Lobar pneumonia: causes, symptoms, stages, treatment

Etiology of the disease

In most cases, the main cause of lobar pneumonia is a bacterium called Friendler's bacillus.
However, this form of pneumonia can also be caused by typical pathogens (streptococcus, pneumococcus, Klebsiella, staphylococcus and E. coli) against the background of reduced immunity.

Many people confuse lobar pneumonia with focal pneumonia. In fact, these are two different forms of pneumonia. The main reason for the development of the disease is the pathogenic activity of various microorganisms.

The main pathogens of the disease penetrate the lung tissue in several ways:

Airborne. This is the most common route of penetration of microorganisms in lobar, focal and other types of pneumonia.
Hematogenous.
Lymphogenic.

Clinical picture and stages of the disease

Lobar pneumonia in children and adults first manifests itself very strongly, like any inflammatory disease. Characterized by an increase in body temperature to +40C, profuse sweating, a feeling of cold and trembling.

The sick person feels lethargic, tired, depressed, loses appetite, his lips turn blue, and his limbs are cold almost all the time.

In cases where a high temperature persists for a long enough time and no measures are taken to eliminate unpleasant symptoms and prompt treatment, the patient may show signs of damage to the nervous system, such as:

headache;
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noise in ears;
disturbances of memory, attention, consciousness;
nausea and vomiting.

One of the symptoms of lobar pneumonia of the respiratory tract is a cough. At the first stage of the disease, it is unproductive, then thick, viscous sputum begins to separate, which is characterized by its whitishness and turbidity, breathing becomes difficult, and pain occurs in the chest. Breathing is significantly difficult.

With proper, rational treatment, sputum thins out, becomes less dense, comes out easily and does not clog the lungs.

Sometimes there may be traces of blood in it, this is typical for those types of diseases that appear after injuries, as well as with concomitant pathologies of the blood vessels and heart. Some children with lobar pneumonia may groan during the exhalation phase.

There are several stages of the disease, depending on which a different clinical picture of lobar pneumonia, its symptoms and signs may be observed. The basis for dividing lobar pneumonia into several different stages is morphological changes at the cellular level, understandable to specialists from urine, blood, sputum, etc. tests, for example:

The first stage is characterized by increased temperature and tide. It can last for three days; during its process, the alveoli expand and an inflammatory process appears, accompanied by intensive separation of exudate, clearly visible when tested for sputum.
The second stage of lobar pneumonia is the displacement of air by effusion, which contains a large number of foreign cells: red blood cells, leukocytes, and various elements of the epithelium. Difficulty in breathing begins.
During the third stage, the number of leukocytes in the effusion becomes predominant.
The fourth stage occurs after a week of the pathology. At this time, fibrin begins to break down.

Causes of formation and causative agent of pathology

Symptoms of lobar pneumonia may appear due to external and internal causes, namely:

hypothermia of the body is the main cause of the development of all inflammatory colds,
lack of sufficient amounts of vitamins and minerals in the human body,
general weakening of the immune system,
chronic diseases that activate seasonally and cause a decrease in the level of the human defense system,
injuries,
poisoning,
stress and overwork, which have a debilitating effect on the nervous system.

All of the above factors increase the risk of the causative agent of lobar pneumonia entering the human body, causing unpleasant symptoms of the disease, the appearance of fever, sputum and chest pain.

In order to protect yourself from such an outcome, you need to pay attention to your health in a timely manner, select the right treatment and not ignore dangerous signs and symptoms, such as difficulty breathing and constant fatigue.

The causes of the formation of lobar pneumonia and other types of inflammatory diseases of the lungs, upper and lower respiratory tract are the penetration of certain types of pathogenic microorganisms into the patient’s body and their vigorous activity. The main causative agent of lobar pneumonia is pneumococcus.

In the absence of treatment and an irresponsible attitude towards one’s own health and dangerous symptoms, the patient may develop dangerous complications of lobar pneumonia, such as:

Inflammatory processes in the lungs - pleurisy, abscesses.
Various types of tissue compaction - carnification, gangrene.
Inflammation of the membranes and disruption of the functioning of other vital organs - blood vessels, heart, brain, kidneys.

Pleurisy

The consequences of untreated lobar pneumonia are very dangerous and can even be fatal.

