the disease and quantify the content of microflora. But this kind of diagnostics has certain difficulties. First of all, this is due to the fact that the coughing material is contaminated with conditionally pathogenic bacteria. Typically, this is contamination by anaerobic bacteria. To confirm the diagnosis, anaerobic microflora of the material obtained from their lower respiratory tract by aspiration through the trachea, bronchoscopy or transthoracic puncture is investigated.

The causative agent of the disease are microorganisms sown from sputum in an amount of 1 million or more microbial bodies. Simultaneously with sowing on elective biological media, sputum smears are taken during bacterioscopy. A portion of the smears are stained for cytological analysis by the Romanovsky-Giemsa method. This allows to determine the presence of atypical cells, erythrocytes, alveolar and bronchial epithelium, the number of leukocytes. The second part of the smears is used to identify gram-positive and gram-negative microorganisms and assess microflora. Staining is carried out using the Gram method.

Instrumental diagnostics

To identify focal inflammation, many different methods are used, but instrumental diagnostics deserve special attention. This diagnostic complex includes lung radiography. It allows to reveal pathological changes in tissues from the first days of illness. Focal inflammation is characterized by the appearance of separate lesions that can localize both on one and several segments of the lung.

If the disease has a complicated course, then as an instrumental diagnosis use CT and ultrasound. It is also necessary for differentiation from pleural effusion, lung abscesses, drained pleurisy and other similar diseases. There are invasive instrumental methods that help in the diagnosis of the disease. This is a fibrobronchoscopy with a quantitative assessment of phlegm, trans-torcal biopsy, transtracheal aspiration and other procedures.

Differential diagnosis

In its symptoms, focal inflammation of the lungs and bronchi is similar to other diseases that affect the respiratory system. Differential diagnosis allows you to recognize pneumonia from other lesions. First of all, differentiation is carried out with tuberculosis, various tumors, a lung infarction, chronic bronchitis, an abscess. For clarification, X-rays and tomography of the lungs, morphological and cytological examination of sputum, biopsy and bronchoscopy are performed.

From tuberculosis pneumonia differs in the localization of inflammation in the lower lobes, characteristic radiographic data and the absence of tuberculous microbacteria in sputum. The disease is difficult to distinguish from focal pneumosclerosis. Pathology is characterized by small bubbling rales in a certain area of the lung for a long period of time. Exacerbation of pneumosclerosis is similar in its features with an acute onset of focal pneumonia.

Difference of croupous pneumonia from focal pneumonia

All diseases that affect the respiratory system are similar in their symptoms. The difference between croupous pneumonia and focal pneumonia lies in the mechanism of development of the disease.

1. Croupous pneumonia is an inflammatory process that affects a whole fraction of the lung. It occurs because of staphylococcal or pneumococcal infection.
   • Acute onset, a sharp rise in temperature, cough, severe pain in the chest, general sweetness, face hyperemia, shortness of breath, tachycardia, persistent high fever.
   • The disease has several stages of destruction of lung tissue, which are determined by radiography. The first (draining) stage occurs in the first days of the disease, the stage of curation 4-7 days and the stage of resolution - from 7-9 days until complete recovery.
   • To eliminate the disease, active therapeutic treatment is carried out. Patients are given a course of antibiotics or sulfonamides. Treatment can take place both in hospital and outpatient settings. Patients are prescribed bed rest, plenty of drink and diet.
2. Focal pneumonia - inflammatory lesion of small areas of lung tissue, alveoli and bronchi.
   • It arises against the background of an infectious and inflammatory process in the bronchi and bronchioles, extending to the whole system of respiration. Very often it is preceded by acute respiratory viral infection, laryngitis, tracheobronchitis and even a cold.
   • The causative agents are various harmful microorganisms (staphylococci, pneumococci, streptococci), often in combinations. Infectious diseases, lung trauma, postoperative period, can also lead to the development of the disease.
   • Characterized by a sharp onset with a strong chill, a sharp increase in temperature, rapid breathing and coughing with sputum separation. If the disease appears as a secondary lesion, then the symptomatology is blurred. Against the background of a slow onset, the general condition worsens, tachycardia, subfebrile temperature.
   • Treatment, as a rule, takes place in a hospital under medical supervision. Patients are prescribed antibiotics, antimicrobial and anti-inflammatory drugs. Particular attention is paid to ventilation of the lungs, as pneumonia can cause pathological complications.

