Pneumonia in children

Pneumonia in children can be primary, but more often secondary, occurring at the background of viral respiratory diseases, as well as sandwiches as a complication of infectious diseases and other pathological conditions of the child's body. The emergence of pneumonia contribute unsatisfactory living conditions, improper feeding, and rickets, malnutrition, vitamin deficiencies, artificial feeding and other
In children older than 3 years is mainly lobar pneumonia. In the youngest age group is dominated by small pneumonia (pneumonia). Pathogens of pneumonia: bacteria, viruses, fungi.
The disease often begins gradually. Clinically prevail common symptoms of lethargy, poor appetite, sleep. Increased body temperature, appear dry cough, shortness of breath, tension or swelling of the nose, recurrent episodes of cyanosis, particularly pronounced in the area of naso-lip triangle; diarrhoeal disorders. Auscultation of the beginning of the disease are determined scarce dry or wet scattered wheezing. Percussion and auscultation data more audible during the drain extensive lesions. It should be remembered that the clinical features of pneumonia disappear faster than anatomical recovery. Improper or untimely treatment may lead to recurrence of disease or to be the cause of a protracted course of the disease.
The diagnosis of pneumonia is based on clinical and radiological examination.
Pneumonia in newborns. Easy coming aspiration, shallow breathing, horizontal position of children on the back easily lead to the violation of patency of the bronchi and atelectasis, stagnation in the lungs, creating fertile ground for the development of the inflammatory process. Of considerable importance in the origin of pneumonia has pathology descent act, aspiration of amniotic fluid, asphyxia. In the period of pneumonia in newborns distinguish mild and severe forms. Body temperature more low-grade.
The clinical picture is dominated by the common symptoms: failure from the chest, regurgitation, vomiting, weight loss, cyanosis, increasing during feeding, the voltage of the wings of the nose, shortness of breath. Sometimes breathing becomes kraftysim, moaning, up to 80 - 100 in 1 min, violated his rhythm, some children on the lips appears frothy saliva. In newborns and infants with pneumonia, especially viral-bacterial etiology, usually dominated by the symptoms of General intoxication. Often, the disease is accompanied by convulsions, loss of consciousness, meningeal symptoms. Possible lethal outcome.
In recent years, due to the rapidly emerging resistance of Staphylococcus to antibiotics has become increasingly meet P: staphylococcic etiology, mostly at an early age (up to 3 years).
For staphylococcal pneumonia is characterized by the formation of abscesses and air cavities (bull) in the lung tissue. Pneumonia in most cases are usually severe, with pleural complications (see Pleurisy purulent). The disease often has all the signs of septic process from the very beginning is accompanied by high temperature, expressed intoxication and respiratory failure. With the annexation of pleural complications disorders are particularly pronounced. In the diagnosis of the most important are the data of x-ray examinations: in the lung abscesses, Bulla, in the pleura - the exudate or exudate, together with the free air at the break of abscess connected to the bronchus.
Treatment of pneumonia in children should be complex. Of great importance mode, good care and nutrition. The child must often turn to take his hands and early to start gymnastics. Children should be in well-ventilated areas. In severe breathing disorders in infants fed expressed milk. Oxygen therapy is carried out with the help of an oxygen tent or by filing a humidified oxygen through nasal catheter. One of the main places is antibiotic therapy. Antibiotics administered in the age doses intramuscularly, and in severe cases, intravenous. Penicillin is usually administered in combination with streptomycin injection. In severe cases of pneumonia in children prescribe antibiotics broader spectrum (oletetrin, oleandomitin, erythromycin and other). When staphylococcal pneumonia in recent years is widely used semi-synthetic antibiotics (methicillin, oxacillin). Antibiotics of tetracycline group is more suitable for viral pneumonia.
Antibiotics prescribed courses duration-7-10 days, then produce a replacement. With long-term use must be assigned nystatin. The purpose of detoxification is injected plasma (8-10 ml per 1 kg of weight), 20% glucose solution (10-20 ml). Appoint vitamins B1, B6, B12, in the age dosages. To stimulate the body's defenses apply gamma globulin 1.5-3 ml 1-2 days intramuscularly (three times). On the elimination of phenomena toxicity, and when staphylococcal pneumonia - from the first days shows blood transfusion (3-5 ml of blood per 1 kg of weight). The evidence used cardiovascular drugs (kordiamin, caffeine, corglycon), symptomatic (amidopyrine, acetylsalicylic acid at high temperatures).
Treatment of staphylococcal pneumonia should be conducted jointly by a pediatrician and a surgeon, as is often the acceding pleural complications require first of all surgical interventions (puncture, drainage of the pleural cavity etc).

Pneumonia has a significant place among all other diseases in children, especially the first year of life.

