Inflammation of the lungs in a child

Inflammation of the lungs in a child is a serious infectious disease, and for children the pathology is more typical, due to the peculiarities of the construction of the respiratory system and the underdevelopment of immune processes. Inflammation of the lungs in a child is usually acute infectious, with water-electrolyte and metabolic disorders, shifts in all organ systems of a pathological nature. But, on the other hand, the concept of inflammation of the lungs in a child is understood as an entire group of infectious and inflammatory lung diseases, with the mandatory presence of intraalveolar exudative fluid. It is this exudate that prevents physiological gas exchange in the lung structures. The amount of oxygen is sharply reduced, adding disturbances to the work of the bloodstream. This state represents an extreme health hazard, but not only, but for life in general, increasing the possibility of death, so you should immediately seek medical help for the speedy appointment of treatment.

This disease occupies almost 80% of the pathology of the respiratory system, annually killing 1.4 million lives of children under 5 years old. Among those hospitalized before 1 year, 25-30% of cases fall, the inflammation of the lungs in a child 2 years to 5 - more than 50%.In children of schoolchildren and adolescents, the incidence is significantly reduced and is 8-12%.

Inflammation of the lungs in a child of 4 years can vary significantly from such manifestations in an infant, it manifests itself as a specific symptom complex, and on rengen-pictures. The highest mortality rates were recorded just before the age of four. Do not forget that children can fall ill of any age group, even just born. And since this disease, which is extremely dangerous for its course and complications, especially for the child's organism and extremely dangerous to infants, it is important to suspect, recognize and begin to treat at the time, differentiating other respiratory diseases. Procrastination leads to very difficult, difficult to correct states, in the future. This will help x-ray research, because it clearly identifies the apparent darkness inherent in pneumonia.

Inflammation of the lung in a child is classified into the following forms:

• Focal - is more often diagnosed in the 1-3 year age range. Pathology is secondary and, mainly, as a result of bronchitis. Symptomocomplex: hyperthermia, dry and deep cough. It is treated for 2-3 weeks with the use of antibiotic drugs.

• Segmental - affects the lungs partially, while the baby does not eat well, refuses it, does not want to play, does not sleep well, the temperature is 37-38 ° C.Coughing can practically not occur, because of what often this species is difficult to detect from the first days.

• Share - capturing only one or more lobes of the lung.

• Drain - when the process from several segments-segments merges into one large lesion.

• Total - damage to the entire lung tissue.

• Lobar - the lesion may equally be left-sided or right-sided. The baby has hyperthermia up to 39-40 ° C.In the area of ​​the projection of the lung and abdominal pain zone, there is a moist cough with rusty sputum, red rashes on the trunk and one-sided redness of the face.

• Staphylococcal - more common in newborns and infants. The main symptom-complex include: shortness of breath, subfebrile condition, vomiting, coughing, hearing wheezing. With timely and adequately prescribed treatment, the disease recedes after about 2 months, followed by a rehabilitation course of 10 days.

If the lesion is localized in only one lung, then this inflammation of the lungs in a child is called one-sided, both are bilateral. Also, the primary condition is distinguished - the development of the disease itself, the secondary one - as a consequence, already transferred earlier, of an infectious disease.

For the reasons of infection, the following forms are distinguished:

• Hospital - the child becomes ill after having been hospitalized for three days or three days after discharge.

• Community-acquired - an infection that has nothing to do with medical institutions. The most common kind. It is subdivided with or without impairment of immunity.

• From medical interventions - pathogens are entered into the human body during procedures, operations, often provoke frequent hospitalizations, hemodialysis, parenteral administration of drugs.

• Aspiration - manifested when foreign particles, pieces of food or liquid, infectious sputum from the nasopharynx enter the respiratory tract.

• Ventilation - early( up to 72 hours) and late( after 96 hours), when a person is on the ventilator.

• Intrauterine - congenital form, revealed in the first 3 days from the appearance of the child to the light.

• Cytostatic - when taking cytostatic drugs.