For the differentiation of croupous and focal inflammation, radiography, microbiological and bacteriological examination of sputum, ultrasound, CT, bronchoscopy are used.

[68], [69], [70]

X-ray in case of focal pneumonia

One of the most reliable methods of diagnosing diseases of the respiratory system is the radiograph. X-rays have extensive opportunities to detect inflammation from the first days.

Indications for X-ray:

• Cough with phlegm, chills, fever, increased white blood cell count.
• To monitor the results of treatment and monitor changes in the state of tissues.
• If suspected inflammation of the lung tissue or other disease.

The only contraindication is the period of pregnancy. But with suspicions of acute inflammation, the X-ray is performed with the maximum protection of the woman from radiation.

Signs of focal lesions:

• Intensive infiltrate of non-homogeneous structure.
• Linear tautness and fluid level in the costal-diaphragmatic sinus from the side of the lesion upon inflammation of the pleura.
• The shading has a fuzzy outline.

X-ray at the stage of resolution:

• The disappearance of infiltration.
• Adhesive process of rib-diaphragmatic sinus.
• Linear tautness due to connective tissue.

After the picture has no infiltrates, a deformation of the pattern of the lungs appears on the lesion area. To identify residual tissue changes, radiography is performed one month after recovery.

Treatment of the focal pneumonia

Various methods are used to eliminate pneumonia. Treatment depends on the pathogen, in 80% of cases it is pneumococcus. But staphylococcus aureus, streptococcus, chlamydia, E. Coli, mycoplasma and other harmful microorganisms, can also cause damage to the respiratory system. Therefore, in the treatment should be present antibacterial drugs: fluoroquinolones, cephalosporins, penicillins. Medications can be combined, used for both intravenous and intramuscular administration, the duration of use should not exceed 14 days.

In addition to antibiotics, the patient is prescribed general tonic and anti-inflammatory drugs. Particular attention is paid to mucolytic drugs. They are indispensable for coughing with phlegm to cleanse the bronchi from mucus and bacteria. Similar effect has and expectorant potions. For local treatment of the throat, inhalations and sprays based on medicines and vegetable oils are used.

If the inflammation is secondary, that is, appeared against the background of the underlying disease, then first of all treat this ailment. With prolonged pneumonia, the best treatment option is the use of strong antibiotics (Streptomycin, Penicillin, Biomycin). Chronic forms are treated with autohemotherapy, that is, the means that cause a general restructuring of the body. This method is based on the introduction of the patient's own blood, not mixed with drugs. As a supportive treatment, cardiovascular drugs can be prescribed.

As soon as acute manifestations of the disease are gone, the patient is prescribed physiotherapeutic procedures - electrophoresis, UHF. Treatment with any medicinal products should take place only under the medical prescription and under its control. Self-treatment threatens with deterioration and death.

Medications

Treatment of focal pneumonia is based on the use of various drugs. Medicines are selected individually for each patient. Immediately after the diagnosis is established, the patient is prescribed broad-spectrum antibiotics. The duration of antibiotic therapy is from 5 to 14 days.

• If the disease has an acute course, then in addition to antibiotics, prescribe sulfonamides: Sulfalen, Bactrim, Sulfatiazine, Biseptol.
• For the purpose of anti-infectious protection, they use Immunoglobulin, Remantadin (an anti-influenza drug), and Anastafilococcal plasma.
• Of the anti-inflammatory drugs most often used Indomethacin, Antipyrine, Ethizimol. Anti-inflammatory and expectorant properties have Erespal, Hydrocortisone, Prednisolone.
• To regenerate the drainage function of the bronchi, bronchodilators are needed: Adrenaline, Euphyllinum, Ephedrine.
• With a dry, debilitating cough, use antitussive medications - Tusuprex, Codeine, Glauvent.
• For better expectoration sputum appoint Bromgeksin, Lazalvan, Solutan and physical methods of therapy - massage, chest, respiratory gymnastics, positional drainage.

If the disease has a severe course, then use the aids to normalize the acid-base balance, cardiovascular, diuretic and analgesic drugs.

