Symptoms of pleuropneumonia

When one or more lobes of the lung become inflamed and there is a simultaneous inflammatory process in the surrounding pleura, symptoms of pleuropneumonia appear, the nature of which depends on many factors, including the location of the inflammatory focus, the stage of the disease, the patient’s age, as well as the state of his respiratory tract and immune system. [ 1 ]

The first signs and manifestations of pleuropneumonia

Since in 70% of cases the course of lobar (fibrous lobular or lobar) pneumonia is complicated by inflammation of the serous membrane of the lungs – pleurisy, in pulmonology the symptoms of pleuropneumonia, which is not distinguished as a separate nosological form and is defined by some specialists as parapneumonic or synpneumonic pleurisy, are considered in combination with the symptoms of lobar pneumonia. [ 2 ]

Most often, acute pleuropneumonia develops, and almost from the very beginning of such inflammation or after two or three days, the first signs of the spread of bacterial infection from the lobe of the lung to the pleura begin to appear, supplementing the clinical picture of the disease with symptoms of perifocal dry (fibrinous) pleurisy, when fibrinous deposits form on the surface of the pleura, and in cases of accumulation of pulmonary fluid in the pleura - exudative pleurisy. [ 3 ]

With pleuropneumonia, the body temperature can rise to +39-40°C, and the fever lasts for several days; all this time the patient feels very weak, loses appetite, is shivering and sweating, his head and muscles may hurt, and sometimes a rash appears on the face. [ 4 ]

But if pleuropneumonia in children is caused by chlamydia (Chlamydia trachomatis), then this is considered atypical pneumonia, and pneumonia without fever and, accordingly, pleuropneumonia without fever or with subfebrile temperature can be observed. See more - Symptoms of pneumonia in children

Symptoms and signs are sometimes not so specific (for example, without a fever reaction) if pleuropneumonia develops in the elderly and aged, as well as in weakened patients suffering from severe concomitant diseases (causing a decrease in the immune system response) or confined to bed. For more information, see Pneumonia in the elderly.

Experts note that in patients with atypical pneumonias not associated with Streptococcus pneumoniae or Haemophilus influenzae, but caused by other infections (anaerobic bacteria, fungi or viruses), small pleural effusions of a serous nature from the inflamed lung are detected during X-rays quite often, but do not manifest themselves clinically in any way.

And the typical course of the inflammatory process in the lung and pleura leads to:

• shortness of breath, intermittent shallow breathing;
• increased heart rate;
• paleness of the skin and cyanosis of the face (in the nasolabial area);
• unproductive (dry) cough, which as the disease progresses becomes wet, and may cough up mucus streaked with blood or sputum with blood;
• wheezing in the lungs;
• limitation of chest mobility during breathing (due to inflammation).

Key features of the physical examination are dull percussion in the affected lung lobes, bronchial breath sounds, and occasional breath sounds. Pleural friction and narrowing on the affected side may be present.

The fact that the inflammation has affected the parietal pleura, which is innervated by somatic nerves, is indicated by intense chest pain when inhaling - sharp, cutting, sometimes burning. The pain is ipsilateral: if the patient has left-sided pleuropneumonia, the pain is felt on the left, if right-sided - on the right. Moreover, to reduce it, patients lie on the side on which the inflammatory focus is located. When the pleura is inflamed near the diaphragm, the pain can radiate to the neck or shoulder. In young children, pleural pain is localized in the hypochondrium and abdomen. [ 5 ]

How pleuropneumonia can progress in premature babies, see the publications:

• Intrauterine pneumonia
• Pneumonia in a newborn baby

Pneumonia during pregnancy and pleuropneumonia during pregnancy have the same symptoms.

But pleuropneumonia without symptoms, in particular, without coughing and wheezing in the lungs, is hardly possible, they can just be blurred in people with weak immunity. Also, there may be no cough in newborn babies, but the doctor will not be able to help but notice other symptoms: changes in skin color, weakening of breathing, expansion of the nostrils when inhaling, foamy discharge from the nose and mouth, a decrease in the volume (retraction) of the chest, etc.

More information in the extensive article - Features of symptoms of pneumonia of various etiologies.

Stages

The stages of pneumonia are usually determined by morphological changes in the lung tissue at the site of inflammation, and the stages of development of pleurisy are determined by the processes occurring in the affected part of the parietal pleura. [ 6 ]

The initial stage of lobar pneumonia (serous exudation) lasts approximately three days and is characterized by the proliferation of bacteria with the formation and rapid increase of local inflammatory edema in the lobe of the lung. [ 7 ]

Then, at the peak of the disease (lasting from a week to ten days), leukocytes rush to the site of inflammation, and insoluble fibrin fibers settle as a film on the damaged areas of the lung tissue, compacting it and making it look like liver parenchyma, which is commonly called hepatization (or hepatization, which is divided into gray and red). Compaction and decreased elasticity of the tissue is a gross morphological damage to the lung with inflammatory exudate in the alveolar spaces.

Fibrous lobar pneumonia and pleuropneumonia in the resolution stage means that fibrin undergoes protease dissolution, i.e. is absorbed. The body temperature of patients normalizes, the cough weakens and stops, and this takes at least two weeks.

Inflammation of the pleura goes through three stages:

• exudative, during which (up to five days) sterile fluid accumulates in the pleural cavity;
• bacteriological or fibropurulent (lasting five to ten days), associated with microbial invasion of pleural fluid;
• formative – with the formation of connective tissue deposits on the pleura (which are formed by fibroblasts and are called pleural adhesions), and in the case of effusion – inflammatory fibrin exudate.

When fluid accumulates in the pleural space - pleural effusion - then as it increases, the pain weakens or disappears, since the layers of the pleura no longer touch.