What Is Lobar Pneumonia?

Lobar pneumonia, also known as pneumococcal pneumonia, is an acute inflammation of the lungs with a lobulous distribution caused by bacterial infections such as pneumococci. Common causes include cold, tiredness, or rain. Acute pulmonary parenchymal inflammation caused by Pneumococcus pneumoniae. Occurs in young men and winter and spring season. Common causes include cold, rain, drunkenness or general anesthesia, and excessive sedatives. The main pathological changes were exudative inflammation and consolidation of the alveoli. Clinical symptoms include sudden chills, high fever, cough, chest pain, and cough rusty sputum. Increased white blood cell counts; typical X-ray findings are consolidation of lung segments and leaves. The course is short, and timely treatment with antibiotics such as penicillin can be cured.

Basic Information

nickname

Pneumococcal pneumonia

Visiting department

Respiratory Medicine

Common locations

lung

Common causes

Streptococcus pneumoniae infection

Common symptoms

Chills, high fever, chest pain, cough, rusty sputum, nausea, vomiting, etc.

Causes of lobar pneumonia

A variety of bacteria can cause lobar pneumonia, but most of them are Streptococcus pneumoniae, of which type III has the strongest pathogenicity. Streptococcus pneumoniae is a normal parasitic flora in the mouth and nasopharynx. If the self-purifying function of the respiratory tract and the body's resistance are normal, pneumonia will not be caused.

When the body is exposed to cold, excessive fatigue, drunkenness, cold, and diabetic immune function, the defense function of the respiratory tract is weakened, bacteria invade the alveoli, and the permeability of the capillaries of the alveolar wall is enhanced through allergic reactions. Bacteria multiply rapidly in the exudate of the protein, and spread to the adjacent lung tissue through the alveolar foramen or bronchioles, spreading to one lung segment or the entire lung lobe. The exudate of the spreading bacteria between large leaves is caused by the leaf bronchus spreading.

Llobular pneumonia is alveolitis in one lobe or segment of the lung caused by a Streptococcus pneumoniae infection. Due to the use of a large number of powerful antibiotics in recent years, typical lobar pneumonia has been rarely seen. Usually when the climate changes suddenly, the body's resistance decreases. More common in winter and spring, mainly seen in children over 3 years of age, so the body's immune function, that is, defense ability, gradually matures, which can limit the lesion to a lung lobe or a lung segment without spreading. Generally, lobar pneumonia is acute and manifests as sudden high fever, chest pain, loss of appetite, fatigue, and irritability. A small number of children may have abdominal pain and are sometimes misdiagnosed as appendicitis. Severe children show symptoms of toxic encephalopathy, convulsions, delirium, and coma; or even septic shock.

Clinical manifestations of lobar pneumonia

1. Sudden onset of illness, chills, high fever, chest pain, cough, rusty sputum. Extensive lesions can be associated with shortness of breath and cyanosis.

2. Some cases have nausea, vomiting, bloating, and diarrhea.

3. Severe cases may have neuropsychiatric symptoms, such as irritability, delirium, etc. Failure can also occur with septic shock, called shock (or toxic) pneumonia.

4. Acute illness, shortness of breath, and nasal agitation. Some patients have herpes on the lips and around the nose.

5. Lung signs during congestion period showed a decrease in local breathing activity, a slight increase in speech tremor, dullness in percussion, audible and convoluted pronunciation.

There may be typical signs during consolidation, such as weakened breathing on the affected side, increased speech resonance, tremor, dullness or solid sound on percussion, and auscultation of pathological bronchial breath sounds; percussion on dissipation gradually becomes unclear, and bronchial breath sounds also gradually weaken. It is a wet chirp.

Lobar pneumonia test

Auxiliary inspection

(1) For general patients, the inspection project mainly focuses on the A of the inspection frame.

(2) Severe cases must be distinguished from other pathogenic pneumonia. The inspection project may include an inspection frame "A", "B", or "C".

2. Laboratory inspection

The white blood cell count (10-20) × 10 ⁹ L, most of the neutrophils are above 80%, and the nucleus is shifted to the left. Toxic particles are visible in the cells. Those who are frail, alcoholic, and immunocompromised may not increase their white blood cell counts, but the percentage of neutrophils is still high. The sputum smear is directly examined for gram staining and capsular staining. If a typical gram staining positive, capsulated diplococcus or streptococcus is found, a preliminary diagnosis of the pathogen can be made. Sputum culture for 24 to 48 hours can identify the pathogen. Polymerase chain reaction and detection of fluorescently labeled antibodies can increase the rate of etiological diagnosis.