Antibiotics for focal pneumonia

Pneumonia refers to infectious inflammatory diseases affecting the interstitial tissues of the lungs, bronchi and alveoli with accumulation of exudate. Antibiotics for focal pneumonia have been used since the first days of the disease. They are appointed after determination of the pathogen, therefore at first antibiotics of a wide spectrum of action are used.

Modern antibacterial agents:

1. Semisynthetic penicillins
   • Amoxicillin
   • Solutab
   • Augmentin
   • Amoxiclav
   • Sulacillin
   • Tazocin
   • Ampiox
   • Oxacillin
2. Cephalosporins
   • 2nd generation - Cefuroxime, Cefaclor, Aksetil.
   • III generation - Claforan, Cefotaxime, Ceftazidime, Cefoperazone, Ceftibuten.
   • IV generation - Tsefpirom, Cefepim.
3. Fluoroquinolones
   • Levofloxacin
   • Avelox
   • Moxifloxacin
   • Tavanik
4. Carbapenems
   • Tienam
   • Meropenem
   • Cilastatin
   • Imipenem
5. Macrolides
   • Azithromycin
   • Fromromide
   • Sumamed
   • Midekamycin
   • Clacid

In addition to the groups of drugs described above, aminoglycosides (Amikacin, Amikan), monobactams (Azactam, Azrethra) and tetracyclines (Vibramycin, Doxycycline, Solutab) are also used.

The advantage of modern antibiotics is that they are more effective and active against most microorganisms. They have an extended spectrum of action with minimal toxic effects on the central nervous system, kidneys, liver. And also have high bioavailability and minimal side effects.

[71], [72]

Alternative treatment

In the treatment of pneumonia are used, as classical methods, approved by medicine, so unconventional. Alternative treatment is used as an adjunct to the main therapy. But do not forget that plant remedies and other alternative methods are not an alternative to modern drugs.

Alternative treatment includes:

• Herbal preparations and infusions
• Inhalation
• Warm foot baths
• Massage and grinding
• Compresses

All procedures are used for symptomatic therapy, restoration of drainage function of bronchial tubes and restorative action. Such treatment helps to eliminate cough and improve overall health. But it is possible to use non-traditional methods only after the doctor diagnoses the focal shape of lesions of the lungs and bronchi.

Alternative recipes from focal pneumonia:

• Pair the heads of garlic, peel and put into a glass container, closing the lid. After 30-40 minutes strain, and to garlic juice add a liter of cahors. The drug should be infused for 2-3 weeks, after which it must be filtered once more and poured into a jar or glass bottle. The medicine is taken 1 spoonful per hour during the whole illness.
• Grind one onion and squeeze out the juice. Mix the juice with an equal amount of honey, let it brew. Take the medicine on a spoon before each meal.
• Preheat 100 g of honey and mix it with the same amount of fresh cottage cheese. The resulting mixture is evenly distributed on the body in the chest area, the verification is covered with a warm cloth or towel. It is better to put the compress on all night, after having drunk hot tea.
• Chop a couple of garlic heads and mix them with 500 g of melted goose fat. The mixture should be heated in a water bath for 10-20 minutes, applied to parchment and attached to the body. On top, wrap the wrap with a warm woolen shawl and leave it overnight.

Herbal Treatment

Methods of alternative medicine can minimize painful symptoms and accelerate the process of recovery. Especially popular is the treatment of focal pneumonia with herbs. Consider effective herbal prescriptions used for inflammation of the respiratory tract.

• A handful of herb wormwood, pour 300 ml of vodka and let it brew for 4-6 days. The agent should be shaken daily and kept in a dark cool place. As soon as the medicine is absorbed, it must be filtered and taken for 1 spoon 3-4 times a day.
• Spoon the flowers of calendula, chamomile and St. John's wort pour 500 ml of boiling water and leave for 1-2 hours. Infusion should be filtered and take 1/3 cup 2-3 times a day.
• Mix 200 grams of oats with 50 g of melted butter, 150 g of liquid honey and a liter of milk. The medicine is well mixed and heated to a boil over a slow fire for 30 minutes. The resulting broth should be filtered and taken 1 glass before going to bed.
• Berries of a viburnum fill in 500 ml of hot liquid flower honey and insist 5-8 hours. Spoon a honey-berry mixture pour a glass of boiling water and let it brew for 1.5-2 hours. The resulting infusion is filtered and taken warm by 1/3 cup 2-3 times a day. This remedy perfectly helps with a strong cough and wheezing.
• Take the fruits of raspberries, mother-and-stepmother leaves and oregano grass in the proportion 2: 2: 1. Spoon the mixture with boiling water, let it brew for 20-30 minutes and strain. The medicine should be taken before bedtime, it is contraindicated for pregnant women.

