Bacterial destruction of lungs are the complications of bacterial pneumonia proceeding with development of pyoinflammatory processes in a lung and a pleura. As the general manifestations of various forms of bacterial destruction of lungs serve symptoms of purulent intoxication and respiratory insufficiency. Diagnostics and differential diagnostics is based on the lungs given to a X-ray analysis, ultrasonography of a pleural cavity, a torakotsentez, a laboratory research of a phlegm, exudate, peripheral blood. The basic principles of treatment of bacterial destruction of lungs include antibiotic treatment, an infusional detoxication, sanitation of bronchial tubes, according to indications – a puncture and drainage of a pleural cavity, surgical treatment.
Bacterial destruction of lungs
Bacterial destruction of lungs (Xing. it is purulent - destructive pneumonia) is the inflammation of pulmonary fabric getting is purulent - necrotic character and leading to rough morphological changes of a parenchyma of lungs. About 10% of pneumonia at children are complicated by bacterial destruction of lungs, the lethality at the same time makes 2–4%. Among adults it is purulent - destructive pneumonia most often is registered at men at the age of 20-40 years. Approximately in 2/3 cases the right lung, in 1/3 is surprised – the left lung, very seldom (at 1-5% of patients) develops bilateral bacterial destruction of lungs. As this state always again also develops against the background of bacterial pneumonia, the most important problem of pulmonology is search of ways of the prevention, early diagnostics and optimum treatment of destructive processes in lungs.
As the most frequent initiators of destructive pneumonia the green streptococci, proteas, sinegnoyny and intestinal sticks act staphylococcus. Among activators absolute prevalence of staphylococcus is noted that forced to allocate staphylococcal destruction of lungs in special etiologichesky subgroup. Less often bacterial destruction of lungs is caused by Pfeyffer and Friedlander's sticks, pneumococci. In most cases the beginning is purulent - necrotic processes are given the microbic associations which are at the same time presented by 2-3 and more species of bacteria.
The aerogenic or aspiration mechanism of penetration of activators into lungs with development of bacterial pneumonia is the cornerstone of development of primary bacterial destruction of lungs. As risk factors in this case the SARS preceding pneumonia, aspiration of contents noso-and rotoglotka, a stomach act; GERB, fixing of foreign matters in bronchial tubes, etc. At secondary and metastatic destruction the predominating value belongs to hematogenic spread of an infection from the local purulent centers (at sharp osteomyelitis, a furunkuleza, umbilical sepsis and so forth).
Development of bacterial destruction of lungs is promoted by the states which are followed by decrease in a kashlevy reflex, level of consciousness and resistance of an organism: nicotine addiction, abuse of alcohol, drug addiction, professional harm, ChMT, overcooling, epileptic attacks, a stroke, a coma, the postponed infections, etc. Quite often destructive processes in pulmonary fabric develop owing to the functioning esophageal and bronchial fistulas, a slight injury.
Bacterial destruction of lungs takes place three stages in the development: predestructions (from 1-2 to 7-14 days), actually destructive changes and outcome. The stage of predestruction proceeds as focal and drain pneumonia or a purulent lobit. The second stage is characterized by a necrosis and disintegration of a pulmonary parenchyma with the subsequent rejection of necrotic masses and formation of an osumkovanny purulent cavity. The favorable result of bacterial destruction of lungs is recovery with formation of pneumofibrosis or cyst of a lung, adverse complications and death are among.
Bacterial destructions of lungs are classified by an etiology, the infection mechanism, defeat forms, a current. Depending on type of the activator distinguish the processes caused by aerobic, anaerobic, aerobic and anaerobic flora. Some authors on the basis of the same principle distinguish the staphylococcal, streptococcal, proteyny, sinegnoyny, mixed destructions. Pathological processes are divided by the defeat mechanism on primary (aerogenic – 80%) and secondary (hematogenic – 20%). Distinguish from kliniko-radiological forms of bacterial destruction of lungs:
- predestruction (acute massive pneumonias and lobita)
- pulmonary forms (bulls and abscesses of lungs)
- pulmonary and pleural forms (, pheumothorax, )
- chronic forms (cysts of lungs, bronkhoektaza, pneumofibrosis, chronic abscess of a lung, an empiyem of a pleura) are the result of sharp destruction.
In clinical practice pulmonary and pleural forms of destruction prevail, only 15-18% fall to the share of pulmonary. On dynamics of a current process can be stable, progressing, regressing; uncomplicated and complicated. The course of bacterial destruction of lungs can be sharp, long and septic.
The clinical symptomatology of destructive pneumonia is developed when sharp displays of pneumonia already abate. Thus, against the background of satisfactory health there is a hyperthermia to 38-39o With, a fever, weakness, perspiration, dry cough, morbidity in a thorax again. Promptly short wind and cyanosis accrues; the condition of the patient quickly worsens. Usually in a predestruction stage specific radiological data are absent therefore the diagnosis of pneumonia is exposed to the patient.
