Bacterial lung destruction - Complication of bacterial pneumonia, occurring with the development of inflammatory processes in the lung and pleura. Common manifestations of different forms of bacterial destruction of lungs are symptoms of purulent intoxication and respiratory failure. Diagnosis and differential diagnosis based on data from X-ray of lungs, pleural cavity ultrasound, thoracentesis, laboratory sputum, exudates, peripheral blood. Basic principles of treatment of pulmonary bacterial degradation include antibiotics, infusion detoxification, reorganization of the bronchi, according to testimony - puncture and drainage of pleural cavity, surgical treatment.
Bacterial lung destruction
pneumonia) - inflammation of the lung tissue, necrotic acquiring character and leads to gross morphological changes in the lung parenchyma. Bacterial lung destruction compounded about 10% of pneumonia in children, while mortality is 2-4%. Among adults, suppurative necrotizing pneumonia is most often recorded in men aged 20-40 years. Approximately 2/3 of the right lung is affected, in the third - the left lung is very rare (1-5% of patients) developed bilateral pulmonary bacterial degradation. Since this condition is always secondary and develops against the background of bacterial pneumonia, the most important task is to find pulmonology ways to prevent, early diagnosis and optimal treatment of destructive processes in the lungs.
staph, strep, Proteaceae, Pseudomonas, mixed degradation. On the mechanism of injury pathological processes are divided into primary (inhalatory - 80%) and secondary (hematogenous - 20%).
Among the clinical and radiological form of pulmonary bacterial degradation release:
In clinical practice, dominated by pulmonary pleural form of destruction, the share of the lung account for only 15-18%. According to the flow dynamics of the process can be stable, progressive, retrogressive; uncomplicated and complicated. Current bacterial destruction of lungs can be acute, protracted and septic.
streptococci, Proteus, Pseudomonas aeruginosa and Escherichia coli. Among the agents noted the absolute predominance of Staphylococcus that made highlight in particular etiological subgroup staphylococcal destruction of lungs. Less common bacterial causes destruction of the lung sticks Pfeiffer and Friedlander, pneumococci. In most cases, the beginning of the necrotic processes produce microbial associations, at the same time presented 2-3 and more types of bacteria.
At the core of the primary bacterial lung destruction is aerogenic or suction mechanism of penetration of pathogens into the lungs with the pneumonia of bacterial development. Risk factors in this case are the previous SARS pneumonia, aspiration of the contents of nasopharynx and oropharynx, stomach; GERD, the fixation of foreign bodies in the bronchi, and others. At the secondary metastatic destruction belongs to the primacy of hematogenous spread of infection from the local septic foci (in acute osteomyelitis, abrasions, umbilical sepsis and so on.).
The development of bacterial destruction of lungs contribute to the state, accompanied by a decrease in the cough reflex, level of consciousness and the resistance of the organism: nicotine addiction, alcohol abuse, drug abuse, occupational hazards, traumatic brain injury, seizures, stroke, coma, diabetes, hypothermia, borne infections and other often destructive. processes in the lung tissue developed as a result of operating the esophageal-bronchial fistula, lung injury.
In its development, the bacterial degradation of light passes through three stages: preddestruktsii (from 1-2 to 7-14 days), actually destructive changes and outcomes. preddestruktsii Stage flows by type, focal pneumonia or purulent discharge Lobito. The second stage is characterized by necrosis and collapse of the lung parenchyma with subsequent sloughing and the formation of encysted purulent cavity. A favorable outcome of the bacterial lung destruction is healing with the formation of fibrosis or lung cysts are among the adverse complications and death.
tachycardia, temperature peaks up to 39-40 about C, anorexia, etc.). After breaking the abscess starts in the bronchi copious purulent expectoration of foul-smelling sputum. Against this background, it marked improvement of health, reduction in temperature, increased activity, the occurrence of appetite and so on. D. If the drainage of an abscess occurs, septic syndrome persists and progresses.
When pyothorax patient's condition worsens gradually. There are severe pain in the chest when breathing, progressive shortness of breath, body temperature rises, mainly in the evening. Children can develop abdominal syndrome, simulating an acute abdomen, and neurotoxicosis. The rapid clinical course may take pneumoempyema, which is a consequence of pulmonary tissue rupture and break purulent focus in the pleural cavity. In this case, there is a sharp paroxysmal cough, shortness of breath, increasing cyanosis, tachycardia. Due to a sudden-onset lung collapse and shock plevropulmonalnogo possible short apnea. When all symptoms limited pneumoempyema expressed moderately.
Forms of chronic bacterial lung destruction peculiar symptoms of purulent intoxication (pale, earthy-gray skin color, malaise, poor appetite, weight loss). Worried cough with a moderate amount of purulent sputum with a smell, coughing up blood, shortness of breath a little. Typical light cyanosis, thickening of the distal phalanges.
Various forms of bacterial destruction of lungs may be complicated by pulmonary hemorrhage, intrapleural hemorrhage (hemothorax), pericarditis, acute renal failure, amyloidosis, sepsis, multiple organ failure.
Microscopic examination of sputum determines its purulent nature, a large number of leukocytes, the presence of elastic fibers, cholesterol, fatty acids. Identification of agent is made with the bacteriological seeding sputum. Bronchial secretion can be obtained as in the expectoration, and during diagnostic bronchoscopy.
The picture detectable radiographic light varies depending on the form of bacterial lung destruction. Typically lung destruction as determined by the cavities with the liquid level horizontal, which extends around the inflammatory infiltration of lung tissue. When pleural complications detected offset of the shadow of the mediastinum to the healthy side, the level of liquid in the pleural cavity, the partial or complete collapse of the lung. In this case, it is advisable to supplement radiographic data ultrasound pleural cavity, pleural puncture exudate and research.
Bacterial degradation of light is required to differentiate from the cavity form of lung cancer, bronchogenic and hydatid cysts, cavernous tuberculosis. In carrying out difdiagnostiki should participate pulmonologists, thoracic surgeons, TB doctors.
drainage of the pleural cavity). Besides detoxification infusion in the treatment of bacterial lung destruction are widely used methods of extracorporeal (VLOK, UBI, plasmapheresis, hemosorbtion). Immunotherapy involves the administration of gamma globulin, hyperimmune plasma, immunomodulators, and others. In the phase of the inflammation subsided drug therapy supplemented by methods of functional rehabilitation (physiotherapy, exercise therapy).
From the operational methods of treatment for inadequate evacuation of an abscess in the lung is used pneumonopathy (open drain), sometimes - lobectomy, or pneumonectomy bilobektomiya. In chronic pleural empyema may require thoracoplasty or pleurectomy with decortication of the lung.
alcoholism and drug addiction.