• Atypical form - with etiopathogenetic rare species of pathogens( mycoplasma, chlamydia).

The incidence of inflammation of the lungs of children is explained by the following factors: the pulmonary tissue is not yet fully ripe;Respiratory tract narrow;Mucous membranes are saturated with blood vessels, which is why they tend to swell, which leads to a deterioration of ventilation functions;Ciliated epithelium is unable to adequately eliminate phlegm and infection easily penetrates, settles and multiplies;Due to underdevelopment of additional sinuses of the nose, lower nasal passage, immaturity of local factors - air does not warm up sufficiently when inhaled and is not cleaned to the right degree;Immaturity of alveoli and surfactant;In the roots of the lungs, a rich vascularization;The length and width of individual bronchuses is different from adults, which creates unequal drainage conditions. It differs from the adult form with lightning speed of flow, in infants it is rarely contagious, more often secondary - as a complication of tonsillitis, bronchitis, laryngitis.

Inflammation of the lungs in a child of 2 years is risky for life because the breathing is shallow, the lungs are worse ventilated and this is a wonderful soil for the development of etiopathogenic agents.

Inflammation of the lungs in a child: causes of

The causes of inflammation of the lungs in a child and in an adult are the same - the immediate presence of the pathogen itself and reduced immunity.

Inflammation can be caused by:

- Bacteria. The most common etiopathogenetic agent is pneumococcus, as it is the most trophic to the lung tissue. Staphylococcus, streptococcus, chlamydia, mycoplasmas, Legionella, Klebsiella, and Escherichia can also act as provocateurs.

- Viruses. Occupy 50% of the etiological cohort. This is the wand of Afanasyev-Pfeiffer, influenza, parainfluenza, adenovirus, herpes virus, chickenpox virus, PC virus, cytomegalovirus.

- Fungi. Rarely does fungal contamination occur( for example, candidiasis or aspergillosis).In general, this subtype of lesion is typical for strong changes in immunity and there is a very severe course of the disease.

- Parasites. Pathogenetically emerges a picture when the penetration of parasites into the lungs to eliminate the latter occurs accumulation of eosinophils. As a consequence, an eosinophilic infiltrate is formed. Representatives of this lesion may act - ascarids, pulmonary flukes, pork tapeworm, echinococcus.

There are a number of etiopathogenetic factors of pneumonia in a child:

- intrauterine hypoxia or lack of oxygen during childbirth;

- complicating factors in childbirth( trauma, asphyxia);

- prematurity with morphofunctional immaturity;

- congenital heart, lung, immunity;

- pneumopathy in a child;

- cystic fibrosis and endocrine diseases, asthmatic manifestations;

- transferred organ transplantation;

- congenital and acquired immunodeficiency states;

- anemia, rickets, physical underdevelopment, hypotrophy;

- infection from mother to child( chlamydia, herpes);

- unfavorable conditions for living, unbalanced diet and digestive disorders;

- exudative diathesis;

- chronic inflammatory foci of the rhinopharyngeal cavity( tonsillitis, adenoiditis, pharyngitis, laryngitis);

- frequent recurrent bronchitis;

- lack of vitamin substrates and trace elements;

- inhalation of toxic chemical fumes( household chemicals, not far from ongoing construction works);

- allergic processes, especially with accompanying cough;

- cooling and overheating, overwork. With significant supercooling, the defenses and microbes weakens easily penetrate into the lungs, this includes the cold season, as a predisposing risk factor;

- tobacco smoking, alcoholism, drug addiction in adolescents;

- long stay on bed rest in a horizontal posture( after fractures, burns, surgical operations);

- provokers are ARVI, under their influence the immune system weakens, the production of mucus increases and its bactericidal activity decreases;

- the bacteria that cause the process penetrate with the inhaled air stream, from household items, surrounding us, soft toys, on the covers, and in the airways themselves;

- contact with patients for purulent-inflammatory diseases;

- improper treatment of diseases( self-medication, preventive courses of antibiotics).