3.X-ray inspection

In the early stage, only the lung texture was thickened or the affected lung segments and lung lobes were slightly blurred. As the disease progresses, the alveoli are filled with inflammatory exudates, which are manifested as large inflammatory infiltration shadows or consolidation shadows. Bronchial inflation signs can be seen in the consolidation shadows. There may be a small amount of pleural effusion in the costal angle. The line shows that the inflammatory infiltration is gradually absorbed, and there may be rapid absorption in the flaky area, showing a "false void" sign. Most cases only completely dissipated after 3 to 4 weeks of onset. In elderly patients, the lesions dissipate slowly, and they are prone to incomplete absorption and become organizing pneumonia.

Diagnosis of lobar pneumonia

1. The disease occurs in young and middle-aged men and is more common in winter and spring.

2. There are many incentives before the onset of disease, and about half of the cases first have precursor manifestations such as upper respiratory virus infection.

3. Sudden illness, chills, and high fever.

4. Cough, chest pain, shortness of breath, rusty sputum; severe patients may be accompanied by shock.

5. Pulmonary consolidation signs. The blood pressure of severe patients often drops below 10.5 / 6.5kPa (80 / 50mmHg).

6. The total number of white blood cells increased, neutrophils reached above 0.80, the nucleus shifted to the left, and there were poisonous particles.

7. A large number of Gram-positive cocci were seen on the sputum smear.

8. Sputum and blood cultures have pneumococcus growth.

9. Serological test is positive (coagulation agglutination test, convection immunoelectrophoresis to detect pneumococcal capsular polysaccharide antigen).

10. X-ray examination of the chest shows that the segments or lobes are uniformly large and dense, increasing the shadow.

11. PaO ₂ and PaCO ₂ decreased during blood gas analysis. PaCO ₂ increased in patients with chronic obstructive pulmonary disease.

Differential diagnosis of lobar pneumonia

Caseous pneumonia

A history of tuberculosis, slow onset, and normal white blood cell count. Mycobacterium tuberculosis can be found in sputum. X-ray examination of the lungs may form holes.

2. Secondary infection of lung cancer

Older, slow onset, symptoms of poisoning are not obvious, and may have blood in sputum. X-ray examination and fiberoptic bronchoscopy or assist diagnosis.

3. Acute lung abscess

A large amount of purulent sputum is often present. X-ray examination shows the formation of holes in the liquid level, which can be identified.

Lobar pneumonia treatment

Antibiotic treatment

Penicillin, sulfa drugs, erythromycin, jiecomycin, Pioneeromycin IV.

Symptomatic treatment

(1) Those with high fever generally do not use antipyretics such as aspirin and paracetamol to avoid hypovolemic shock due to severe dehydration.

(2) Patients with pain and severe irritability can be treated with chloral hydrate sedation. Cocaine and diazepam are not used to suppress respiratory drugs.

(3) Those who cough and sputum should use ammonium chloride mixture.

(4) Maintain water and electrolyte balance.

(5) Shock respiratory failure should be dealt with in a timely manner.

(6) Those with intracranial hypertension can use diuretics.

3. Efficacy evaluation

(1) Cure symptoms and signs disappear, total white blood cells are normal, and lung shadows are completely absorbed.

(2) The symptoms and signs have basically disappeared, the total number and classification of white blood cells are normal, and most of the lung shadows are absorbed.

(3) No improvement in symptoms and signs.

4. Emergency treatment

(1) Rest in bed, give a high-calorie, multi-vitamin and digestible food diet, encourage patients to drink plenty of water or vegetable soup to add water.

(2) Apply large doses of antibiotics throughout the body such as penicillin and ampicillin.

(3) Those with high fever can place ice packs or cold water bags on the head, armpits, popliteal fossa, etc., and physically cool the body with warm water or alcohol rubbing bath. Oral antipyretics such as APC, indomethacin, etc., if necessary.

(4) Those who are stunned or comatose should remove foreign bodies in the mouth in time to keep the airway open.

(5) Those who are in shock should lie on their backs with their heads slightly lower and rushed to the hospital for rescue.

Lobar pneumonia prevention

1. Pay attention to prevent upper respiratory tract infection and strengthen cold hardening exercise.

2. Avoid incentives such as rain, cold, drunkenness, and overwork.

3. Active treatment of primary diseases such as chronic cardiopulmonary disease, chronic hepatitis, diabetes and oral diseases can prevent lobar pneumonia.