Symptoms of acute pneumonia

Symptoms of pneumonia depend on the age, morphological form, pathogen 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 often develops during the period of acute respiratory viral infections and in most cases during the first week of the viral disease.

Symptoms of pneumonia are characterized by the appearance and increase of intoxication phenomena: lethargy, adynamia, tachycardia that does not correspond to fever, pale skin, restless sleep, loss of appetite, and vomiting may occur. Febrile temperature appears for more than 3-4 days (after 1-2 days of decrease due to acute respiratory viral infection), cyanosis in the nasolabial triangle (early symptom), the cough becomes deep and wet. An important diagnostic sign of pneumonia in young children is a change in the ratio of respiratory rate to pulse (from 1:2.5 to 1:1.5 with a norm of 1:3), while the accessory muscles participate in the act of breathing - distention of the wings of the nose, retraction of the intercostal spaces of the jugular fossa in the absence of broncho-obstructive syndrome. In severe conditions, breathing becomes moaning, groaning.

The decisive symptom of focal pneumonia is a shortening of the percussion sound in a certain local area of the lung, in the same area one can hear harsh breathing and localized small bubbling moist rales, crepitation (heard only at the height of inspiration). Sonorous moist rales are the most subtle indicator of even small pneumonic changes in the lungs. Crepitation sounds occur when the alveoli straighten out and indicate the appearance of effusion in the alveoli; they occur in the initial period of pneumonia and when pneumonia resolves.

X-ray confirmation is based on the detection of focal changes on the X-ray, most often located in the posterior parts of the lungs. Blood tests show leukocytosis, a neutrophilic shift to the left, and ESR over 25-30 mm/h. An increase in C-reactive protein is an indicator of the activity of the inflammatory process.

Diagnostic criteria. General deterioration, increased body temperature, cough, dyspnea of varying severity and characteristic physical changes. Radiographic confirmation is based on the detection of focal or infiltrative changes on the radiograph.

The "gold standard" of five features:

1. acute onset with fever;
2. the appearance of cough, purulent sputum;
3. shortening of the percussion sound and the appearance of auscultatory signs of pneumonia over the affected area of the lung;
4. leukocytosis or (less commonly) leukopenia with a neutrophilic shift;
5. X-ray examination revealed an infiltrate in the lung that had not been previously identified.

Criteria of respiratory failure. According to WHO recommendations, dyspnea is considered to be a respiratory rate of more than 60 per 1 min in children under 2 months; more than 50 - from 2 to 12 months and more than 40 - in children aged 1-3 years. Flaring of the wings of the nose, retraction of the intercostal spaces, sternum in the absence of broncho-obstructive syndrome. Cyanosis of varying severity (perioral, acrocyanosis, general, mucosal cyanosis).

There are 3 degrees of respiratory failure:

Respiratory failure of the 1st degree. Respiratory distress during exertion, breathing increases by 10-20%. Moderate tachycardia. The ratio of heart rate (HR) to respiratory rate (RR) is 3:1 instead of the normal 3.5:1. The blood gas composition is almost unchanged.

Respiratory failure grade II - dyspnea and cyanosis at rest. Breathing is increased by 20-30%. Pulse is rapid. HR:RR = 2:1. Involvement of accessory muscles. Persistent hypoxemia and hypercapnia in the blood. The child is restless.

Respiratory failure grade III - dyspnea and cyanosis are pronounced. Breathing is increased by 40-70%, shallow, tachycardia. HR:RR = 1.5:1. The skin is gray-cyanotic. There is hypoxemia and hypercapnia in the blood. The child is lethargic.

A clinical manifestation of microcirculation disorders in pneumonia in children is pronounced “marbling” of the skin.

Segmental pneumonia is a focal pneumonia occupying a segment or several segments according to X-ray examination data. In the overwhelming majority of cases, it occurs without previous viral infections, has a primary segmental character as a result of blockage of a segmental bronchus with infected mucus or the development of edema and inflammation in the interalveolar septa of one segment. In young children, pulmonary atelectasis and decreased surfactant production are of certain importance. Atelectasis can occur simultaneously with the onset of pneumonia or join later. Segmental pneumonia is a lesion of the entire segment, therefore the infiltrative shadow in the acute phase of the disease completely coincides with the anatomical boundaries of the segment. In young children, the pneumonic process is localized in the II segment of the right lung or in the IV-VI, in the IX-X segments on the right or left.

In most cases, intoxication symptoms are expressed: lethargy, refusal to eat, high fever, sharp tachycardia that does not correspond to the temperature level, pronounced pallor of the skin, adynamia, and microcirculation disorders. Cough is not typical in the first days, dyspnea is tachypneic. Shortening of the percussion sound is determined according to the affected segment, weakened breathing, and increased bronchophony. In the first days, wheezing in the lungs is not heard, local moist rales or crepitation appear during the period of pneumonia resolution.

On the radiograph, the darkening is always homogeneous and the pulmonary pattern within it is indistinguishable. The darkening area coincides with the anatomical boundaries of the segment. The radiological presence of atelectasis causes a slight inward curvature of the segment.

From the blood side - leukocytosis, neutrophilia with a shift to the left, increased ESR. In segmental pneumonia, there is a high tendency to abscess formation, destruction and protracted course.

Lobar pneumonia. Pneumonia with localization of the inflammatory process within a lobe of the lung, more often observed in school-age and preschool-age children.

The onset of the disease is usually acute. In the presence of complete health, often after cooling, the temperature suddenly rises to 39-40 ° C, a severe headache appears, often chills. The general condition deteriorates sharply: severe weakness, there may be confusion, delirium, sleep is disturbed. Then complaints of pain in the chest (more often in schoolchildren), complaints of abdominal pain - in preschoolers. In the first day, less often later, a dry cough appears, and subsequently a cough with the separation of a small amount of mucous viscous sputum containing streaks of blood. Then the cough becomes wet, sometimes the sputum can acquire a "rusty" appearance.

On examination, the skin is pale with a blush on the cheeks, often more pronounced on the side of the inflammation in the lungs; the eyes are shiny, the lips are dry. Dyspnea is noted with the participation of accessory muscles in the act of breathing (wings of the nose, retraction of the fossa above the sternum), with a deep breath there is pain in the side on the side of the lung lesion.

After 2-3 days, a shortening of the percussion tone and inconstant gentle crepitant rales over the lesion may be noted, as well as a weakening of the vocal fremitus, increased bronchophony and swelling of the skin. From the cardiovascular system, muffled heart sounds, gentle systolic murmur, changes in the ECG - decreased voltage, increased height of the P and T waves, shift in the ST interval.

The blood shows significant leukocytosis, neutrophilia with a pronounced shift to the left, and an increase in ESR.

In X-ray examination of lobar pneumonia, a homogeneous darkening focus is found, occupying the entire lobe. In children, lobar pneumonia is usually localized in the right lung - in the lower or upper lobe.

Prognosis: With early treatment, the prognosis for lobar pneumonia in children is favorable.

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