Kazeozny pneumonia – hard proceeding independent clinical form of tuberculosis of lungs of which the bystry progressing of a specific inflammation which is followed by destruction of a pulmonary parenchyma and formation of cavities is characteristic. The leading clinical symptoms of a disease are the expressed intoxication, cough with a phlegm, respiratory insufficiency. In the diagnostic purposes beam methods of a research of bodies of a thorax are used, laboratory analyses are made. The etiotropny chemotherapy is appointed, dezintoksikatsionny means, immunostimulators are applied. According to indications surgical treatment is performed.
Kazeozny pneumonia develops as an independent disease or is a complication of the progressing tubercular process. It is widespread in the countries with high incidence of tuberculosis. Arises against the background of an immunodeficiency. Specific weight of a kazeozny inflammation at patients with for the first time the diagnosed pulmonary tuberculosis makes 3-15%. Bakteriovydeleniye is observed in 90-95% of cases. Approximately primary or secondary multiple medicinal antitubercular medicines resistance is found in 60% of patients. 30-50% of cases come to an end with a lethal outcome within the first 2-6 weeks of a disease.
Reasons of kazeozny pneumonia
The causative agent of an infectious disease is the tuberculosis mikobakteriya (Koch's bacillus). Kazeozny pneumonia is formed at massive infection of the person with the agent, high-virulent, quite often resistant to tuberkulostatika, or at activation of a persistiruyushchy tuberculosis infection in an organism. Most often the kazeozny necrosis of pulmonary fabric complicates a current disseminirovanny or fibrous tubercular process. An indispensable condition of developing of a disease is the expressed immunosupression. In risk group on development of severe forms of a tuberkulyozny infection belong:
- Socially deadapted persons. Includes the persons of no fixed abode who are engaged in vagrancy, refugees. The expressed secondary immunodeficiency often is observed at patients with alcoholic dependence, drug addiction. The probability of infection with medicinal and steady tuberculosis and emergence of its severe forms at the people serving sentence in prisons is high.
- Group of medical risk. The most often kazeozny pneumonia comes to light and becomes a cause of death at the patients with AIDS who are not accepting anti-virus medicines and means of specific chemoprophylaxis. The risk of this pathology at patients is high, it is long receiving corticosteroids and cytostatics, patients with diabetes.
The disease is formed against the background of deficiency of immunity cages, active concerning an infection. Mikobakteriya freely breed, allocating a number of toxic substances. Waste products of microorganisms damage a membrane of immunocompetent cages. The vicious circle is formed – immune frustration are aggravated, tuberculosis progresses, oppressing immunity even more.
Originally pathological process is localized within one segment. In a zone of defeat microcirculation is broken. In the vessels feeding pulmonary fabric blood clots are formed. Lack of due blood supply causes mass death of cages – a kazeozny necrosis. In the Bronkhogenny and limfogematogenny way of a mikobakteriya get to the next segments, an opposite lung, can be brought in other bodies and fabrics. Within 2-3 weeks widespread tubercular pneumonia develops. At a patomorfologichesky research it is found extensive, bilateral damage of lungs with the characteristic cavities of disintegration of irregular shape which are partially filled with kazeozny masses is more often. The parietal and visceral pleura is involved in process. Kazeozny pleural imposings are formed.
Classification of crushing kazeozny defeat of a pulmonary parenchyma is constructed on the basis of patomorfologichesky changes in the damaged fabric. Some authors of scientific articles from the field of phthisiology consider that it also reflects staging of pathological process. Depending on damage of these or those anatomical structures distinguish the following forms of pneumonia with kazeozny fusion of a lung:
- Atsinozny. A large number of atsinus – structural units of alveolar fabric is at the same time involved in pathological process. Quite often complicates the course of sharp miliarny tuberculosis.
- Lobulyarny. Lung segments are surprised. Kazeozny lobulyarny pneumonia is characterized by existence numerous, enough large sites of a specific necrosis. Sometimes develops against the background of a tubercular dissemination.
- Lobarny. The inflammation occupies all pulmonary share. Fusion of massive sites of a kazeoz leads to formation of cavities of destruction. Usually arises as independent pathology.
Symptoms of kazeozny pneumonia
The disease begins sharply, is more rare . Temperature increase to high febrilny and hyper thermal values is defined. Fever of gektichesky or wrong type with considerable fluctuations of daily temperature is followed by a fever, a headache. Intoxication symptoms are brightly expressed. Sharply appetite up to full anorexia decreases. Patients feel considerable general weakness, fatigue. The sleep is interrupted. Pouring night sweats disturb. Sometimes the clinical picture in a debut of a disease reminds the beginning of a sharp respiratory infection. Patients complain of cold, pains and irritation in a throat, an ache in joints, moderate fever.