Causes of the disease

Croupous pneumonia can develop under the influence of several factors, the most common include:

Hypothermia.
Chest injury.
Intoxication of the body.
The presence of concomitant pathologies (acute or chronic stages).
Anemia.
Avitaminosis.
Overwork.
Stress.

Pneumonia rapidly begins to develop when pathogenic microflora penetrates the lungs. The pathogenesis of the disease is directly related to the toxins released by pathogens. Penetrating into the lung tissue, these substances increase the permeability of vascular walls, fibrin and exudation of red blood cells into the alveoli.

Signs of the disease in its different stages

The symptoms of lobar pneumonia are somewhat different during different stages of the inflammatory process.

The onset of the disease is usually characterized by high fever: a rise in temperature to 39-40 degrees or higher,

as well as severe chest pain, which becomes stronger during breathing. This indicates inflammation of the pleura - pleurisy. The fever usually lasts about a week. And if the patient is quickly prescribed adequate antibacterial therapy, then the symptoms decrease within 3-4 days from the onset of the disease.

On the first day of illness, a dry cough may occur, which usually begins when the patient tries to take a deep breath.

After a couple of days, the cough is usually accompanied by sputum, which may have a rusty color due to the presence of blood cells in it. This indicates the beginning of the hepatization stage.

In addition to fever, cough and pain, lobar pneumonia is characterized by shortness of breath. This means that the patient's breathing is difficult, he begins to breathe more often and less deeply. The patient also usually notes general weakness, headache, sweating and a feeling of malaise.

These symptoms reflect intoxication, that is, the toxic effect of the pathogenic bacterium on the patient’s body.

Listening to the lungs is usually characterized by a weakening of the respiratory sound, as well as crepitus in the first and last stages of the disease. Crepitation is a sound similar to the creaking of snow under a shoe. This sound occurs at the end of inhalation.

In the second stage, listening to the lungs will give so-called pathological bronchial breathing. This means that the breathing sounds are a bit like the sounds you hear if you start listening for breathing in the neck area. Crepitation is not audible. A pleural friction rub may be heard, which is similar to crepitus, but can be heard not only when the patient inhales, but also when the patient exhales.

Stages of lobar pneumonia

In the development of lobar pneumonia, clinicians distinguish several stages, depending on which a different clinical picture is clearly observed, as well as its symptoms and signs.

Their duration is a maximum of 10 days. The features of the course of each stage accurately characterize the patient’s condition.

Classification

First stage (high tide stage). Lasts about a day, it is characterized by: microbial edema, severe hyperemia of the lung lobe. Capillary permeability increases, and red blood cells leak into the lumen of the alveoli, while the affected lobe of the lung becomes significantly denser. An x-ray can reveal all of these changes. If you examine the edematous fluid at this stage, you can identify a huge number of pathogens in it.
Second stage (red liver stage). Occurs on the second day of the disease. Due to the presence of plethora and edema, erythrocyte diapedesis gradually intensifies. However, not only red blood cells, but also neutrophils leak into the lumen of the alveoli. The lymphatic vessels that are located in the lung tissues significantly expand and become filled with lymph. In density, the affected lobe of the lung becomes identical to the density of the liver and becomes dark red in color. Regional lymph nodes are slightly enlarged.
Third stage (gray hepatization stage). It appears in the patient on days 4-6 of the disease. It is characterized by the presence of neutrophils and fibrin threads in the lumen of the alvioles. The presence of red blood cells decreases, which leads to a decrease in the severity of hyperemia. At this stage of the disease, the lobe of the lung slightly increases and becomes heavier, and fibrinous changes begin to appear on the pleura.
Fourth stage (resolution stage). As a rule, it appears on the 8-10th day of the disease. The formed fibrinous exudate begins to gradually melt and dissolve. The affected lung is cleared of fibrin and pathogenic microflora. Exudate is removed from the organ along with sputum through the lymphatic drainage of the lung.

