Symptoms of pneumonia in children

The classic symptoms of pneumonia are shortness of breath, cough, fever, symptoms of intoxication (weakness, impairment of the general condition of the child, etc.). With pneumonia caused by atypical pathogens (eg C. trachomatis), fever usually does not occur; body temperature or subfebrile, or normal. In addition, bronchial obstruction, not characteristic of pneumonia, is observed. Thus, the diagnosis of pneumonia should be assumed if the child has a cough and / or dyspnea (with a respiratory movement rate of more than 60 per minute for children up to 3 months, more than 50 per min for children up to a year, more than 40 per min for children under 5 years ), especially in combination with the retraction of the compliant places of the chest and with fever above 38 "C for 3 days or more or without fever.

Corresponding percussion and auscultatory changes in the lungs, namely: shortening of percussion sound, weakening or, conversely, the appearance of bronchial respiration, crepitus or small bubbling rales. - determine 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 for almost any ARI, and the physical changes in the lungs in pneumonia in most cases (with the exception of lobar pneumonia) are virtually indistinguishable from changes in bronchiolitis and bronchitis. Nevertheless, in a physical examination, special attention is paid to identifying the following symptoms:

• shortening (blunting) percussion sound over the affected area / lung sites:
• local bronchial respiration, sonorous small bubbling rales, or inspiratory crepitations in auscultation;
• in older children and adolescents - strengthening bronchophonia and vocal tremor.

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 about 15-25% of sick children and adolescents.

Clinical manifestations of hospital pneumonia (dyspnea, cough, fever: violation of the general condition of the child and other symptoms of intoxication) are the same. As with community-acquired pneumonia. Thus, the diagnosis of hospital pneumonia should be assumed if a child in hospital has a cough and / or dyspnea (with a respiratory movement more than 60 per min for children up to 3 months, more than 50 per min for children up to a year, more than 40 in min for children under 5 years), especially in combination with the retraction of compliant places of the chest and with fever over 38 ° C for 3 days or more or without fever.

It is difficult to assume and diagnose VAP. Here it is necessary to consider. That the child is on the IVL, therefore, no shortness of breath, no cough, no physical changes are characteristic. Pneumonia is accompanied by a marked violation of the general condition of the patient: the child becomes restless, moody or. On the contrary, "loaded", the appetite is reduced, in children of the first months of life there is regurgitation. Sometimes vomiting, flatulence, upset of the chair, the symptoms of cardiovascular failure, CNS disorders and excretory renal function, and occasionally observe non-occlusive hyperthermia, or vice versa - progressive hypothermia, join and grow.

For hospital pneumonia in adverse cases, a lightning course is typical when pneumonia occurs for 3-5 days due to respiratory, cardiovascular and multiple organ failure, as well as the development of an infectious-toxic shock. Often, in such cases, joins the DIC syndrome. Accompanied by bleeding, including from the lungs.

Complications of pneumonia in the child

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Intrauterine destruction

Intrapulmonary destruction is an inflammation 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 before the opening and emptying of the abscess / bulla, which occurs either in the bronchial tubes, accompanied by increased coughing, or into the pleural cavity, causing pyopneumothorax.

Sinpneumonic pleurisy

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

Metapneumonic pleurisy

Metapneumonic pleurisy usually develops with pneumococcal pneumonia, less often - with community-acquired pneumonia (at the stage of its resolution) caused by a hemophilic rod. 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 in 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. Violation of the general condition is expressed. The febrile period lasts an average of 7-9 days, and antibiotic therapy does not affect its duration.

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

The resorption of fibrin due to low fibrinolytic activity of the blood occurs slowly, within 6-8 weeks.

Piopevneumotorax

Pyopneurmotorax occurs as a result of the breakthrough of an abscess or bulla into the pleural cavity. If there is a valve mechanism, an increase in the amount of air in the pleural cavity leads to a displacement of the mediastinum. Piopnevmotorax usually develops quickly and unexpectedly. The child has acute pain syndrome, dyspnea, severe respiratory failure. With strained valve pyopneumothorax, urgent decompression is indicated.