Types of pleuropneumonia

Pneumonia is divided according to the degree of lung damage. If the inflammatory process covers only the lobes, without spreading to the vessels and alveoli, then they talk about pleuropneumonia, or croupous pneumonia - an infectious disease that can be triggered by viruses, microbes or fungi. In turn, different types of pleuropneumonia are known, which can only be identified by a medical specialist.

To date, there are a number of pleuropneumonias, which differ in certain characteristics. Such a classification is necessary, first of all, for the optimal choice of treatment for the disease.

Forms

The division of different types of pleuropneumonia is based on clinical, etiological and other signs. For example, they distinguish aspiration, post-traumatic, postoperative pleuropneumonia, as well as viral, bacterial, fungal, etc. Consider the basic types of pleuropneumonia, their features and main characteristics.

Infectious pleuropneumonia

Many types of pleuropneumonia differ depending on the causative agent of the infectious process. Identification of the infection is mandatory, since the treatment regimen and the methods and drugs used depend on it. Infectious pleuropneumonia is classified as follows:

• Viral pleuropneumonia - caused by viruses, can be a complication with improper treatment or untreated influenza, SARS. Rarely is a primary infection. It is diagnostically difficult to identify the virus in pleuropneumonia, therefore, antiviral agents with a wide spectrum of activity, as well as various symptomatic drugs, are most often prescribed for treatment.
• Mycoplasma pneumonia occurs after penetration into the lung tissue of a special type of microorganisms called mycoplasma. This disease is more often fixed in childhood and adolescence. It can be hidden, without certain symptoms, but responds well to treatment with antibacterial drugs.
• Fungal pneumonia and pleuropneumonia can be triggered by various types of infection, including a fungal pathogen. The diagnosis of fungal pleuropneumonia is made only after a complete diagnosis, since the clinical symptoms of this type of disease are usually poor, the signs are blurred and indistinct, and often do not correspond to the classical manifestations of microbial damage. The disease can be caused by fungi, Candida, endemic dimorphic fungi, pneumocystis. Most often, the “culprit” is Candida albicans, as well as aspergillus or pneumocysts - that is, an infection focused on the lung tissue. Pathogens can enter the respiratory system, both from external foci and from other mycotic foci that are present in the human body. For example, Candida is a constant component of the skin and mucous microbiocenosis, but under certain circumstances it can be activated and become pathogenic: as a result, pneumomycosis develops. Treatment for a fungal infection in the lungs is long-term, using a powerful antimycotic course.
• Actinobacillus pleuropneumonia is caused by Actinobacillus, a gram-negative capsule-forming pleomorphic rod. Only ruminants are affected by this disease: cattle, pigs, less often sheep. Other animals and humans are immune to infection and do not get sick. Previously, until 1983, the disease was called "hemophilic pleuropneumonia": at the moment this term is considered obsolete, since the pathogen, which was previously considered to be in the genus Haemophilus, has now been moved to the genus Actinobacillus.

Another predominantly veterinary term is "contagious pleuropneumonia". This is a particularly contagious variety of pneumonia, which is easily transmitted from one animal to another, causing a general defeat of the disease. The causative agent is usually Mycoplasma mucoides. Animals that recover from contagious pleuropneumonia become immune to this infection.

Abscessing pleuropneumonia

Speaking of abscessing pleuropneumonia, they mean the presence of foci of infectious purulent-necrotic destruction of the lung. These are multiple purulent-necrotic areas of tissue decay, and there is no clear border with healthy lung tissue. Due to the presence of characteristic destructive processes, many experts call this disease the term "destructive pleuropneumonia".

In the lungs, zones of fusion of tissues of the drain type are formed. Staphylococcus aureus is considered the main causative agent of the pathology, but Klebsiella and other enterobacteria, as well as hemolytic streptococcus, pneumococcus and anaerobic microbes, are affected.

The most common cause of the development of abscessing pleuropneumonia is the aspiration of oropharyngeal secretions and the presence inside the body of foci of purulent infection adjacent to the lymphatic and blood vessels.

The symptomatology of the disease is similar to that of total pneumonia.

Community-acquired pleuropneumonia

Community-acquired pleuropneumonia is one of the varieties of inflammatory pulmonary processes in which an infectious agent enters the respiratory system outside of a hospital or other medical institution. This form of pleuropneumonia can be bacterial or viral, and the transmission route is airborne.

In most patients, the inflammatory reaction starts after an untreated ARVI or influenza infection, tracheitis or bronchitis.

The causative agent enters the lungs along a descending path - from the upper respiratory organs. If the immune defense is weakened, then it becomes difficult for the body to overcome new inflammatory foci. As a result, the infection settles on the lung tissue, and acute pleuropneumonia develops.