Stages of development of lobar pneumonia:

The lobar form of pneumonia goes through four stages. The illness lasts approximately eleven days. The stages of disease development are as follows:

During this stage, a person experiences serious changes in the vascular system of the lungs, and inflammatory swelling of the organ occurs. Hyperemia of the affected area occurs. The pathogenic process develops in capillaries and small arteries. Excess blood forms in this area. In other parts of the lungs, edematous fluid is formed, in which pathogens develop. This stage lasts for the first three days.
The duration of this stage is up to three days. During its course, the process of accumulation of blood and fluid continues. The area that is affected by the disease becomes dark red in color, sometimes brown. The capillaries are compressed. The nutrition of the lung tissue is disrupted. The color of the lung resembles the liver. This process is called hepatation.
Its duration reaches 5 days. It is also called the stage of gray anxiety. Leukocytes begin to rapidly develop in the lungs. As a result of this, the color of the lung is transformed into gray-green. It increases in size, the texture of the lung tissue becomes granular, and fluid continues to accumulate in the lung.
This is the final stage of the disease and it occurs on the ninth day of the disease, and also lasts about three days. Fibrin and leukocytes are reabsorbed. Mucus begins to come out. The cough becomes coughing.

Symptoms

The disease develops quite quickly and acutely. One of its first symptoms is hyperthermia to high levels. However, such a development of the disease does not always occur.

A prodromal period is also possible, during the development of which the patient may experience the following condition:

Headache.
Gastrointestinal disorders (in the form of diarrhea or constipation).
General weakness.
Lack of appetite.

As the pathology progresses, additional symptoms may appear:

Cough . At the early stage of the disease it is unproductive, but on the third day of the disease it usually becomes wet. The patient produces thick sputum when he coughs. At the initial stage, it is foamy and white, but as the disease progresses, it gradually changes color due to the presence of blood impurities and becomes “rusty.”
Cyanosis. This symptom occurs due to a disruption in the gas exchange process. The tissues of the body no longer receive sufficient oxygen. The patient has cyanosis of the lips, nasolabial triangle, fingers, the skin becomes hot and dry.
Side pain . It manifests itself on the side of the lung and has a stabbing or acute character of varying degrees of intensity. The painful symptom can radiate to the stomach or shoulder. As a rule, this symptom disappears on the third day. If the pain persists a little longer, this may indicate the development of pleural empyema in the patient.
Shortness of breath . The patient has difficulty inhaling, the frequency of respiratory movements is 25-50 per minute, and the affected half of the chest lags significantly behind in the breathing process.

First symptoms of the disease

The onset of the disease is acute; the causative agent of lobar pneumonia is most often pneumococcus. The first symptom is an increase in body temperature to high levels. Pneumonia can also begin in the prodromal period, when the patient develops the following symptoms:

general weakness and lethargy;
severe headaches;
deterioration or complete loss of appetite;
dysfunction of the gastrointestinal tract.

Macroscopic specimen: the affected part of the lung lobe has a dense consistency, it is gray with a thickened pleura, and becomes similar to the lobe of the liver.

Microslide: Inflammation is spread over the entire histological section, the lumens of the alveoli are filled with serous fluid, which does not adhere tightly to the alveolar walls. Inflammation does not affect the partitions between the alveoli and is absent in the walls of the bronchi and peribronchial tissue.

In adults

In adults, lobar pneumonia has an acute onset. The first manifestation is a rise in temperature to 39 - 40 degrees. The patient trembles, feels cold, and the limbs become icy.

As inflammation intensifies, the symptoms of lobar pneumonia are supplemented by:

pain in the side on the affected side. The pain is aching or stabbing, can have varying strengths, sometimes radiating to the stomach and shoulder. Painful sensations usually go away within 2–3 days from the onset of the disease. When they do not retreat even longer, this is a dangerous signal, since the disease could affect pleural empyema.
unproductive cough. After 3 days, it turns into wet with the discharge of thick sputum of foamy consistency and white color. Due to the admixture of blood, the mucus gradually acquires a rusty tint, the patient complains of severe shortness of breath due to difficulty in inhaling.
slight lag of the affected side of the chest in the respiratory act.
the development of cyanosis due to problems with gas exchange, since tissues do not receive enough oxygen to function properly. Cyanosis is usually visible on the nasolabial triangle, on the fingers and toes, and on the lips.
coldness of the extremities, although the entire skin on the body becomes hot and dry.
involvement of auxiliary muscles in the act of breathing.

In children

Recently, lobar pneumonia in children is diagnosed much less frequently. Children of preschool and school age are more susceptible to it, and there are much fewer cases in children from one to three years old. The disease does not occur in the same way as in adults; there are some peculiarities due to the structure of the child’s body. Children in the first stages of the lesion do not develop side pain, cough and chills. The main signs of the pathological condition include:

vomit;
paleness of the skin;
bloating and abdominal pain;
increased breathing;
fever and convulsions;
neck rigidity.