The etiology and pathogenesis
Pneumonia in children can be primary, but more often secondary, occurring at the background of viral respiratory diseases, as well as layering as a complication of infectious diseases and other pathological conditions.
Pathogens P. in children: filterable virus, various cocci, bacteria, Salmonella, parasites (Pneumocystis, and Toxoplasma), fungi, literally.
The emergence of P. in children is facilitated by various factors: poor living conditions, defects of the regime, nutrition, etc. these factors contribute to the emergence of rickets, malnutrition, vitamin deficiencies, and so on, lowers the body's resistance to infections, including respiratory.
A decisive role in the incidence of P., in the modern view, plays an age reactivity, which is determined morphological and functional features of the Central nervous system, respiratory organs and the whole of the child's body as a whole, the imperfection of protective mechanisms and undifferentiated, often inadequate reactions to external stimuli. This explains, in particular, and the originality of clinical forms and currents pneumonia depending on the age of the children. Therefore, the most appropriate is the description of P. in children depending on age.

Pathologic anatomy
Pneumonia in children are common, and, despite the success of modern therapy, still offer fatal, especially in children of the first year of life. Burden of P. depends on the anatomical and physiological characteristics as the whole body of the child, and his lung tissue. The latter include: lower respiratory surface of the lung, compared with easy adult, weak development of elastic tissue in the alveoli and the alveolar moves and muscles bronchi, the wealth of loose connective tissue with an extensive network of lymph vessels.
These features reduce self-cleaning function of the lungs and the spread of the arising of the inflammatory process.
Lobar pneumonia, especially nowadays, children are almost not observed and mortality does not. The unit of observation in utero lobar pneumonia fruit depend on sensitization coming from the parent body.
Pneumonia is the most common form of P. in children. It may occur as manifestations of influenza, Korn, pertussis, psittacosis, adenovirus infections, be a consequence of autoinfection in various diseases of infectious and noninfectious character (neuralgia, titantic, intestinal infections, and so on) or be in the nature of the primary disease.
Macroscopically pneumonia in young children are not always easily recognized. This easy-full-blooded, edematous, paravertebral areas in the context of detected small wibehouse dark red foci that do not sink in the water thanks to the surrounding air tissue.
Histologically, on the background of hyperemia and edema gleams of the alveoli are made rich in protein serous fluid with a large number of cells sladenkogo alveolar epithelium. In the bronchi can be significant desquamation of the epithelium. Sometimes there is a proliferation of giant cells as of bronchus cancer, and from alveolocytes. Like pneumonia are called sero-desquamating and more often observed in children under one year for respiratory viral infections. The nature of the giant cells in some cases, you can judge the pathogen (adenovirus, measles virus). For further diagnosis should resort to virological study.
When a large process more ago characteristic is the diversity of species easy on the cut, which depends on the rotation of pneumonic trick red or black-red color, wibehouse above the surface of cut, with a gray or grayish-yellow magic tricks and stuck with dark parts of atelectasis, alternating with the bright swollen emphysematous fields. In the propagation process peribronchial tissue in the center of pneumonic lesions detected small bronchus with swollen grey wall and the subtle level. Such peribronchial and pembrokcity can mimic tuberculosis tubercles. Detection of bronchi under a magnifying glass removes the diagnosis of tuberculosis. Microscopic examination can detect lesions of pneumonia at different stages and with different character of the exudate, what determines the diversity of lesions on the context. Such drain pneumonia more common as a result of autoinfection or prolonged for respiratory viral pneumonia. In the latter cases, there is a tendency to necrotic changes as of exudate in the alveoli and the bronchial tree (necrotic unbranched). As the etiologic factor autoinfection of bronchopneumonia great importance currently has aureus. Staphylococcal on can be a primary and a secondary, joining viral P.; they are characterized by the development of purulent processes in the lungs. Fungal P. with the advent of effective antibiotics are relatively rare.
Newborns are relatively frequent aspiration pneumonia caused by the inhalation of amniotic fluid and meconium. The diagnosis of these P. confirmed by the presence in the gaps of the alveoli of foreign particles (lanugo, Horny particles, meconium plug masses). In newborns against the background of hypostasis develop alveolitis - damage to the group of the alveoli without the participation of the bronchial tree.
Interstitial pneumonia in children - hematogenous emerging inflammatory process, unfolding in the field of alveolar walls; they can be primary (possibly a virus) and secondary, emerging infections and intoxications (sepsis, dyspepsia, gastrointestinal infections, diphtheria, and so on). Macroscopically interstitial P. not recognized, there is a subtle resistance of lung tissue. Microscopically, the process can be focal and diffuse. For diffuse interstitial pneumonia severe due to significant violations of gas exchange. Alveolar walls swollen, swollen, the number of cellular elements in them increased. The nature of cells depends on the prescription process. In rare cases, a possible outcome in diffuse fibrosis of the lung. Among interstitial P. occupy a special place Pneumocystis pneumonia characterized by massive plasma-cell infiltration of alveolar walls and foamy exudate in the alveoli (see Pneumocystosis), and cytomegalie P. characterized by the appearance of special giant cells in the lungs (see Cytomegalovirus). Both P. often combined with each other.
Participation of easy-to-immunogenesis (see Immunity, immunomorphology) results in swelling of the membranes and cell proliferation on the territory of the alveolar walls. The delimitation of the immune perestroika and true interstitial P. morphologically difficult and hardly necessary. Criterion pneumonia is the degree of clinical and functional disorders. In pediatric patients need to know that the immune restructuring can always develop into true interstitial P.