Often, patients with community-acquired pleuropneumonia already have various chronic respiratory conditions, such as chronic bronchitis. The disease enters the active stage when certain conditions are created, when the immune system is weakened. If you are late with treatment, or completely ignore it, pleuropneumonia may develop.

Hypostatic pneumonia

A special form of the disease is hypostatic pleuropneumonia, which is predominantly secondary. Most often, the disease develops as a result of prolonged stagnation of blood circulation in the small circulatory system, which should provide trophism to the lung tissue. Impaired blood flow leads to the accumulation of intoxication products in the lungs. A viscous sputum is formed, to which microorganisms actively multiply - usually streptococci and staphylococci, which causes a new inflammatory process.

Hypostatic, or congestive pleuropneumonia, usually occurs in long-term patients who are unable to move and lead a normal life as a result of injuries or somatic pathologies. So, primary diseases can be heart attacks, strokes, diabetes, oncopathology, etc. A long horizontal position worsens blood flow and causes stagnation in tissues.

Types of pleuropneumonia depending on the extent of the lesion

There are three lobes in the right lung and two lobes in the left. In turn, each lobe is divided into segments - parenchymal zones, ventilated by a segmental bronchus and a certain branch of the pulmonary artery.

When the inflammatory reaction is located in one pulmonary lobe, they speak of lobar pleuropneumonia, and in both lobes - about bidoleic pleuropneumonia. There are also unilateral and bilateral lobar pleuropneumonia. The clinical picture and therapeutic measures are similar to other varieties of the disease.

In addition, specialists have identified the following types of lobar pathology:

• segmental pleuropneumonia - characterized by damage to one segment of the pulmonary lobe;
• polysegmental pleuropneumonia - indicates the defeat of several lobar segments at once;
• upper lobe pleuropneumonia can be either right- or left-sided, and indicates damage to the upper lobe of the lung;
• lower lobe pleuropneumonia is also right or left-sided, depending on the location of the pathological process;
• mid-lobe pleuropneumonia is an inflammatory process in the middle lobe of the right lung (the middle lobe is absent in the left lung);
• total - proceeds with the defeat of the entire field of the lung (all lobes of both the right and left lungs);
• subtotal pleuropneumonia - for this form, damage to both lobes of one lung is typical;
• focal pleuropneumonia indicates a clear localization of the inflammatory focus, without spreading to closely located tissues;
• subpleural pleuropneumonia is an inflammatory process localized in the subpleural lung;
• basal pleuropneumonia - characterized by an inflammatory reaction in the lower part of the lung.

This classification is based on the degree of spread of the inflammatory reaction. In this case, the severity of symptoms depends on the extent of the lesion: the more extensive the inflammation, the deeper and brighter the clinical picture. [1]

Confluent pleuropneumonia

With a confluent form of pleuropneumonia, painful disorders cover several sections of the lung at once, or even the pulmonary lobe. There is a pronounced lag in the process of breathing from the affected side, the symptoms of respiratory failure (shortness of breath, cyanosis) intensify.

Confluent pleuropneumonia is characterized by infiltrative changes, against which there are compacted zones of infiltration and (or) destructive cavities. The term "confluent" in this case means the fusion of multiple or single small pathological foci into larger formations. Given this feature of the development of pleuropneumonia, it is considered by experts as a relatively peculiar form of the pulmonary inflammatory process.

Complications and consequences

If therapeutic measures were prescribed in a timely manner, and the treatment itself was competent, then the course of pleuropneumonia usually loses its typical cyclicity and is interrupted at the initial stage of development.

If the process of resorption of exudate is disturbed, then complications of pleuropneumonia develop. In some cases, connective tissue grows in the pathological focus: carnification occurs with further pulmonary cirrhosis. In some patients, purulent processes are observed with the destruction (melting) of tissues, and pleuropneumonia turns into an abscess or gangrene of the lung.

With pleuropneumonia, there are manifestations of the dry form of pleurisy with fibrinous layering and the formation of adhesions. Lymphogenic spread of the infection leads to the development of purulent mediastinitis and pericarditis. If the spread of microbes occurs through the circulatory system, then

Metastatic purulent foci in the brain and other organs and tissues: the development of purulent meningitis, peritonitis, acute polyposis-ulcerative or ulcerative endocarditis, purulent arthritis begins.

