The symptoms and treatment of caseous pneumonia
To date has significantly worsened sanitary-epidemiological situation, mortality from respiratory infections is extremely high. Caseous pneumonia, as well as all forms of tuberculosis requires early treatment. One of the most dangerous forms of inflammation of the lungs with prevalence of cheesy necrosis is caseous pneumonia. When caseous mass rapidly rasizada, formed numerous cavities of small size. Expressed disease severe intoxication syndrome, respiratory distress, serious impairment of body functions (including and bleeding of the lungs) and often leads to death.
Pathomorphological changes and epidemiology
Caseous pneumonia is a clinical form of pulmonary tuberculosis. Such pneumonia can result from complications of fibrous-cavernous tuberculosis, or it may be an illness. The main causes of pathogenesis are the following: immunodeficiency, getting into the lungs of infectious agents and associated serious diseases, mycobacterial infection, alcohol dependence and drug addiction. A stressful situation and starvation can also be in some measure provocateurs caseous pneumonia.
Caseous pneumonia is:
- Acinosa. Complicated form miliary tuberculosis. Appears when you defeat acini (a single skin).
- Lobular. Is a complication of tuberculosis with lesions of the several parts of the lung. Occurs due to tuberculosis intoxication, the disease is very difficult.
- Lobar. Is an independent form of tuberculosis, affects fully half a lung. Occurs when there is inflammation. Can be formed as large cavities, large areas of necrosis. Lobar and lobular lesions happen from mild pneumonia.
For caseous pneumonia is observed in respiratory failure, and lymph nodes inside the chest is affected, then develops a generalization of infection. Caseous necrosis progresses rapidly (2 - 3 weeks). The cavities can be both small and large, contributing to significant destruction of the lung. Caseous pneumonia often becomes the cause of the thrombo-haemorrhagic changes, therefore, occur toxic and allergic reactions, ischemia, and sepsis. Dying lymphocytes leading elements of the immune system at the cellular level. Arise monocular destruction. The consequence of disturbed metabolism is adrenal insufficiency, myocardial dystrophy and significant violationthe psychological state. She caseous pneumonia treated problematic.
Symptoms of caseous pneumonia
The main symptoms of this type of pneumonia: leukocytosis, lymphopenia, pain in the chest. At the initial stage of the disease pronounced symptoms of intoxication with the following accompanying symptoms: decreased appetite, chills, severe sweating, fever, dry cough, shortness of breath, hypoxemia, sudden pneumothorax.
Gradually the symptoms become more pronounced, deteriorating General condition, cough accompanied by sputum, which appears a little blood. Further develop cachexia and acrocyanosis. Caseous pneumonia may be masked under the guise of:
- Pneumonic pneumonia. Body temperature becomes high and has a permanent character (to 39 - 40°C). There is pain in the chest and cough.
- Flu. A cough, body aches, runny nose and sore throat.
- Sepsis. Is characterized by symptoms of intoxication, headaches, fever, decrease in appetite until the development of anorexia; weight loss is 10 kg or more.
Closer to the 7 day of the disease the sputum is green, the body temperature rarely rises, the patient weakens, the skin pales, sweating increases. Is cyanosis of the tip of the nose, lips, hypoxia, and tachycardia, there is hemoptysis and bleeding of the lungs.
The disease in these options:
- the syndrome of intoxication was most pronounced;
- appears respiratory failure;
- there is bleeding of the lungs and hemoptysis;
- type can be current, such bronchial inflammation with frequent and heavy discharge of sputum.
If all these symptoms of severe, it is very important the correct definition of tactics of treatment. The difficulty of diagnosing this disease is the difficulty of identifying in the first week. Even with the rapid development of the disease the disintegration of the caseous necrosis is seen only toward the middle of 2 weeks.
During the development of the disease the clinical picture is changing for the worse, the disease gives remission, diffusely affected myocardium, disturbed microflora and appear gram-negative rods and fungi, the mucus becomes a stench. Also with the progression of the disease the number of leucocytes is greatly reduced. Lymphopenia occurs in all cases of caseous pneumonia and becomes more and more pronounced.
Diagnosis and treatment of caseous pneumonia
In severe immunodeficiencytuberculin Mantoux test is often negative or positive, but insignificant. It is affected by the reduced reaction of the skin. Identification of bacteria using microscopy and sputum culture on nutrient media. About 50% of patients are resistant to the drugs.
One of the main means of diagnosis is a chest x-ray. Using this method accurately determined the nature and extent of lung disease, the shift to affected side, narrowing of the intervals of the membranes.
Multiple degradation and cavities of more than 4 cm also indicate the presence of caseous pneumonia. In the picture in 50% of patients this disease is visible in the form of dark areas, with many destructions.
Sputum smear microscopy is the second major method of diagnosis of the disease. Laboratory microscopy for Mycobacterium tuberculosis shows a positive result. Analysis of bacteriological constituents of the sputum gives a 100% correct diagnosis of the disease. All patients entering the hospital are obliged to do x-rays and undergo clinical examination.
The treatment takes place in an infectious TB inpatient unit. Complex therapy has the following main stages:
- stimulation of reparative processes;
- surgical intervention in the form of removal of the destroyed areas of the lungs.
Initial treatment in hospital is caused by the relief of infectious-toxic shock.
Then enter the dissolve and shelters krovezamenauschie of fluid using intravenous injections and infusions, use of antioxidants and antihypoxants.
Then chemotherapy. If the detected resistance to drugs, basic drugs replace on the backup. The course of further treatment includes the use of multiple drugs. The period of treatment lasts at least a year. In complete defeat of the easy surgery along with the comprehensive chemotherapy.