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Pleuropneumonia Symptoms

, medical expert
Last reviewed: 25.02.2021
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With inflammation of one or more lobes of the lung and a simultaneous inflammatory process in a part of the pleura surrounding them, symptoms of pleuropneumonia appear, the nature of which depends on many factors, including the localization 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 variants of manifestation of pleuropneumonia

Since in 70% of cases of inflammation of the serous membrane of the lungs -  pleurisy  - the course of croupous (fibrous lobular or lobar) pneumonia is complicated, in pulmonology the symptoms of pleuropneumonia, which is not isolated in a separate nosological form and is defined by some specialists as parapneumonic or synpnemonic pleurisy, are considered in combination with  symptoms croupous 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 a bacterial infection from the lobe of the lung to the pleura begin to appear, complementing the clinical picture of the disease with symptoms of perifocal  dry (fibrinous) pleurisy , when deposits form on the surface of the pleura fibrinous nature, 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 severe weakness, loses his appetite, shivers and throws himself into sweat, the head and muscles may ache, and sometimes rashes appear on the face. [4]

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

Symptoms and signs are sometimes not so specific (for example, without a temperature reaction) if pleuropneumonia develops in the elderly and elderly, as well as in debilitated patients suffering from severe concomitant diseases (causing a decrease in the immune system response) or bedridden. For more information, see -  Pneumonia in the Elderly .

Experts note that in patients with atypical pneumonia, 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 with this does not manifest themselves clinically.

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

  • shortness of breath, abrupt shallow breathing;
  • increased heart rate;
  • pallor of the skin and blueness of the face (in the nasolabial area);
  • unproductive (dry) cough, which becomes moist as the disease progresses, and may cough up mucus streaked with blood or sputum with blood;
  • wheezing in the lungs ;
  • limiting the mobility of the chest during breathing (from the side of inflammation).

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

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

How pleuropneumonia of premature babies can proceed, see publications:

The same symptoms are manifested by  pneumonia during pregnancy  and pleuropneumonia during pregnancy.

But pleuropneumonia without symptoms, in particular, without coughing and wheezing in the lungs, is hardly possible, they just can be lubricated in people with weak immunity. Also, newborn babies may not have a cough, but the doctor will not be able to fail to notice other symptoms: changes in skin color, weakening of breathing, widening of the nostrils when inhaling, frothy discharge from the nose and mouth, decreased volume (retraction) of the chest, etc.

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

Stages

It is customary to determine the stages of pneumonia by morphological changes in the lung tissue in the focus of inflammation, and the stages of development of pleurisy - by the processes occurring in the affected part of the parietal pleura. [6]

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

Then, at the height of the disease (the duration of which is from a week to ten days), leukocytes rush to the focus of inflammation, and insoluble fibrin fibers are deposited with a film on the damaged areas of the lung tissue, thickening it and making it look like hepatic parenchyma, which is commonly called hepatization (or hepatization, which is divided into gray and red). Compaction and decrease in tissue elasticity is a gross morphological damage to the lung with inflammatory exudate in the alveolar spaces.

Fibrous lobar pneumonia and pleuropneumonia in the resolving stage means that fibrin undergoes protease dissolution, that is, it dissolves. The patient's body temperature returns to normal, 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 fibrous-purulent (lasting five to ten days), associated with microbial invasion of the pleural fluid;
  • forming - with the formation of connective tissue deposits on the pleura (which are formed by fibroblasts and are called pleural moorings), and with 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 cease to touch.

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