Etiological signs of pneumonia in a child at 1 month of age .Causes cause bacterial pathogens, less often viral, weakness of local defense forces. This is an important point, since the common immune system is not formed, the pathogens actively multiply. With a frequent defect in the surfactant of a congenital nature, there is a high risk of dyspnoea and respiratory insufficiency. As a result of the accumulated carbon dioxide in the blood, there is oppression of the functioning of the brain.

Signs of pneumonia in a child 4-6 months old .Inflammation of the lung parenchyma is primarily caused by viruses, due to the attached bacterial flora. Features of the structure of respiratory organs in children cause rapid damage to the respiratory ciliated epithelium. The rich blood supply to the lungs in infancy and frequent lying, feeding by mixes and non-compliance with hygiene rules - all these factors contribute to stagnant changes in the pulmonary parenchyma.

Inflammation in the child 2 years old .Bacterial agents predominate. By the age of two, the strengthened systems( protective-supporting) of the child help to cope with the infection.

Inflammation in the child 3 years old .Up to three years of life, it is difficult to cough up viscous sputum, due to accumulation it is the nutrient medium of the vital activity of pathogenic microorganisms. The immunity is already strong and the surfactant is formed. The highly pathogenic flora with damaging toxins acts on the leading place, capable of destroying the epithelium of the bronchi.

Inflammation of the lungs in a child: symptoms of

The general symptomatology is as follows:

- Lethargy and weakness, sleep disturbance, restlessness, moodiness and tearfulness. Infectious agents affect not only the lungs but also the intestines - nausea and vomiting, diarrhea, a decrease in appetite and a complete refusal to eat. Gastrointestinal disorders are very dangerous for the smallest, as reducing the mass index, up to a critical weight loss, increases the risk of lethality. Seniors complain of muscle and joint discomfort, nasal congestion, runny nose.

- First of all it is worth paying attention to a strong cough, which can be dry, wet, paroxysmal or pertussis-like, deep, with mucous or purulent sputum, blood traces, or absent altogether.

- Dyspnea is an important indicator of lung inflammation in a child, it is by counting the number of respiratory movements that we can judge the severity of the baby's condition. The rate of inspiration at the age of 3 years is 25-30 / min, 4-6 years - the norm is 25 / min, newborns are up to 50 / min. The number of breaths increases many times, in comparison with these indicative figures, in the inflammatory process. Breathing is rapid, foamy substance appears on lips. One of the halves of the breast takes a more active role in the act of inspiration, sleep almost on one side, with considerable sweating. Swelling the intense pale wings of the nose, the blue of the nasolabial space, the very breath itself is superficial. If you undress a baby, then you can see the fate of an additional helping muscle, with the retraction of gaps between the ribs.

- marked pallor, swelling of the entire body, especially the face.

- feverish phenomena, the temperature keeps at the level of 37.2-39.6 ° C for a long time, can change in wave form, despite even competent treatment.

- Painful zarudninnye sensations, especially when coughing and inhaling, gives under the shoulder blade, in the epigastric zone.

- Features in newborns and infants: peak incidence falls for 4-9 months. Symptomocomplex includes: gradual development, by the type of catarrhal phenomena. The child badly takes a breast, there are frequent uncontrollable regurgitation, there is a general malaise with weakness. Signs of respiratory insufficiency increase more rapidly than in the older children's age group. In addition, during feeding and crying, it is possible to observe blueness of the distal phalanges of the fingers or nasolabial folds. The temperature rarely rises, more often it keeps 37.1-37.2 ° C, or it may not rise at all. In a dream, the toddler turns and cries, it hurts to breathe, foam-like discharge comes from the nose and mouth. The skin relief changes: in the intercostal space, the skin is drawn from the side of the lesion. Shortness of breath is accompanied by a nod of the head in time to breathe, the baby swells his cheeks and extends his lips. Possible difficulty breathing until complete apnea.

