Symptoms of pneumococcal infection in children

Lobar pneumonia

Croupous pneumonia (from the English word croup - to croak) is an acute inflammation of the lungs, characterized by the rapid involvement of a lobe of the lung and the adjacent area of the pleura in the process.

The disease is observed mainly in older children. In infants and young children, lobar pneumonia is extremely rare, which is explained by insufficient reactivity and the peculiarities of the anatomical and physiological structure of the lungs (relatively wide intersegmental connective tissue layers that prevent contact spread of the inflammatory process). Lobar pneumonia is most often caused by I, III and especially IV serotypes of pneumococci, other serotypes rarely cause it.

Lobar pneumonia is characterized by staging of morphological changes:

• usually the pathological process begins in the posterior and posterolateral parts of the right lung in the form of a small focus of inflammatory edema, which quickly increases, forming a phase of hyperemia and serous exudation (the stage of the tide) with the proliferation of pneumococci in the exudate;
• subsequently, the pathological process enters the phase of leukocyte migration and fibrin deposition (hepatization stage);
• Subsequently, gradual resorption of exudate elements - leukocytes and fibrin - occurs (resolution stage).

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

The disease begins acutely, often with chills and pain in the side, increasing with deep breathing. From the first hours, a dry cough, headache, weakness, fatigue, high fever (up to 39-40 ° C) appear. Children are excited, sometimes delirious. Symptoms of lobar pneumonia quickly appear: a short painful cough with a small amount of viscous glassy sputum, hyperemia of the cheeks, swelling of the wings of the nose, rapid shallow breathing, herpetic eruptions on the lips and wings of the nose, sometimes cyanosis of the lips and fingertips: on the affected side, you can see a lag in the chest during breathing and limited mobility of the lower edge of the lung. When the process is localized in the lower lobe of the right lung, due to damage to the pleura, pain is felt not only in the chest, but also in the abdomen, imitating a disease of the abdominal organs (appendicitis, peritonitis, pancreatitis, etc.). At the same time, children may experience repeated vomiting, frequent loose stools, and abdominal distension, which complicates differential diagnosis with acute intestinal infection. When the process is localized in the upper lobe of the right lung, children may experience meningeal symptoms (stiffness of the muscles of the back of the head, 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, a tympanic tone of the percussion sound can be noted on the affected side, then over the course of several hours this sound gradually changes to dullness. By the end of the first day, at the height of inspiration, crepitation and fine-bubble moist and dry wheezing begin to be heard.
• At the height of clinical manifestations (2-3 days of illness), dullness in the affected area becomes sharply expressed and bronchial breathing, sometimes pleural friction noise, as well as vocal tremor and bronchophony begin to be heard over the affected area. The cough intensifies, becomes less painful and more moist, sometimes the sputum acquires a reddish-brown color, shortness of breath 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 band cells increases to 10-30%, sometimes there is a shift in the leukocyte formula to young and myelocytes, toxic granularity of neutrophils is often detected, aneosinophilia and moderate monocytosis are typical; ESR is elevated.

The resolution stage usually begins on the 5th-7th day of the disease. Symptoms of intoxication weaken, body temperature decreases critically or lytically. Bronchial breathing in the lungs weakens, vocal tremor and bronchophony disappear, and abundant crepitation appears again. During the process of exudate resorption, bronchial breathing becomes harsh and then vesicular, the shortened percussion sound disappears. The main stages of the development of lobar pneumonia can be seen on the radiograph. In the flush stage, a slight decrease in transparency in the affected area is noted, an increase in the pulmonary pattern due to vascular plethora. In the hepatization stage, a marked decrease in the transparency of the affected lung area is revealed, resembling the picture of atelectasis. The resolution stage is manifested by a slow restoration of 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 febrile period is on average 7-10 days, complete restoration of the structure and function of the lungs occurs after 1-1.5 months.

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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, scream, and often burp. Frequently, the first symptoms are convulsions, tremors, hyperesthesia, bulging of the large fontanelle, and loss of consciousness. Meningeal syndrome is often incomplete and not clearly expressed. In severe cases, it may be absent altogether.

In most patients, the disease immediately begins as meningoencephalitis. In these cases, from the first day, consciousness is impaired, tremors of the limbs, convulsions, and severe psychomotor agitation develop, turning into stupor and coma. Focal symptoms of damage to the cranial nerves appear early, most often the abducens, oculomotor, and facial nerves, and mono- and hemiparesis are possible. In older children, a clinical picture of edema and swelling of the brain with its wedging into the foramen magnum often occurs.

The cerebrospinal fluid is turbid, purulent, greenish-gray. When left standing, sediment quickly forms, neutrophilic pleocytosis with 500-1200 cells per 1 μl is noted. The protein content is usually high, the concentration of sugar and chlorides is reduced.

In the peripheral blood, leukocytosis with a sharp shift to the left, aneosinophilia, monocytosis are detected. Moderate anemia and thrombocytopenia are possible; ESR is increased.

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