Pneumonia( pneumonia) symptoms in children
Pneumonia( inflammation of the lungs) is an acute infectious disease that affects the lung tissue. The disease is insidious, especially for young children.
Classification of pneumonia
The following morphological features are distinguished:
focal;
is segmental;
focal and outflow;
croupier;
interstitial.
According to the conditions of infection are divided into:
out-of-hospital;
is an intrahospital.
with perinatal infection;
in patients with immunodeficiency states.
Following the course of pneumonia, there may be:
acute;
protracted;
chronic.
Ambulatory pneumonia occurs at home or until the first 48 hours in the hospital.
Hospital pneumonia occurs after 48 hours of hospitalization or within 48 hours after discharge from the hospital.
Age of children and characteristic pathogens
Newborns - 1 month - group B streptococcus, Staphylococcus aureus, Klebsiella, Escherichia coli, cytomegalovirus, herpes simplex virus, mushrooms of the genus Candida.
1 month - 6 months - chlamydia, mycoplasma, pneumocysts in premature infants.
6 months - 6 years - pneumococcus, hemophilic rod, rarely staphylococcus.
6-12 years - pneumococcus and hemophilic rod( less often), more often atypical pathogens - chlamydia, mycoplasmas.
Intrahospital pneumonia - Pseudomonas aeruginosa, Klebsiella, Staphylococcus, E. coli.
Pathways of infection
The main path of penetration of the pathogen into lung tissue in children is bronchogenic: the infection spreads along the airway through the bronchi to the alveolar tissue. The hematogenous( metastatic) pathway is less common and is observed with sepsis, a viral infection. A major role in the pathogenesis of pneumonia is played by the inadequacy of the surfactant system, predisposing to atelectasis, the immaturity of the lung tissue in children.
Initial changes in the lungs are usually found in the respiratory bronchioles, where there is ampoule-like expansion of the bronchi, there is no developed ciliate epithelium and less developed muscular tissue. When coughing and sneezing, the infection gets retrograde into the larger bronchi and thus spreads bronchogenic. Thickened membranes, increased blood flow, accumulate inflammatory fluid, detritus, metabolic products. Parts of the lung are turned off from the act of breathing, but reflexively adjacent alveoli, lobules compensate for ventilation, providing diffusion of gases. Under the influence of toxins of pathogens, the body temperature rises, and the release of catecholamines increases. As a result, the blood pressure rises, the blood flow accelerates, the pulse and respiratory rate increase, the metabolism increases.
Pneumonia in school-age children does not differ much from pneumonia in adults. At the same time, the younger the child, the greater the importance for diagnosis have the general symptoms compared to the local ones.
In young children, attention should be paid to such signs as shortness of breath without signs of bronchial obstruction, cyanosis, tension of the wings of the nose, retraction of compliant places of the chest, foamy discharge from the nose. On the other hand, such classic physical symptoms of pneumonia, as local percussion and auscultatory changes, may not be observed, determined in later periods of the disease or in the severe course of the pathological process.
Focal pneumonia
In the initial period: cough, runny nose, subfebrile or febrile body temperature. Pay attention to changes in the ratio of pulse to breathing instead of 1: 3-1: 4, it becomes 1: 2.5 or 1: 1.5.Percutaneous changes until 1-2 days of illness are not noted. In the future, the so-called blunted tympanitis can be noted. Auscultatory at the beginning of the disease, hard breathing is heard, often local moist sonorous or crepitating rales. At the analysis of blood moderate leukocytosis, accelerated ESR is revealed. Uncomplicated pneumonia in children without a pronounced adverse premorbid background is treated for 1-4 weeks.
Segmental pneumonia
Affects 1 or more segments of the lung. At the forefront are respiratory failure, intoxication, more pronounced than in focal pneumonia. Physical data is scarce, percussion data are more important.
Clinical manifestations of segmental pneumonia occur after 1-2 weeks, but radiologic changes persist up to 3 weeks. Possible complications in the form of fibro-teleclosis with further evolution into the bronchiectatic process.
Croupous pneumonia is diagnosed quite rarely, most of the children are sick. The most frequent pathogen is pneumococcus type 4.It occurs mainly in children with increased and altered reactivity. Intoxication is expressed, possibly abscessing.
Treatment of
Treatment of pneumonia in outpatient settings is possible only with a relatively satisfactory general condition, in an older child, with a high sanitary culture of the parents. In such cases, a home hospital is usually arranged.
The hospitalization of the remaining patients is carried out in pulmonological boxes with a maximum separation.
Optimal mode, light, well aerated chambers.
Position in bed. The child must be laid in a semi-sitting position with a slightly upturned head. Clothes should not constrain respiratory movements.
Food should be familiar, full, but easily digestible. More than half of the daily volume of liquid should be glucose, moderately sweet tea, alkaline mineral water.
In the treatment of community-acquired pneumonia, it should be assumed that home pneumonia causes pneumococcus most often. Therefore, drugs of the penicillin series should be prescribed, and in the absence of effect - ampicillin, cephalosporins in the average therapeutic doses. For the treatment of nosocomial pneumonia, a combination of aminoglycosides with cephalosporins and rifampicin is used. When anaerobic flora requires gentamicin with levomitsitinom. Pneumonia, caused by a hemophilic rod, is treated with gentamicin, cephalosporins, rifampicin.