Auscultately, there is a quiet hard breathing with small bubble crepitus wheezing, it is better to listen when crying, when the breathing is deeper.

- Pre-schoolchildren have a more stable immunity, and they can present specific complaints, so the inflammation of the lungs in the child has a clear symptomatology. Complaints of dizziness, muscle pain, number of breaths exceeds 30 / min, subfebrile condition, and hyperthermia may cause seizures, skin pallor is very pronounced, and in addition, rashes may appear, sputum green-yellow.

- Schoolchildren, over 6 years old, do not differ from the picture from adults. Only the frequency of morbidity increases significantly during the autumn-winter period, due to the closely communicating team and the rapid spread of infection in it.

The symptom complex differs depending on the type of pathogen:

- Bacterial pneumonia in a child. With pneumococcal contamination, the debut is overwhelming, the state of feeling sharply becomes bad, the baby is constantly feverish, breathing is frequent, the face is hyperemic, the baby is sluggish, cough with "rusty" discharge, abdominal pain and inspiration. Pfeiffer's wand causes a slow flowing form, with prolonged hyperthermia, spitting out of green sputum and wheezing. Klebsiella causes a fulminant form with a chill and an index of up to 40 ° C, a cough with a viscous mucous substrate. Staphylococcus aureus does not provoke a temperature increase, but there is a cyanotic-gray complexion, the pulse is threadlike, the stomach swollen, often lethal ends. Pseudomonas aeruginosa causes nosocomial tropic to mild infection, acute development with morning feverish peaks, skin with blue, tachypnea with tachycardia.

- Viral inflammation of the lungs in a child. This option used to be called atypical, because it was not possible to find the root cause and the disease did not respond to antibiotic therapy, the symptoms are masked for cold pathologies. Differences appear when the temperature does not drop medically and does not fall off on its own.

- Atypical pneumonia in children. With mycoplasmal infection, the first to manifest rhinitis, throat swelling, dry cough. Later, "breaking the muscles", nosebleeds, inflammation of the lymph nodes. The first signs of chlamydia are rhinitis, a jump to 38-39 ° C, an increase in lymph nodes, allergies and dermatitis, and conjunctivitis joins the newborns. Legionellosis type is characterized by fever up to 40 ° C, with severe migraine headaches, diarrhea and vomiting.

- Aspiration pneumonia in a child. In the bronchi can get food pieces, liquid, foreign particles and then begins to develop an infection, multiply pathogenic microbes. If the cause is in bacteria, then the temperature gradually rises, moist cough;When affected by chemical substances - dyspnea, sputum and pink sputum;If the foreign body is a reflex coughing painful coughing impulses, after a while they subside, but leave behind an inflammatory process.

- Focal inflammation of the lungs in children. The most common form of childhood. The causative agents are bacteria, viruses, fungi, toxins of a chemical nature, an allergic reaction. There is one or multiple foci in the baby's lungs, which can go into a focal-drainage form( segmental lesion or whole lobe).Symptoms at first are indistinguishable from colds: the child coughs, worries about a cold, the condition deteriorates sharply after a week, and the symptoms are becoming more vivid: agitation or apathy, frustration, pale skin, noisy breathing, tachycardia, fever 38-38,7 ° C, coughDry or with mucopurulent sputum, objectively hears the focus of crepitating wheezing.

- Segmental pneumonia in a child. For two days from the time the penetration agent etiopatogennogo occur: the reaction temperature, cough, malaise, loss of the landmark in the space, palpitations and shortness of breath, sweating.

- Croupous inflammation of the lungs in a child. Schoolchildren and schoolchildren are more often sick. It occurs in several forms with inherent symptoms: abdominal( pain as appendicitis), meningeal( headache, drowsiness, convulsions), abortive( can be characterized as follows: acute and violently started and ended in 1-3 days) pain. Also present: pleural reaction, cough with rusty impurity, hemoptysis, forced position in bed, feverish glow on the face with cyanosis, herpetic rash lips, shortening of percussion tones, bronchial breathing, finely krepitiruyuschie wheezing, hypotension, skin ikterichnost.

