Friedlander's pneumonia: causes, symptoms, diagnosis, treatment

Friedlander's pneumonia, caused by Klebsiella (K.pneumoniae), is rare in people who were previously completely healthy. Most often, this pneumonia develops in people with a decreased activity of the immune system, weakened by some other serious 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 Friedlander's pneumonia is severe. There may be a prodromal period with malaise, dry cough, and fever. However, in most patients, the disease begins acutely. Patients are bothered by pronounced weakness, fever up to 38-39°C, persistent, painful cough with difficult to separate sputum. The sputum is viscous, smells like burnt meat and looks like currant jelly.

Typically, the upper lobe is affected. Physically, patients show a sharp weakening or even disappearance of vesicular breathing, bronchial breathing appears (not always clearly expressed due to abundant bronchial exudation, a large amount of mucus in the bronchi), and a pronounced dullness of the percussion sound over the lesion is determined. A characteristic feature of Friedlander's pneumonia is a tendency to pulmonary destruction. Already in the first 2-4 days, in the area of inflammatory infiltration, disintegration of lung tissue occurs with the formation of many cavities, often with liquid contents. At the same time, a large amount of bloody sputum is released.

X-ray examination reveals homogeneous infiltration of the entire lobe or most of the lobe, foci of destruction are identified. Fibrinous or exudative pleurisy often develops with corresponding clinical and radiological manifestations.

Diagnostic criteria for Friedlander's pneumonia

Friedlander's pneumonia is diagnosed based on the following provisions:

• severe course of the disease with predominant damage to the upper lobe, in weakened patients suffering from diabetes, alcoholism, often in the elderly, infants;
• coughing up sputum 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 in sputum stained by Gram microscopy;
• detection of specific capsular polysaccharides of K.pneumoniae in blood, urine, cerebrospinal fluid;
• sputum culture on differential media (bromothymol, bromocresol, purple and glycerol agars). Colonies grow in 24 hours, have a mucous consistency with a characteristic loop-shaped structure. Then, serotyping of the isolated cultures is performed based on the determination of the capsular K-antigen using the capsule swelling reaction, capsular agglutination in test tubes and on glass, immunofluorescence and the complement fixation reaction. There are more than 70 K-antigens, types 1-6 are of greatest practical importance.

Treatment of Friedlander's pneumonia

The therapy of choice is the administration of cephalosporins of the second and third generation parenterally, which in severe forms of the disease are combined with aminoglycosides (gentamicin, tobramycin, netilicine). Treatment should be carried out for 8 days after normalization of body temperature, the total duration of treatment can be about 3 weeks. In case of allergy to 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
• Combating complications of acute pneumonia
• Physiotherapy, exercise therapy, breathing exercises for pneumonia
• Sanatorium and resort treatment and rehabilitation for pneumonia

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