Homeopathy with focal pneumonia

In addition to alternative medicine, another unconventional method of treating infectious inflammation is homeopathy. The use of homeopathic remedies is quite popular. Homeopathy is suitable for patients with individual intolerance to potent drugs on a chemical basis. Correctly selected homeopathic remedy allows qualitatively and completely cure pneumonia of any form.

The famous homeopath Pierre Jusset has developed an effective regimen for the treatment of focal pneumonia, consider it:

At the beginning of the disease, they use such means:

• Aconitum 3X, 3
• Belladonna 3, 6,
• Veratrum virida
• Ferrum phosphoricum 3, 6

As soon as the temperature starts, Ipecacuana 6 and Bryonia 6 take 5-7 drops every 2 hours. With a dry cough appoint Ipecacuan 6 and Phosphorus 6 to 5 drops in turn every 2 hours. If the disease occurs with complications, Jussa recommends Arsenicum Album 3, 6. This scheme is considered conditional, since the drugs and their dosage are selected depending on the symptoms of the disease and the individual characteristics of the patient's body.

Operative treatment

If pneumonia occurs with serious complications, then one conservative therapy is not enough. Surgical treatment is used in the decay of the lung, persistent cicatricial changes in the lung tissue, the presence of purulent exudate and purulent cavities, bronchiectasises and other pathologies. The operation can be performed in chronic forms of the disease, when prolonged intoxication leads to irreversible morphological changes in the lungs and in other vital organs.

If the disease occurs with a large accumulation of fluid in the pleural cavity, the patient is given bronchoscopy with the washing of the bronchial tree. With abscess and the threat of infection of the pleural cavity, drainage is done (the puncture is contraindicated).

Rehabilitation of patients with focal pneumonia

Recovery from respiratory diseases is a lengthy process. Rehabilitation of patients with focal pneumonia takes about 3-4 months. To fully recover patients appoint a program that consists of several stages, consider them:

1. Combating the pathogen and its destruction, alleviating the painful symptoms.

If the disease runs without complications, then this stage takes 1-2 weeks. The patient is prescribed antibiotics, immunostimulants and a number of other drugs to eliminate the ailment. This stage ends after there are no inflammation foci on the x-ray and high temperature has left.

2. Regeneration of lung function and prevention of complications.

The patient is prescribed diet food, special procedures for stabilizing the electrolyte balance. Applied inhalation, electrophoresis and UHF, therapeutic gymnastics. This stage can take place in special institutions - sanatoriums, clinics. The main goal of such measures is restoration of alveolar activity.

3. Full rehabilitation of the body.

With the effective passage of the above-described stages, at this stage the normal functioning of all organs and systems is fully restored.

Prevention

Many effective methods and procedures are used to prevent focal pneumonia. Let's consider the basic preventive measures:

• Timely treatment of colds and any other damage to the body.
• Treatment of chronic diseases.
• Strengthening the protective properties of the immune system (vitamin therapy, hardening).
• Proper healthy eating.
• Physical activity, breathing exercises and therapeutic gymnastics.
• Avoiding hypothermia and communicating with the infected.

Prevention of focal pneumonia helps strengthen the body and increases resistance to various viruses, infections and inflammations.

[73], [74], [75], [76]

Forecast

The outcome of treatment depends on a number of factors, such as the age of the patient, the type of pathogen, the presence of co-morbidities, the general state of immunity and the adequacy of the organism to the therapy being administered. The prognosis is significantly worsened in the presence of such complications as:

• Immune Deficiency of the Patient
• Exudative pleurisy
• Respiratory and cardiopulmonary insufficiency
• Abscesses
• Stability of pathogenic microflora to antibiotic therapy
• Endocarditis
• Anemia
• Toxic shock

Focal pneumonia with timely and adequate treatment always leads to recovery. According to medical statistics, in 70% of cases a complete recovery of lung tissue is observed, 20% - pneumosclerosis and 2% of patients - a decrease in the proportion or segment of the lung.

[77], [78]