At the same time, a number of clinical signs allows to suspect the begun bacterial destruction of lungs: a putrefactive smell from a mouth, the hardest intoxication characteristic of purulent processes (an adinamiya, tachycardia, temperature peaks to 39-40os, anorexia, etc.). After break of abscess in bronchial tubes the plentiful expectoration of a purulent fetid phlegm begins. On this background improvement of health, decrease in temperature, increase in activity, emergence of appetite etc. is noted. If drainage of abscess does not happen, it is purulent - the septic syndrome remains and progresses.
At a piotoraksa the condition of the patient worsens gradually. There are expressed breast pains at breath, short wind progresses, body temperature increases, mainly, in the evenings. At children the abdominal syndrome feigning a sharp stomach, and neurotoxicosis can develop. The rapid clinical current can accept , being a consequence of a rupture of pulmonary fabric and break of the purulent center in a pleural cavity. In this case sharply there is pristupoobrazny cough, short wind, the accruing cyanosis, tachycardia. Owing to suddenly developed collapse of little and plevropulmonalny shock perhaps short-term . At a limited piopnevmotoraks all symptomatology is expressed moderately.
Symptoms of purulent intoxication (pale, earthy-gray skin color, indisposition, small appetite, weight loss) are peculiar to a current of chronic forms of bacterial destruction of lungs. Cough with moderate quantity of a purulent phlegm with a smell, a blood spitting, small short wind disturbs. Slight cyanosis, a thickening of disteel phalanxes of fingers is typical.
Various forms of bacterial destruction of lungs can be complicated by pulmonary bleeding, intra pleural bleeding (gemotoraksy), perikardity. At a massive infection and the reduced immune responsiveness lightning sepsis develops, at a chronic current - internals. Lethal outcomes in the majority are caused by a sharp renal failure, polyorgan insufficiency.
In blood tests – signs of an active inflammation: with shift to the left, substantial increase of SOE; increase in level of sialovy acids, gaptoglobina, seromukoid, fibrin. The microscopic research of a phlegm defines its purulent character, a large number of leukocytes, availability of elastichesky fibers, cholesterol, fatty acids. Identification of the activator is made at bacteriological crops of a phlegm. The bronchial secret can be received both at an otkashlivaniye, and during a diagnostic bronkhoskopiya.
The picture revealed according to a X-ray analysis of lungs differs depending on a form of bacterial destruction of lungs. In typical cases pulmonary destructions decide in the form of cavities on the horizontal level of liquid around which inflammatory infiltration of pulmonary fabric extends. At pleural complications sredosteniye shadow shift in the healthy party, liquid level in a pleural cavity, a partial or full collapse of a lung comes to light. In this case addition of a radiological picture with data of ultrasonography of a pleural cavity, a pleural puncture and a research of exudate is expedient. Bacterial destruction of lungs is required to be differentiated from a band form of cancer of lung, bronkhogenny and ekhinokokkovy cysts, kavernozny tuberculosis. In carrying out a difdiagnostika, pulmonologists, thoracic surgeons, phthisiatricians have to participate.
Treatment of bacterial destruction of lungs
Depending on a form and the course of bacterial destruction of lungs its treatment can be conservative or surgical with obligatory hospitalization in a pulmonary hospital or office of thoracic surgery. Conservative approach is possible at well drained uncomplicated abscesses of a lung, a sharp empiyema of a pleura.
Irrespective of tactics of maintaining pathology the massive antibacterial, dezintoksikatsionny and immunostimulating therapy is carried out. Antibiotics (karbapenema, ftorkhinolona, tsefalosporina, aminoglycosides) are entered intravenously, and also endobronkhialno (during sanatsionny bronkhoskopiya) and vnutriplevralno (in the course of medical punctures or flowing and washing drainage of a pleural cavity). Except an infusional detoxication, in treatment of bacterial destructions of lungs extracorporal methods (VLOK, UFOK, a plasma exchange, haemo sorption) find broad application. Immunocorrective therapy assumes introduction of gamma globulins, hyperimmune plasma, immunomodulators, etc. In a phase of subsiding of an inflammation medicamentous therapy is supplemented with methods of functional rehabilitation (physiotherapy, LFK).
From operational methods of treatment at inadequate depletion of an abscess in a lung is used a pnevmotomiya (open drainage), sometimes – rezektsionny interventions (lobectomy, a bilobektomiya) or a pnevmonektomiya. At a chronic empiyema of a pleura carrying out a torakoplastika or plevrektomiya with a lung decortication can be required.
Forecast and prevention
About a quarter of cases of bronchial destruction of lungs comes to an end with an absolute recovery; at a half of patients clinical recovery with preservation of residual radiological changes is reached. Synchronization of a disease happens in 15-20% of observations. 5-10% of cases come to an end with a lethal outcome. A basis of prevention of development of bacterial destruction of lungs timely antibiotic treatment of bacterial pneumonia and purulent extra pulmonary processes, kliniko-radiological makes control of an izlechennost, special attention to patients of risk group on development of destructive processes in lungs. At a stage of primary prevention promotion of a healthy lifestyle, fight against alcoholism and drug addiction is important.