Important signs of kazeozny damage of lungs are cough and short wind. In an onset of the illness cough dry, a small amount of a mucous phlegm separates hardly. Quite often bronchial secret gets rusty coloring. In 1-2 weeks cough becomes productive. Nonspecific microflora joins a kazeozny inflammation that causes allocation of a flavovirent purulent phlegm. Manifestations of a feverish syndrome change, remission episodes with normal or subfebrilny body temperature are noted. At the same time the general condition of the patient worsens. Quite often during this period of time blood impurity in a phlegm is found.
The expressed short wind disturbs the patient in the first days of a disease. It appears at insignificant physical activity and amplifies in process of progressing of pathology even more. Difficulties of breath are followed by a pain syndrome. Insignificant thorax pains become intensive when involving a pleura in process of an inflammation. The patient considerably grows thin. Gradually pulmonary heart failure accrues.
Kazeozny pneumonia in the sharp period often is complicated by a blood spitting or pulmonary bleeding. Massive infection against the background of an immunodeficiency quite often leads to infectious toxic shock at the first stage of a disease. Sometimes there is spontaneous pheumothorax. During regression against the background of conservative therapy kazeozny lobarny pneumonia is transformed to a fibrous kavernozny tuberculosis of lungs. Cavities are formed of mixed cavities of destruction. The lethal outcome comes at the untimely request of the patient for medical care, lack of treatment, heavy immunosupression. Sharp insufficiency of breath and blood circulation, massive pulmonary bleeding, infectious and toxic shock are the main reasons for death.
It is difficult to diagnose kazeozny damage of a lung within the first week as the disease proceeds behind a mask of krupozny pneumonia, flu or a septic state. Existence of tuberculosis of any localization or contact with the bacillar patient in the anamnesis allow to suspect specific process. At survey of the patient pallor of integuments with a feverish flush on cheeks, cyanosis of lips attracts attention. The final diagnosis is exposed on the basis:
- Fizikalny data. At percussion obtusion of a pulmonary sound in an infiltration projection is defined. Auskultativno is listened bronchial breath which can be amforichesky over a large cavity of disintegration. Numerous damp mixed rattles are noted.
- Radiodiagnosis methods. Lobarny kazeozny pneumonia on the roentgenogram of lungs represents massive shading of a share of a lung with the formed cavities of disintegration and shift of a sredosteniye in the struck party. Existence of the bronkhogenny centers of elimination in the affected and opposite lungs is characteristic. At a lobulyarny and atsinozny kazeoz the multiple centers of infiltration with a tendency to merge and disintegration come to light.
- All-clinical analyses. At a research of peripheral blood the stab shift of a leykotsitarny formula, limfopeniye is observed . Ostrofazovy indicators increase, the gipoalbuminemiya comes to light. The increased urine protein content is defined.
- Phlegm researches. Detection of mikobakteriya in a phlegm of the patient is possible only on the second week of a disease. The simple bacterioscopy according to Tsilyu-Nielsen, crops on liquid and firm environments is carried out, express diagnostics methods are applied. Sensitivity to tuberkulostatika is specified. Existence of a tubercular stick in a phlegm confirms the diagnosis.
Skin immunodiagnostic tests (Test to Mant, the Diaskintest) maloinformativna for diagnostics of kazeozny process because of violation of the immune answer. The result of a research usually is negative or slabopolozhitelny. In the presence of a serious imunnodepresivny condition kvantiferonovy and tubinferonovy tests can not react to a tuberculosis infection.
Treatment of kazeozny pneumonia
After establishment of the diagnosis treatment of a disease is performed by the doctor-phthisiatrician. Etiotropny therapy by tuberkulostatichesky medicines is appointed taking into account resistance of mikobakteriya to medicines. Treatment is two-stage. The intensive phase of chemotherapy is carried out in the conditions of a specialized hospital. Dezintoksikatsionny means, antigipoksant, immunostimulators, kortikosteroidny hormones are used. Food of the patient has to be balanced, high-calorific. In the presence of multiple or huge single cavities of destruction the question of surgical intervention is considered. In the absence of contraindications the lung resection is carried out. Treatment by antitubercular medicines in a phase of continuation is made is long (up to 24 months) on an outpatient basis under control of health workers.
Forecast and prevention
The forecast at pneumonia of specific character always serious. The disease regresses with formation of the dense centers approximately in 25% of cases. Such process of healing is an outcome of an atsinozny or lobulyarny inflammation. Kazeozny lobita are transformed in chronic fibrous or tsirrotichesky tuberculosis of lungs. The long course of a tuberculosis infection gradually leads to formation of pulmonary heart, emergence of an amiloidoz and patient's invalidization. Specific prevention of severe forms of tuberculosis is performed by vaccination of children by vaccine BTsZh in dekretivny terms. Observance of a healthy lifestyle, good nutrition, timely preventive X-ray-fluorographic inspections belong to nonspecific actions. To HIV-positive patients preventive treatment of a tuberkulostatikama is appointed.