Pathology of pneumonia (bronchitis inflammation)

2021-01-27 12:00 AM

The most common types of bacteria that cause pneumonia today are: Pneumococcal, Hemophilus influenzae, Legionella pneumophila, Mycoplasma pneumonia.

Pneumonia diagnosisbook

Define

Pneumonia is a clinical condition caused by damage to the lung organs (alveoli, connective tissue and terminal bronchioles), caused by a variety of agents such as bacteria, viruses, fungi, parasites, and chemicals. matter...

People divide lobar pneumonia and bronchitis inflammation.

Epidemiology

The disease usually occurs in people with bad atopic conditions such as the elderly, malnourished children, at home with chronic diseases, immunodeficiency, alcoholism, malnutrition or pre-existing lung diseases such as (chronic laryngitis, bronchiectasis, bronchial asthma ...). The disease usually appears at the time of changing weather, favourable factors of lips and can form an epidemic, especially viruses, pneumococci, Hemophilus.

In countries: In Poland, acute pneumonia accounts for one-third of acute respiratory infections (Szenuka 1982), in Hungary, the rate is 12% of treating respiratory diseases (1985), mortality in Developed countries are 10-15% in young and old, in Europe, the mortality rate of pneumonia is about 4.4%, Asia 4.1-13.4%, Africa 12.9% ( Hitze. KL 1980).

Causes

Due to bacteria

The most common types of bacteria that cause pneumonia today are: Pneumococcal, Hemophilus influenzae, Legionella pneumophila, Mycoplasma pneumonia. There are also other bacteria such as streptococcus, staphylococcus aureus, Friedlander (Klebsiella pneumonia), Pseudomonas aeruginosa, anaerobic micro-preparations such as Fusobacterium, or gram-negative bacteria, typhoid, plague ...

Caused by virus

Influenza virus, measles virus, adenovirus, smallpox, infectious mononucleosis. In the US, viral pneumonia is 73% of respiratory infections - 40% due to the influenza virus.

Due to fungal

Actinomyces, Blastomyces, Aspergillus...

Due to the parasite

Amoeba, roundworm, pulmonary fluke.

Due to chemicals

Gasoline, oil, acid, gastric juice.

Due to other reasons

As a radiation, bronchial obstruction is caused by bronchial lung tumours, due to stagnation.

Mechanism of pathogenesis

Pathogens that enter the lungs are usually through the airways (air, bacteria in the upper respiratory tract) being drawn down, facing favourable environmental conditions, poor body resistance or by strong bacterial toxicity.  Or pathogens in neighbouring organs such as pleura, pericardium, liver ... or come through blood, lymph and vice versa from the lungs can go to the neighbouring organs and into the blood causing infection. blood.

The most important local role is drug addicts, smoking, malnutrition, reduced immunity and chronic lung diseases play an important role in pathogenesis and response to treatment.

Pathology

Lobar pneumonia

Lesions can be one lobe, one lobe or multiple lobes, or sometimes both sides of the lung, most commonly the right lower lobe.

According to Laennec's description, there are stages:

Congestive phase: The damaged lung area is severely congested, capillaries dilate, red blood cells, white blood cells and fibrin escape into the alveolar lumen, in this fluid contains many bacteria.

The stage of reddening of the liver: In one to 3 days, the damaged lung organization has a dark red colour and is firm like the liver. In this organization, there may be bleeding.

The stage of the greying liver: Grey-brown lung damage contains red blood cells, white blood cells, bacteria and necrosis organization.

Recovery stage: In the alveoli, there is little dilute fluid, there are few white blood cells.

Bronchitis inflammation

The lesions are scattered in both lungs, the lesion area is mixed with the healthy lung area, the bronchioles are more severe, the lesions are uneven and when they heal, they often leave fibrosis.

Symptom learning

Lobar pneumonia

Typically, it is pneumococcal.

This is the leading cause of lobar pneumonia, accounting for 60-70%, occurring at all ages, but most commonly children, the elderly, the rate of malnutrition, immunodeficiency is higher. occurs in winter-spring and sometimes causes epidemics, or occurs after cases of viral infections in the upper respiratory tract such as influenza, measles, herpes ... or in patients who are comatose, long-lying, depleted.

Onset: The disease usually begins suddenly with high fever, chills, fever fluctuating during the day, chest pain, mild difficulty breathing, rapid pulse, dry cough, fatigue, weight loss, loss of appetite, Herpes on the lips and mouth, but the physical symptoms are poor.

Full stage: Usually from day 3 onwards, clinical symptoms are more complete, the infection worsens with persistent high fever, fatigue, weight loss, anorexia, thirst, increased chest pain difficulty in breathing is worse, coughing a lot, thick, rust-coloured or bloody sputum, low urine and dark blood.