- Interstitial pneumonia in a child. It begins acutely, coughing painful, vomiting, tachypnea, arrhythmia of inhalation-exhalation.

- Radical inflammation of the lungs in a child. Inspection, auscultation and an X-ray picture give a completely different picture of the location of the lesion, which makes diagnosis difficult. Disease of a protracted nature, with a marked symptom complex or even without it.

Inflammation of the lungs in a child without temperature

Inflammation of the lungs without temperature is typical for children with weakened immunity. This option is still called quiet or secretive. Children are particularly at risk because the child is not able to adequately explain their complaints or is not yet able to speak at all. Inflammation of the lung in a child of this species can not be transmitted to others, that is, not contagious, but has the nature of the course of infection.

Reasons for lowering the body's defensive-defense forces are very diverse: in the presence of a source of infection - untreated teeth, tonsillitis, laryngitis, bronchitis;Hypothermia of the body;May result from unformed or weak immunity;Young age;uncontrolled reception antibiotic group of medicines( self antibiotics in inadequately high, exceeding the weight and age limit, the doses prolonged use of the body gets used, thus reducing the desired therapeutic effect), against a long reception antitussive( suppressed sputum elimination mechanism that leads toAccumulation of etiopathogenic flora) drugs.

symptom of pneumonia in children without fever include:

- cough duration of more than two weeks, maybe with scanty or copious sputum;

- exhausting weakness, constant thirst against a decrease in appetite, drowsiness, tearfulness, blueing of the nasolabial triangle;

- whistling with breathing, which can be heard, if you focus on this, with uncomfortable pain;

- asymmetry of vibration in the act of breathing of the chest;

- unhealthy face blush on the side of the affected lung, spots of red shade;

- severe sweating;

- when you rotate your torso, there is a noticeable soreness in your chest;

- severe shortness of breath and increased heart rate;

- a deep breath is painful.

pneumonia in a child: diagnosis

pneumonia diagnosis in a child involves the following steps:

- Diagnosis requires a lot of work, experience and accumulated knowledge, because the auscultatory, percussion methods, changes are not recognized. Assesses overall health, examination of the chest, analyzing asymmetry in breathing. You can listen to dry or wet rattles, sometimes there is a dull sound over the lesion.

- General blood and urine tests, biochemical tests and sputum examination are prescribed.

- The most important point is X-ray examination in two projections. Try to find a zone of darkening of lung tissue.

- The x-ray picture is not always informative, then computerized tomography is used. Indications for CT: in the presence of symptoms of inflammation on the roentgenogram indefinable zone of inflammation;With relapses more than three times;If the results of the X-ray image are not comparable with the symptomatic complex of the disease.

- Conduction of a bronchoscopy - examination by a flexible tube inserted with a camera, through the nose and into the lumen of the bronchi, is applicable with concomitant complications to clarify the diagnosis.

With no temperature flow, self-medication is inadmissible in any case. For treatment, antibiotics are used that capture a wide range, often even a combination of two - Cephalosporin and Macrolide, with a course of not a week. Pathogenetic therapy consists in receiving expectorants with mucolytics;With shortness of breath, bronchodilator;Inhalation therapy nebulizer. Symptomatic use of multivitamins, immunomodulators, physiotherapy, drainage massage.

At the end of the treatment, the X-ray examination is repeated. Consultation of the phthisiatrician is necessary, since the probability of decomposition of the lung parenchyma can not be ruled out.

The outcome is mostly unfavorable, because due to untimely started treatment, precious hours are lost and severe damaging processes in the body develop. Lethal cases account for half of all outcomes of the disease.

