Symptoms of pneumonia in children

Classic symptoms of pneumonia are shortness of breath, cough, fever, symptoms of intoxication (weakness, deterioration of the child's general condition, etc.). In pneumonia caused by atypical pathogens (e.g. C. trachomatis), fever is usually absent; body temperature is either subfebrile or normal. In addition, broncho-obstruction is observed, which is not at all typical for pneumonia. Thus, the diagnosis of pneumonia should be assumed if the child develops a cough and/or shortness of breath (with a respiratory rate of more than 60 per minute for children under 3 months, more than 50 per minute for children under 1 year, more than 40 per minute for children under 5 years), especially in combination with retraction of the compliant parts of the chest and with a fever above 38 "C for 3 days or more or without fever.

The corresponding percussion and auscultation changes in the lungs, namely: shortening of the percussion sound, weakening or, conversely, the appearance of bronchial breathing, crepitation or fine bubbling rales. - are determined only in 50-70% of cases. In addition, it should be remembered that in early childhood, especially in children of the first months of life, these manifestations are typical of almost any ARI, and physical changes in the lungs with pneumonia in most cases (with the exception of lobar pneumonia) are practically indistinguishable from changes in bronchiolitis and bronchitis. Nevertheless, during physical examination, special attention is paid to identifying the following signs:

• shortening (dullness) of the percussion sound over the affected area/areas of the lung:
• local bronchial breathing, sonorous fine bubbling rales or inspiratory crepitations during auscultation;
• in older children and adolescents - increased bronchophony and vocal tremors.

It should be noted that in most cases the severity of clinical symptoms depends on many factors, including the severity of the disease, the prevalence of the process, the age of the child, the presence of concomitant diseases, etc. In addition, it is important to remember that physical symptoms and cough may be absent in approximately 15-25% of sick children and adolescents.

Clinical manifestations of hospital-acquired pneumonia (shortness of breath, cough, increased body temperature: deterioration of the child's general condition and other symptoms of intoxication) are the same as in community-acquired pneumonia. Thus, the diagnosis of hospital-acquired pneumonia should be assumed if a child in hospital develops cough and/or shortness of breath (with a respiratory rate of more than 60 per minute for children under 3 months, more than 50 per minute for children under 1 year, more than 40 per minute for children under 5 years), especially in combination with retraction of the compliant parts of the chest and with a fever of more than 38 °C for 3 days or more or without fever.

It is difficult to assume and diagnose VAP. Here it is necessary to take into account that the child is on artificial ventilation, therefore neither shortness of breath, nor cough, nor physical changes are typical. Pneumonia is accompanied by a pronounced violation of the general condition of the patient: the child becomes restless, capricious or, on the contrary, "loaded", appetite is reduced, in children of the first months of life regurgitation appears. sometimes vomiting, flatulence, bowel disorder, symptoms of cardiovascular insufficiency, disorders of the central nervous system and excretory function of the kidneys join and increase, sometimes uncontrollable hyperthermia is observed or, on the contrary, progressive hypothermia.

Hospital pneumonia in unfavorable cases is characterized by a lightning-fast course, when pneumonia within 3-5 days leads to a fatal outcome due to respiratory, cardiovascular and multiple organ failure, as well as due to the development of infectious toxic shock. Often in such cases, DIC syndrome is added, accompanied by bleeding, including from the lungs.

Complications of pneumonia in a child

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Intrapulmonary destruction

Intrapulmonary destruction is suppuration in the lungs at the site of cellular infiltration with the formation of bullae or abscesses caused by some serotypes of pneumococcus, staphylococci. H. influenzae type b, less often - hemolytic streptococcus, Klebsiella, Pseudomonas aeruginosa. Pulmonary suppuration is accompanied by fever and neutrophilic leukocytosis until the moment of opening and emptying of the abscess/bulla, which occurs either in the bronchus, accompanied by increased cough, or in the pleural cavity, causing pyopneumothorax.

Synpneumonic pleurisy

Synpneumonic pleurisy can be caused by any bacteria and viruses (pneumococcus, mycoplasma, adenoviruses, etc.). The exudate in pleurisy can be different. Purulent exudate is characterized by a sharp dullness of percussion sound, weakening of breathing, sometimes it is impossible to listen to breathing at all. In addition, low pH (7.0-7.3) of the contents of the pleural cavity (when examining the puncture) is characteristic. leukocytosis above 5000 ml. The exudate can also be fibrinous-purulent or hemorrhagic. With full antibacterial therapy, the exudate ceases to be purulent and pleurisy gradually regresses. However, complete regression of pleurisy occurs in 3-4 weeks.

Metapneumonic pleurisy

Metapneumonic pleurisy usually develops with pneumococcal pneumonia, less often - with community-acquired pneumonia (in the stage of its resolution) caused by Haemophilus influenzae. In the development of metapneumonic pleurisy, the main role belongs to immune processes. In particular, against the background of the disintegration of microbial cells, immune complexes are formed in the pleural cavity, which is a shock organ. Metapneumonic pleurisy develops at the stage of resolution of community-acquired pneumonia, after 1-2 days of normal or subfebrile temperature, when the temperature again rises to 39.5-40.0 C. A violation of the general condition is expressed. The febrile period lasts on average 7-9 days, and antibacterial therapy does not affect its duration.

X-ray examination reveals pleurisy with fibrin flakes, and in some children, echocardiography reveals pericarditis. In the peripheral blood analysis, the number of leukocytes is normal or decreased, and the ESR is increased to 50-60 mm/h.

Due to the low fibrinolytic activity of the blood, fibrin resorption occurs slowly, over 6-8 weeks.

Pyopneumothorax

Pyopneumothorax occurs as a result of an abscess or bulla breaking through into the pleural cavity. In the presence of a valve mechanism, the increase in the amount of air in the pleural cavity leads to a shift in the mediastinum. Pyopneumothorax usually develops quickly and unexpectedly. The child develops acute pain syndrome, dyspnea, and severe respiratory failure. In case of tense valve pyopneumothorax, urgent decompression is indicated.