Pulmonary examination with typical (or atypical) pulmonary coagulation syndrome with increased vocal fibrillation, pressure flank space compression, percussion, hearing reduced bronchial sounds, tube blowing and dry explosions around the frozen region. If the damage is much, there are signs of acute respiratory failure, large and painful liver, sometimes jaundice and subcutaneous haemorrhage, in children with digestive disorders such as nausea, vomiting, bloating.

Subclinical: Blood tests with increased leukocytes, increased neutrophils, high sedimentation rate, perfusion and sputum culture can find pneumococcus, sometimes pneumococcal blood cultures. Pulmonary imaging reveals a clear or unknown blurred cloud that occupies a lobe or segment and is more commonly the right lower lobe.

The recovery phase: If the resistance is good, the treatment is early and correct, the disease will recover after 7-10 days, the temperature gradually decreases, the whole body is better, the food feels delicious, the urine increases gradually, the cough increases. Thin, clear sputum, chest pain and shortness of breath lessen. On examination of the lungs, the sound of tube blowing disappeared, the crackling decreased instead of humid hum. Often, muscle symptoms decrease earlier than physical symptoms. Blood test, white blood cell count returned to normal, sedimentation was normal, lung lesions on X-ray faded. The disease is completely cured after 10-15 days.

If not treated or treated incorrectly, the resistance is too poor, the disease will worsen, infections, intoxication increase, respiratory failure, sepsis or other complications such as lung abscess, overflow fluid, pleural effusion, pericardium ...

Bronchitis inflammation

The disease usually occurs in children and the elderly, the depressed, lethargic, after infection with the immunodeficiency virus or has a chronic disease 

The disease starts slowly with increasing fever, increasing difficulty in breathing leading to acute respiratory failure, a manifestation of an acute, severe infection, can be drowsy, delirious ... ran, hyperventilation, bronchial ran, scattered both lungs, spread very rapidly, this is a clinical case with both lung damage and diffuse bronchi.

Blood tests showed that leukocytes increased, neutrophils increased, blood sedimentation increased, especially pneumonia showed a lot of clouds scattered both lungs progressing each day.

If not treated or treated slowly, the disease will lead to severe respiratory failure, sepsis, overall collapse and possibly death.

Diagnose

Lobar pneumonia

Implementing the quadrants:

Infectious syndrome.

Typical (or atypical) pulmonary characteristic syndrome.

Acute respiratory distress syndrome (possible).

Diagnose the cause:

Clinical progress.

Epidemiological factors.

Sputum test results.

Response to treatment.

Differential diagnosis:

Tuberculosis: The long-term illness, the infectious syndrome does not show any signs of TB, do TB tests to distinguish.

Pulmonary infarction: The site has cardiovascular disease, lies for a long time, has sudden, severe chest pain, heavy bleeding, and dizziness.

Bronchial - lung cancer superinfection: Lung damage is often repeated in one area and gets worse.

Early-stage lung abscess.

Pleural inflammation is based on X-rays and clinics.

Atelectasis: no infectious syndrome, bronchial tone loss, no explosive. X-rays show atelectasis of the lungs.

Bronchitis inflammation

Implementing the quadrants:

The site is exhausted, after virus infection, there is a chronic disease.

Severe and acute infection syndrome.

Diffuse alveolar lesion syndrome.

Bronchial injury syndrome.

Acute respiratory distress syndrome

Differential diagnosis:

Tuberculosis bronchus: Must be tested for TB.

Asthma superinfection: History of bronchial asthma, previous attacks of shortness of breath, followed by an infectious syndrome, in response to bronchodilators.

Bronchiectasis: Prolonged disease, history of morning coughing and excessive sputum production, chronic respiratory failure, finger drumstick.

Symptoms

Due to the virulence of the strong pathogen, poor resistance, chronic illness, incorrect treatment, the disease will lead to.

Lung abscess.

Fluid, purulent pleura, pericardium.

Acute pulmonary oedema (due to diffuse injury).

Sepsis.

Clinical forms

Due to the golden staph

It may be primarily through the airway or secondary to the bloodstream (sepsis), clinically likely to be pneumococcal, but usually in the form of many small abscesses in the lung, bronchitis, inflammation, in children. are a pulmonary abscess and pleural effusion called pleural staphylococcus a lot of complications, very serious disease and high mortality rate?

Due to Friedlander

Gr (-) bacillus type, causing necrotic lesions in the lungs very seriously and quickly causing a lot of blood cough, strong infection and very high mortality.

Due to viruses

Usually occurs during outbreaks such as influenza, measles, or viral infection in the upper respiratory tract, the illness starts suddenly. Atypical pulmonary condensation syndrome, physical symptoms are poor and resolves after 7 to 10 days.

Due to fungus

Often lung lesions on both sides, mainly in the area near the umbilical lung and then gradually spread out, sometimes spread across the lungs, the clinical symptoms are similar to bronchitis inflammation, with a diagnosis of haemorrhage by finding fungi in the sputum.

