Pneumococcal pneumonia

Pneumococcal pneumonia is the most common type of pneumonia, the causative agent of which is Str.pneumoniae. About 5-25% of healthy people are carriers of pneumococcus, especially in children.

[1], [2], [3], [4], [5],

Causes and pathogenesis of pneumococcal pneumonia

Pneumococcus most often causes inflammation of the entire lobe or most of the lobe of the lung, but quite often pneumococcus is the cause of focal pneumonia.

There are 4 pathoanatomical stages of development of lobar pneumococcal pneumonia.

• Stage 1 (hyperemia, microbial edema, high tide) - characterized by pronounced blood filling of the vessels, expressed exudation of serous fluid, and exudate are pneumococci. This stage lasts from 12 hours to 3 days.
• Stage 2 - red surgery - is characterized by the fact that the alveoli of the affected area of the lung are completely filled with exudate containing plasma proteins (primarily fibrinogen) and a large number of erythrocytes (due to their diapedesis). The inflamed part of the lung becomes airless, dense, has a reddish color, resembling the liver in appearance. This stage lasts from 1 to 3 days.
• 3 stage - gray curing. At this stage, there is a large number of leukocytes (mainly neutrophils) in the alveolar exudate, the erythrocytes are much smaller. The lung is still dense, on the incision has a grayish-yellow color, the granularity of the lung is clearly visible. A microscopic examination reveals a large number of neutrophilic leukocytes with phagocytosed pneumococci. The duration of this stage is from 2 to 6 days.
• Stage 4 - resolution - is characterized by a gradual dissolving of exudate in the alveoli under the influence of macrophages, leukocytes, fibrin gradually dissolves, the granularity of the lung tissue disappears. Gradually restored airiness of lung tissue. The duration of this phase depends on the prevalence of the inflammatory process, the reactivity of the organism, the type and intensity of the therapy.

It should be taken into account that a succession of stages is not always observed. More often in the affected lobe of the lung there is at the same time a combination of signs of different stages or the predominance of any stage.

It should be noted that in pneumonia, not only the alveoli, interstitial tissue, but also the pleura, lymphatic vessels, regional lymph nodes are involved in the pathological process.

In focal pneumonia, the inflammatory process captures the lobe or segment, with the areas of inflamed densified tissue alternating with the zones of the vocal emphysema. Exudate is predominantly serous, although it is often purulent, the content of fibrin in the exudate is small.

[6], [7], [8], [9], [10], [11],

Symptoms of pneumococcal pneumonia

As a rule, pneumococcal pneumonia begins acutely, suddenly, with a single tremendous chill, after which the body temperature quickly rises to 38-40 ° C, there is pain when breathing on the side of the lesion, cough (painful and initially dry, but soon begins to separate mucopurulent sputum with blood veins, in many patients the admixture of blood is significant - "rusty sputum"). Symptoms of intoxication are expressed significantly - patients are troubled by weakness, myalgia, headache, decreased appetite, tachycardia appears. There is shortness of breath.

Diagnosis of pneumococcal pneumonia

Shared pneumococcal pneumonia has typical physical manifestations, depending on the pathomorphological stage of the disease.

In the initial phase (the phase of accumulation of exudate) - dull-tympanic sound over the lesion, hard breathing with prolonged exhalation, initial (ungrowth) indux crepitation, sometimes in a limited area - dry and wet wheezing. In the phase of densification, a sharp increase in vocal tremor, the appearance of bronchophoria, percussion, dull sound, vesicular breathing is not audible, crepitation disappears, often the noise of friction of the pleura. In the phase of resolution - voice tremor gradually normalizes, bronchophonia disappears, redux crepitation appears (abundant, sonorous, over a long period), sonorous small bubbling rales, bronchial breathing gradually replaced by hard, then vesicular. However, it should be borne in mind that the regularity of the stages of pneumococcal pneumonia is not always observed, therefore different physical data are determined at the same time in different parts of the lung.

In focal pneumococcal pneumonia, the physical data are much less demonstrative: dullness of percussion sound over the lesion, crepitation and small bubbling rales (due to the presence of concomitant focal bronchitis) can be determined (not always).

[12], [13], [14], [15], [16], [17], [18], [19]

Radiographic data

The most characteristic changes are observed in the phase of entrapment (compaction) of lung tissue. Shared pneumonia is characterized by intense darkening of the lobe of the lung. When tomography study against the background of inflammatory infiltration, bronchi are clearly traced, which reliably distinguishes pneumonia from lung atelectasis. Focal pneumococcal pneumonia is manifested by local compaction (focal shadow).

Laboratory Diagnosis of Pneumococcal Pneumonia

The most demonstrative changes in the general blood test. As a rule, there is a pronounced leukocytosis (the number of white blood cells reaches 20-30 x 10 ⁹ / l), a significant increase in the number of neutrophils, a pronounced shift of the leukocyte formula to the left (up to myelocytes and promyelocytes). In the period of the height of the disease, eosinophils disappear, the number of lymphocytes and platelets decreases, with the onset of the phase of resolution of the amounts of lymphocytes, eosinophils and platelets normalizes. Characteristic increase in ESR.

Biochemical blood analysis reveals signs of an inflammatory process: increased levels of a, - and y-globulins, seromucoid, sialic acids, fibrin, haptoglobin.

Diagnostic criteria for pneumococcal pneumonia

Pneumococcal pneumonia can be diagnosed on the basis of the following provisions:

• acute onset of the disease with chills, fever, chest pain, dyspnea, cough;
• characteristic data of physical and radiological examination of the lungs;
• detection of Gram-stained sputum in gram-positive formulations, gram-positive lancet-like diplococci forming short chains, with at least 10 typical pneumococci (diplococci) in the field of vision. For the final proof of belonging streptococci found to pneumococcus, it is advisable to put the reaction of swelling of its capsule. This reaction occurs when a polyvalent pneumococcal antiserum is added;
• the growth of titres of anti-pneumococcal antibodies in the patient's paired blood serum taken at the onset of the disease and after 10-14 days.

[20], [21], [22], [23], [24], [25], [26]

Treatment of pneumococcal pneumonia

With mild pneumonia, oral antibacterial antibiotics can be used. Phenoxymethylpenicillin, ampicillin (amoxicillin), cephalosporins of the 1st generation, with intolerance of the above-mentioned drugs - erythromycin, less commonly used biseptol (groseptol). Penicillin treatment is also possible.

With pneumonia of moderate severity and severe course, the drug of choice is penicillin, which is administered intramuscularly at doses of 1-2 million units every 4 hours. When complicating pneumonia of the empyema pleura, lung abscess, infective endocarditis, the dose of penicillin doubles for better penetration of the drug into the tissue.

In recent years, a large number of penicillin-resistant strains of pneumococcus have been reported. In this case, cephalosporins should be used, imipenem, vancomycin are also effective.

• 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