Symptoms of pneumococcal infection in children

Croupous pneumonia

Croupous pneumonia (English croup - croaking) is an acute inflammation of the lungs, characterized by the rapid involvement of the lung and adjacent portion of the pleura in the process.

The disease is noted mainly in older children. In infants and young children, croupous pneumonia is extremely rare, which is explained by the lack of reactivity and features of the anatomical and physiological structure of the lungs (relatively wide intersegmentary connective tissue layers that prevent the contact spread of the inflammatory process). Croupous pneumonia is often caused by I, III and especially IV serotypes of pneumococci, other serotypes cause it rarely.

With croupous pneumonia, the staging of morphological changes is characteristic:

• usually the pathological process begins in the posterior and posterolateral regions of the right lung in the form of a small focus of inflammatory edema, which rapidly increases, forming a phase of hyperemia and serous exudation (the tidal stage), with multiplication in pneumococcal exudate;
• in the future, the pathological process enters the phase of migration of leukocytes and proliferation of fibrin (hepatic stage);
• in the subsequent there is a gradual resorption of elements of exudate - leukocytes and fibrin (the stage of resolution).

In children, the pathological process rarely spreads to the entire share, more often only a few segments are affected.

The disease begins acutely, often with chills and pains in the side, intensifying with deep breathing. From the first hours there are dry cough, headache, weakness, weakness, high fever (up to 39-40 ° C). Children are nervous, sometimes raving. Rapidly appearing symptoms of croupous pneumonia: a short painful cough with a small amount of viscous vitreous sputum, hyperemia of the cheeks, swelling of the wings of the nose, rapid surface breathing, herpetic eruptions on the lips and wings of the nose, sometimes cyanosis of the lips and fingertips: when breathing and limiting the mobility of the lower edge of the lung. When the process is localized in the lower lobe of the right lung due to the pleural lesions, the pain is felt not only in the chest but also in the abdomen, imitating the disease of the abdominal organs (appendicitis, peritonitis, pancreatitis, etc.). At the same time, children may experience repeated vomiting, frequent loose stools, bloating, which complicates differential diagnosis with acute intestinal infection. When the process is localized in the upper lobe of the right lung, meningeal symptoms may appear in children (neck stiffness, convulsions, frequent vomiting, severe headache, delirium),

Changes in the lungs undergo a very characteristic evolution.

• On the first day of the disease, in typical cases, the tympanic hue of percussion sound can be noted on the side of the lesion, then within a few hours this sound is gradually replaced by blunting. By the end of the first day, at the height of the inspiration, crepitation and finely bubbling damp, as well as dry wheezing begin to be heard.
• At the height of clinical manifestations (2-3 days of the disease) dullness in the affected area becomes pronounced and bronchial breathing begins to be heard above the lesion, sometimes the pleural friction noise, and also voice trembling and bronchophonia. The cough becomes worse, less painful and more moist, sometimes the sputum becomes reddish-brown, dyspnea increases, cyanosis of the lips and face intensifies.

In the peripheral blood at the height of the disease, neutrophilic leukocytosis is noted, the content of stab samples increases to 10-30%, sometimes the shift of the leukocyte formula to the young and myelocytes, often reveals the toxic granularity of neutrophils, typical aneosinophilia, mild monocytosis; ESR is enhanced.

The resolution stage usually begins on the 5th-7th day of the disease. Symptoms of intoxication are weakened, the temperature of the body decreases critically or lytically. In the lungs, bronchial breathing weakens, vocal tremor and bronchophonia disappear, and abundant crepitus appears again. In the process of resorption of exudate, bronchial breathing becomes rigid, and then vesicular, a shortened percussion sound disappears. On the roentgenogram, you can see the main stages of development of croupous pneumonia. At the tide stage, an insignificant decrease in the transparency in the area of the affected area is noted, an intensification of the pulmonary pattern due to the vasoconstriction of the vessels. In the stage of hepatization, a pronounced decrease in the transparency of the affected lung area is revealed, reminiscent of atelectasis. The resolution stage is manifested by a slow restoration of the transparency of the affected area of the lung. In some cases, fluid is detected in the pleural cavity (pleuropneumonia). The total duration of the disease is about 3-4 weeks, the duration of the feverish period is on the average 7-10 days, complete restoration of the structure and function of the lungs occurs after 1-1,5 months.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Pneumococcal meningitis

Pneumococcal meningitis is the most severe form of purulent meningitis in children.

The disease usually begins acutely, with a rise in body temperature to high values, but in weakened children, the temperature may remain subfebrile and even normal. Children become restless, shout, often regurgitate. Often the first symptoms are convulsions, tremors, hyperesthesia, bulging of a large fontanel and loss of consciousness. Meningeal syndrome is often incomplete and not pronounced. In severe cases, it may be absent altogether.

In most patients, the disease immediately begins as a meningoencephalitis. In these cases, from the first day, consciousness is disturbed, tremors of limbs, convulsions, a sharp psychomotor agitation, which turns into a sopor and to whom. Early focal symptoms of lesions of the cranial nerves, which often divert, oculomotor and facial nerves, mono- and hemiparesis are possible. In older children, there is often a clinical picture of swelling and swelling of the brain with its incidence in the large occipital opening.

The cerebrospinal fluid is turbid, purulent, greenish-gray in color. When standing, a precipitate precipitates rapidly, neutrophilic pleocytosis is noted with 500-1200 cells per 1 μl. The protein content is usually high, the concentration of sugar and chloride is lowered.

In the peripheral blood, leukocytosis is revealed with a sharp leftward shift, aneosinophilia, monocytosis. Moderate anemia and thrombocytopenia are possible; ESR is enhanced.

Pneumococci relatively often are the causative agents of otitis media, purulent arthritis, osteomyelitis, pericarditis, endocarditis, primary peritonitis, etc. All these conditions can be in patients with pneumonia, bronchitis, tracheitis or arise independently, as a result of bacteremia. Usually they are observed in young children, especially in premature babies and in the first month of life. Clinically, they can not be distinguished from diseases caused by other pyogenic bacteria.