Due to the parasite

Due to roundworm: A small lesion in the lung that can have a cough, little sputum, but this lesion disappears spontaneously, called a flighty infiltrate or Loeffler's syndrome.

Due to amoeba: Usually secondary to the hepatic amoeba but also the primary in the lung, the damage is mainly on the right lung base close to the diaphragm (sometimes in the left lung), moderate infection syndrome, chest pain and coughing up. chocolates blood or sputum. Need to test sputum smear for amoeba, good response to anti-amoeba.

Due to chemicals

The most common is petroleum aspiration, clinical symptoms occur after 6-12 hours when chemicals enter the lungs, the damage is mainly on the bottom of the right lung, severe chest pain and coughing up blood, high fever. Must be treated early with antibiotics (anti-infection) and corticosteroids.

Treatment

The principles of treatment are early, strong, adequate and monitoring disease progression.

Supportive treatment

Bed rest during an advanced illness.

The secret is easy to digest, ensuring enough calories, adding protein and vitamins B and C groups

Fluid and electrolyte replacement for high fever, poor appetite, vomiting, diarrhoea ...

Symptomatic treatment

Antipyretics:

Antipyretics often have analgesic effects. Paracetamol can be used 0.5g x 3-4 times / day. or is Acetaminophen, Diantalvic.

Ensure ventilation:

If there is respiratory failure, then use oxygen through the nasal tube 5-10 litres/minute depending on the level (note if there is chronic respiratory failure, reduce the dose to 1-2 litres/min and interrupt).

Bronchodilators:

If signs of bronchospasm can be added Theophylline 100-200 mg 3 times/day.

Medicines for coughs and expectorants:

If you have a lot of coughs, you can use codeine (Acodin, Neocodeon ...) 100 mg x 3 times/day.

If the sputum is thick and difficult to cough, it is possible to use types such as Terpin, Sodium Benzoate, Eucaylyptin ... or Acemuc, Exocemuc, Mucosolvon, Rhinathiol ... 2-3 packs/day. Or 3-4 pills / day.

Treat the cause

This is the main treatment to address the cause of the disease. Specifically, antibiotics must be used early, with the right type, with sufficient doses, based on the antibiotic map, when there is no antibiotic, it will be based on epidemiological factors, the clinical course of the disease, and the experience of the physician. patient's condition and response to treatment must be monitored in order to have time management directions.

Due to pneumococci, streptococci:

The main antibiotics today are still: Penicillin G. 500,000-1,000,000v x 4 times / day TB. If severe, the dose can be increased and intravenously. Cefapirine (Cefaloject) 0.5g-1g can be used every 8-12 hours.

If you are allergic to Penicillin, use a Macrolide such as Erythromycin by injection or 2g / day in 4 divided doses or Roxithromycin 150mg x 2 times/day.

Due to staphylococcus:

Staphylococcus aureus sensitive to Methicillin, can use Cefapirine or Aminoside group as Amikacin 15mg / kg / day intramuscularly or the Fluoroquinolone group like IV ofloxacin or oral 400 mg/day in 2 divided doses.

Methicillin-resistant staphylococci:

Cephalosporin generation III can be used: as Cefotaxime (Claforan, Cefomic) 3g / day divided 3 times or Vancomycin 30-50 mg/kg/day intravenously divided into 3 times.

If severe, it can be combined with Amikacins.

Due to Hemophilus Influenza:

Can use:

Ampicillin 2-3g / day orally in 3 divided doses or TB. Or Ofloxacin or Cefapirine.

Gentamycin 3-4 mg / kg / day TB in 2-3 divided doses.

Do Mycoplasma, Legionella:

Can be used as the treatment of Hemophilus influenzae.

Do Klebsiella pneumoniae:

Usually, treatment with Cephalosporin III generation with Amikacins.

Due to anaerobic bacteria:

Penicillin G or Metronidazole 1-2 g / 24 hours. Or Cephalosporin II, III

Due to chemicals:

Penicillin G combined with Prednisone 5 mg x 6 - 8v / day.

Complicated cases of pneumonia must be treated for a long time until clinical and subclinical symptoms return to normal (repeated testing) to avoid complications and relapses.

Prevention

Pneumonia is one of the most common lower respiratory tract infections, and thanks to many new, powerful antibiotics today the morbidity and mortality rate has been greatly reduced. However, there are still cases that happen into outbreaks, especially because of the virus. To prevent diseases and reduce complications, you must improve your physical condition, stay warm in the cold season, eliminate easy factors such as an unclean environment, do not smoke, prevent and treat early, take root infections in the upper respiratory tract, chronic lung disease exacerbations, early treatment and close monitoring of the early stage of respiratory tract infection, avoid transmission.

Today several vaccines for many viruses are used and also some antivirals.

Related articles

Symptoms, causes, diagnosis, treatment for bronchitis

Bronchiectasis

Lecture of chronic bronchitis