Inflammation of the lungs in a child: treatment of

The earlier the diagnosis and treatment is prescribed, the better the chances of recovery without complications. Treatment of pneumonia in children includes the following steps:

- First, determine whether the patient needs to be hospitalized. And already starting from an outpatient or inpatient stay, the amount of the complex of procedures and medicines is prescribed. Treatment of infants under 3 years of age should be strictly inpatient, since daily dynamic monitoring is necessary and, if necessary, emergency care, it is not feasible on an outpatient basis. Also, under the constant supervision of doctors should be children with severe respiratory failure, rickets, immunodeficiency states. Urgent hospitalization at any age in the absence of positive dynamics to two from the start of treatment.

- Antibiotic therapy consists in the use of the 2nd - 3rd generation of antibiotics, since resistance to the previous ones already exists. These are Amoxicillin, Cephalosporins, Fluoroquinolones, Macrolides, Carbopenems, Sulfamethoxazole. Therapy is empirical, begins before the results of the bacsearch. If the condition does not change for 2 days, then the medicine changes. In the treatment of rhinopoietic, adeno-, parainfluenza and influenza viruses, antibiotics often do not bring the expected effect, so antiviral drugs should be added to the course of treatment( Oseltamivir, interferon preparations).When fungal etiopathogenesis is mandatory use of antifungal drugs( Fluconazole, Diflucan).

- General recommendations include: bed rest with a raised head end, frequent cleaning of the room and ventilation, diet food with digestible food, abundant drinking of warm liquids - tea, mors, herbal infusions.

- Pathogenetic treatment: oxygen therapy - with dyspnea and changes in pulse oximetry, gas components, capnography. When expressed hypoxia is transferred to the ventilator under supervision in the intensive care unit. When dehydrated, oral rehydration with saline solutions or, if necessary, the use of infusions - glucose-salt solutions. Life-saving extracorporeal membrane oxygenation of the bloodstream( oxygen is supplied to the blood through a special apparatus, excluding the sick lungs from gas exchange).

Expectorants, mucolytics( Mucaltin), bronchodilators( Ventolin, Euphyllin), bronchoscopic sanitation, antipyretic and NSAIDs are applicable.

- Symptomatic therapy: physiotherapy, ultraviolet irradiation, drainage massage, respiratory gymnastics, postural drainage, exercise therapy, inhalation with nebulizer, vitamin prophylaxis, immunomodulators, probiotics for recovery of intestinal microflora, sorbents for toxin removal( Polysorb, Enterosgel).

The timely treatment will prevent the complications, consequences in the future, and maintain psychological comfort, especially for young children.

Inflammation of the lungs in a child: complications of

In the inflammatory process in the lungs, children often develop the following complications:

- Destruction of the parenchymal part of the lung: single and multiple abscesses, gangrenous lesion, cavernous changes, fungal and parasitic abscessing. The outlined processes are characterized by necrosis - death of the pulmonary tissue of the central zone in the infiltrate. Dead necrotic tissue favors fulminant contamination with etiopathogenic microflora, the progression of purulent-putrefactive lesion with further melting and the organization of purulent cavities. They are dangerous for the possibility of breaking through thin walls into pyopneumotorax.

- Dry pleurisy, or when the bacterial component, neutrophilic decomposition, becomes fibrinous, progresses to pleural empyema.

- Cirrhosis of the lung( carnification), that is, the germination of connective tissue in the parenchyma, followed by the formation of bronchiectasises.

- In infants up to one year old, exudative pleurisy, allergic bronchial obstruction, otitis media inflammation, otitis media, tonsillar lesions, pharyngitis, edema of already narrow airways or even the lungs themselves are more common.

Inflammation of the lungs in a child: consequences of

After a disease such a pathological phenomenon as pneumonia, the child may develop burdening, requiring corrective measures in the future, the condition:

- bronchoobstructive syndrome, up to progression to frequent obstructions and asthmatic events;

- toxic-infectious shock phenomenon;

- lung atelectasis;

- combined pulmonary-cardiac pathology;

- myo-, endo- and pericarditis;

- anemia;

- pneumosclerosis - proliferation of connective tissue elements in the lungs, which entails severe respiratory failure processes with heavily adjusted dynamics.