Friedlander pneumonia: causes, symptoms, diagnosis, treatment

Friedlander's pneumonia caused by Klebsiella (K.pneumoniae) is rare in people who have been perfectly healthy before. Most often, this pneumonia develops in people with a decrease in the activity of the immune system, weakened by some other severe diseases, exhausted, as well as in infants, the elderly, alcoholics and with neutropenia, decompensated diabetes mellitus.

Clinical Features of Friedlander's Pneumonia

The course of unfreezing pneumonia is severe. There may be a prodromal period with malaise, dry cough, fever. However, in most patients, the disease begins acutely. Patients are disturbed by pronounced weakness, an increase in body temperature to 38-39 ° C, cough resistant, painful, with hard to separate sputum. The sputum is viscous, has the smell of burnt meat and the appearance of currant jelly.

Characteristic defeat of the upper lobe. Physically in patients, a sharp weakening or even disappearance of vesicular breathing is determined, bronchial breathing appears (not always pronounced in connection with abundant bronchial exudation, a large amount of mucus in the bronchi), pronounced blunting of the percussion sound over the lesion is determined. A characteristic feature of Freelender's pneumonia is the tendency to pulmonary destruction. Already in the first 2-4 days in the zone of inflammatory infiltration, the disintegration of the lung tissue occurs with the formation of a multitude of cavities, often with liquid contents. In this case, a large amount of bloody sputum is allocated.

X-ray examination reveals a homogeneous infiltration of the entire fraction or a larger proportion of the fraction, and foci of destruction are determined. Fibrinous or exudative pleurisy often develops with appropriate clinical and radiological manifestations.

Diagnostic criteria of Friedlander pneumonia

Friedlander's pneumonia is diagnosed on the basis of the following provisions:

• severe course of the disease with predominant involvement of the upper lobe, weakened patients suffering from diabetes mellitus, alcoholism, often in the elderly, infants;
• expectoration of the color of currant jelly with the smell of burnt meat;
• rapidly growing destruction of lung tissue and pleural damage;
• detection of gram-negative rods during bacterioscopy in Gram-stained sputum;
• detection of specific capsular polysaccharides of K. Pneumoniae in blood, urine, cerebrospinal fluid;
• sputum culture on differential media (bromothymol, bromocresol, purple and glycerin agar). Colonies grow in a day, have a mucous consistence with a characteristic loop-like structure. Next, serotyping of the isolated cultures is performed on the basis of the determination of capsular K-antigen by the capsule swelling reaction, capsular agglutination in test tubes and on glass, immunofluorescence and complement binding reaction. There are more than 70 K-antigens, the most practical types are 1-6.

Treatment of Friedlander pneumonia

Therapy of choice is the appointment of cephalosporins II and III generation parenterally, which in severe forms of the disease combine with aminoglycosides (gentamycin, tobramycin, netillicin). Treatment should be carried out within 8 days after the normalization of body temperature, the total duration of treatment can be about 3 weeks. In case of allergy in beta-lactam antibiotics, combined treatment with aminoglycosides and fluoroquinolones is used.

• Pneumonia - Treatment regimen and nutrition
• Antibacterial drugs for the treatment of pneumonia
• Pathogenetic treatment of pneumonia
• Symptomatic treatment of pneumonia
• Fighting complications of acute pneumonia
• Physiotherapy, exercise therapy, respiratory gymnastics with pneumonia
• Sanatorium treatment and rehabilitation for pneumonia

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