Often patients are concerned about the question why, while taking antibiotics for pleuropneumonia, the temperature does not drop: can this indicate the development of complications? With pleuropneumonia, temperature indicators usually range from 37-38 ° C. Against the background of antibiotic therapy, a high temperature can be maintained for 2-3 days, and with a bilateral pathological process - up to 10-14 days (at the same time, the mark of 38 ° C is not exceeded). If the indicators overcome the border of 39-40 ° C, then this indicates an increase in the inflammatory reaction and the loss of the body's ability to fight the pathogen. In such a situation, the doctor should immediately review the treatment and possibly change the antibiotic. [2]

Diagnostics of the pleuropneumonia

Examination of a patient with suspected pleuropneumonia is carried out according to an individual plan drawn up by a doctor. This plan typically includes:

General blood tests, urine, sputum, blood biochemistry (determination of total protein, protein electrophoresis, determination of the content of bilirubin, fibrinogen);

Sputum bakposev with the determination of the sensitivity of the bacterial flora to antibiotic therapy;

ECG.

A chest x-ray is almost always the baseline for diagnosing all types of pleuropneumonia. The study is done in two projections:

• during the tide stage, there is an increase and enrichment of the lung pattern, which is explained by tissue hyperemia;
• the degree of transparency is normal, or slightly reduced;
• there is a uniform shadow, and the pulmonary root is slightly expanded on the affected side;
• if the pathological reaction is localized in the lower lobe sector, then there is a reduced excursion of the corresponding diaphragmatic dome;
• during the hepatization stage, a pronounced decrease in the transparency of lung tissue is detected (in accordance with the affected area);
• the affected area of the lung has a normal or slightly enlarged size;
• the intensity of the shadow slightly increases towards the periphery;
• in the middle zones of darkening, areas of enlightenment are found;
• the pulmonary root on the affected side is expanded, it is distinguished by the uniformity of the shadow;
• compaction of the adjacent pleura is observed;
• during the permissive stage, there is a decrease in the intensity of the shadow of the pathologically altered zone;
• the fragmented shadow is reduced, the pulmonary root is expanded.

If pleuropneumonia is suspected, then it is preferable to conduct a full-fledged x-ray examination, rather than standard fluorography, which is considered more of a preventive rather than a therapeutic and diagnostic method. Pneumonia on fluorography is not always traced properly, since it depends both on the severity of the pathological process and on the condition and density of tissues through which X-rays penetrate. With the help of fluorography, it is possible to prevent the development of chronic pneumonia in advance, to protect against the atypical course of the inflammatory process, however, this procedure does not allow us to note the localization of inflammation and assess the degree of complexity of the process.

Patients with any type of pleuropneumonia are advised to investigate the function of external respiration, and if indicated, a pleural puncture is performed.

Multislice CT is indicated in such cases:

• if there are obvious clinical symptoms of pleuropneumonia, but there are no typical abnormalities on the x-ray;
• if during the diagnosis of pleuropneumonia atypical disorders are detected, such as obstructive atelectasis, abscess, or pulmonary infarction;
• with a recurrent course of pleuropneumonia, if pathological infiltrates are found in the same zone of the lung;
• with prolonged pleuropneumonia, if pathological infiltrates are not resolved within a month.

Additional instrumental diagnostics can be represented by fiberoptic bronchoscopy, transthoracic biopsy, transtracheal aspiration. The presence of pleural effusion against the background of the possibility of safe pleuropuncture is an indication for the study of pleural fluid. [3]

At each stage of pleuropneumonia, a mandatory auscultation is performed:

• at the stage of the tide, weakness of vesicular respiration, crepitus is noted;
• at the stage of hepatization, it is possible to listen to clear fine bubbling rales, with increased bronchophony;
• crepitus is also present at the permissive stage.

Differential diagnosis

Different types of pleuropneumonia are usually differentiated from tuberculous bronchopneumonia (caseous pneumonia). The particular complexity of such a diagnosis is observed in cases where pleuropneumonia affects the upper lobes, and tuberculosis affects the lower lobes: the fact is that at the initial stage, tuberculosis does not detect itself as mycobacteria in sputum, and the clinical and radiological signs of these pathologies are very similar. Sometimes it is possible to make a correct diagnosis of tuberculosis if there is a typical early onset of the disease: early weakness, increased sweating, constant unmotivated fatigue. Pleuropneumonia is characterized by an acute development of symptoms, including a sharp increase in temperature, chest pain, cough with sputum. As for the tuberculous infiltrate, it differs from the pleuropneumonic one in that it has a clear outline.

A blood test in patients with tuberculosis demonstrates leukopenia against the background of lymphocytosis, and pleuropneumonia is characterized by significant leukocytosis and accelerated ESR.

Tuberculin tests (+) are considered another confirmation of tuberculous lesions.

Various types of pleuropneumonia are also differentiated from bronchogenic cancer and small-branched pulmonary embolism.