Symptoms of acute pneumonia

Symptoms of pneumonia depend on the age, morphological form, causative agent and premorbid background of the child.

Focal pneumonia. In young children, focal community-acquired pneumonia is more common, caused by Streptococcus pneumoniae or Haemophilus influenzae. Pneumonia in young children is more likely to develop during ARVI and in most cases during the first week of a viral illness.

Symptoms of pneumonia are characterized by the appearance and growth of intoxication: lethargy, adynamia, tachycardia, not corresponding to a fever, pallor of the skin, restless sleep, anorexia, may be vomiting. Appears febrile temperature more than 3-4 days (after 1-2 days of decline in the background of acute respiratory viral infection), cyanosis in the nasolabial triangle (early symptom), cough becomes deep and wet. An important diagnostic symptom of pneumonia in young children is a change in the ratio of respiratory rate to pulse (from 1: 2.5 to 1: 1.5 at a rate of 1: 3), while in the act of respiration, the auxiliary musculature - inflating of the wings of the nose, intercostal spaces of the jugular fossa in the absence of bronchial obstructive syndrome. In severe condition, breathing becomes moaning, groaning.

The decisive symptom of focal pneumonia is the shortening of percussion sound in a certain local area of the lung, rigid breathing and localized small bubbling wet rattles, crepitation (heard only at the inspiration height) are heard in this area. Sound wet rales are the thinnest indicator of even small pneumonic changes in the lungs. Crepitating sounds occur when the alveoli is spreading and indicate the appearance in the alveoli of effusion, they arise in the initial period of pneumonia and in the resolution of pneumonia.

X-ray confirmation is based on the detection of focal changes on the radiograph, located more often in the posterior parts of the lungs. In the study of blood, leukocytosis, neutrophil shift to the left, ESR more than 25-30 mm / h. An indicator of the activity of the inflammatory process is an increase in the C-reactive protein.

Criteria for diagnosis. Violation of the general condition, fever, cough, shortness of breath of varying severity and characteristic physical changes. X-ray confirmation is based on the detection of focal or infiltrative changes on the roentgenogram.

"Golden standard" of five signs:

1. acute onset with fever;
2. the appearance of coughing, purulent sputum;
3. shortening of percussion sound and the appearance of auscultatory signs of pneumonia over the affected area of the lung;
4. leukocytosis or (less often) leukopenia with neutrophil shift;
5. with radiographic examination - infiltrate in the lung, which was not previously determined.

Criteria for respiratory failure. On the recommendation of WHO, shortness of breath is considered to be more than 60 breaths per minute in children up to 2 months; more than 50 - from 2 to 12 months and more than 40 - in children 1-3 years. Inflating of the wings of the nose, the retraction of the intercostal space, the sternum in the absence of bronchial obstructive syndrome. Cyanosis of varying degrees of severity (perioral, acrocyanosis, general, cyanosis of the mucosa).

There are 3 degrees of respiratory failure:

Respiratory failure of the I degree. Disturbance of breathing during exercise, breathing is increased by 10-20%. Tachycardia is moderate. The ratio of the heart rate (HR) to the respiratory rate (BH) 3: 1 instead of 3.5: 1 is normal. The gas composition of the blood is almost intact.

Respiratory failure grade II - dyspnea and cyanosis at rest. Breathing is increased by 20-30%. Pulse is frequent. Heart rate: BH = 2: 1. Participation of auxiliary muscles. In the blood, persistent hypoxemia and hypercapnia. The child is restless.

Respiratory insufficiency of the third degree - dyspnea and cyanosis are pronounced. Breathing is increased by 40-70%, superficial, tachycardia. Heart Rate: BH = 1.5: 1. The skin is gray-cyanotic. In the blood, hypoxemia and hypercapnia. The child is inhibited.

Clinical manifestation of microcirculatory disorders in pneumonia in children is a pronounced "marbling" of the skin.

Segmental pneumonia is a focal pneumonia occupying a segment or several segments according to an X-ray study. It overwhelmingly occurs without previous viral infections, is primary segmental in the result of blockage of the segmental bronchus with infected mucus or the development of edema and inflammation in the interalveolar septa of one segment. In children of early age, atelectasis of the lung and the reduction in the production of surfactant are of particular importance. Atelectasis can occur simultaneously with the onset of pneumonia or join later. Segmental pneumonia is a lesion of the entire segment, so the infidrative shadow in the phase of the height of the disease completely coincides with the anatomical boundaries of the segment. In young children, the pneumonic process is localized in segment II of the right lung, or in IV-VI, in IX-X segments to the right or left.

In most cases, the manifestations of intoxication are expressed: lethargy, refusal to eat, fever to high figures, a sharp tachycardia that does not correspond to the level of temperature, severe pallor of the skin, adynamia, a violation of microcirculation. Cough in the early days is not typical, dyspnea is tachypnea. The shortening of percussion sound in accordance with the affected segment is determined, weakened breathing, strengthening of bronchophony. In the early days, wheezing in the lungs is not heard, local wet wheezing or crepitus appear during the resolution of pneumonia.

On the X-ray diffraction, the always homogeneous and pulmonary pattern within it is indistinguishable. The area of darkening coincides with the anatomical boundaries of the segment. The radiological presence of atelectasis causes a small incision of the segment inside.

From the blood - leukocytosis, neutrophilia with a shift to the left, an increase in ESR. With segmental pneumonia, there is a high tendency to abscess, destruction and prolonged course.

Croupous pneumonia. Pneumonia with the localization of the inflammatory process within the proportion of the lung is more often observed in school-age children and in the preschool age.

The onset of the disease is usually acute. Among the overall health, often after cooling suddenly increases the temperature to 39-40 ° C, there is a severe headache, often chills. The general condition sharply worsens: sharp weakness, confusion of consciousness, delirium, the dream is broken. Then there are complaints about 6oli in the chest (more often in schoolchildren), complaints about pain in the abdomen - in preschool children. In the first day, less often later, a dry cough appears, followed by a cough with the separation of a small amount of mucous viscous sputum containing blood veins. Further, the cough becomes moist, and sometimes sputum can become "rusty".

The examination is characterized by pallor of the skin with a blush on the cheeks, often more pronounced on the side of inflammation in the lungs; eyes shining, lips dry. There is shortness of breath with the participation of auxiliary muscles in the act of breathing (the wings of the nose, pulling the hole above the breastbone), with deep inspiration, pain in the side appears on the side of the lungs lesion.

After 2-3 days, shortening of the percussion tone and unstable gentle crepitations over the lesion focus, as well as weakening of the voice jitter, increased bronchophonia and swelling of the skin can be noted. On the part of the cardiovascular system, muffling of cardiac tones, gentle systolic noise, changes in the ECG - a decrease in voltage, an increase in the heights of P and T, the shift of the ST interval.

In the blood there is a significant leukocytosis, neutrophilia with a pronounced shift to the left, an increase in ESR.

When X-ray examination in croupous pneumonia, the homogeneous darkening focus occupies a whole fraction. In children, croupous pneumonia is usually localized in the right lung, in the lower or upper lobe.

Forecast. With early treatment, the prognosis for croupous pneumonia in children is favorable.

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