The listed manifestations of the disease are somewhat reminiscent of meningitis, but the doctor differentiates lobar pneumonia by acute respiratory failure. In a child, from the first days of the development of the disease, additional muscles take part in breathing - this is manifested by swelling of the wings of the nose, severe pain during coughing and constant lying on the affected side.

Diagnostics

Diagnosing lobar pneumonia is not difficult, since its symptoms are not characteristic of other forms of pneumonia and are quite specific.
However, when the first symptoms appear that indicate the progression of the disease, it is important to seek qualified help.

The most informative and accurate diagnostic method is x-ray. It is performed on adults and children at the slightest suspicion of the development of lung pathology.

It makes it possible to quickly and accurately determine the presence and extent of the pathological process.

The main signs of this form of pneumonia, which can be identified in this way:

Uniform darkening of the lobe.
The affected lobe has somewhat convex borders.
The reaction of the pleural membrane is clear.

If a specialist is unable to make a diagnosis using radiography, an additional effective examination is carried out - CT or MRI.

For the purpose of comprehensive diagnosis, the patient is prescribed:

Blood chemistry.
Sputum analysis for bacteriological examination.
General blood analysis.
Analysis of urine.

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Signs and symptoms of lobar pneumonia

Signs of the disease in children and adults have their own characteristics, which are taken into account during the initial examination.

Symptoms in children

First of all, pay attention to possible breathing problems. It may become more frequent, and breathing movements may deviate from the normal rhythm. Infants nod their heads in time with their breaths, puff out their cheeks, and stretch out their lips.
The inflamed lung becomes deformed and this becomes noticeable upon visual observation.
Look for a dry, persistent cough. It becomes more intense when the baby eats or cries. The presence of inflammatory processes is determined by a blood test.
The onset of pneumonia is characterized by an increase in temperature. It cannot be reduced even with the help of antipyretics.
Weakness sets in, severe sweating occurs, and appetite disappears. The child is constantly naughty and cries.

Symptoms in adults

The main symptom of the disease is a severe dry cough that lasts for a long time. Gradually, it worsens, purulent discharge appears.

The inflammatory process in the lungs is a continuation of infectious and colds that last over seven days. Malaise occurs, weakness is felt in the body. In addition to the cough, my throat hurts. Antipyretic drugs for colds have zero effect. At the slightest suspicion of a disease, you should immediately consult a doctor.

Complications of lobar pneumonia

Previously, lobar pneumonia was very difficult to tolerate and lasted for quite a long time. Almost everyone experienced some kind of complications, and the disease itself was often fatal. Currently, with modern treatment methods, the disease is much easier and with a more favorable prognosis. But sometimes patients still experience complications. For example:

Pulmonary complications: abscess, pleurisy, gangrene.
Extrapulmonary complications. A variety of inflammatory diseases of organs such as the heart lining, mediastinum, kidneys, joints. One of the extrapulmonary complications may be the development of acute cardiovascular failure, liver failure, cerebral edema, psychosis, and toxic shock.

The prognosis for lobar pneumonia is very disappointing. Due to a lack of leukocyte reaction and an increase in the level of neutrophils, there is a significant increase in heart rate, a decrease in blood and vascular pressure, the development of jaundice, and bloating.

Symptoms of pleuropneumonia

Lobar pneumonia is characterized by certain symptoms, which often allow a preliminary diagnosis to be made even without laboratory and hardware examination of the patient. During the incubation period of the disease, patients complain of general weakness, lethargy and headaches. In the initial stage of lung disease, general malaise is replaced by chills, migraine attacks, which may cause vomiting. Very often, patients’ temperature rises to 40 degrees and only goes down after taking appropriate micropreparations and macropreparations.

Lobar pneumonia in children and adults may be accompanied by the following symptoms:

severe cough that produces sputum;
sneeze;
acute pain in the back or right hypochondrium (sometimes the pain syndrome can manifest itself in the thigh, shoulder, abdominal cavity, and is confused with a symptom of other diseases);
change in skin tone;
the appearance of blush on the cheeks (more often a pink or red tint is observed precisely on the side of the lungs in which the focus of the disease is located);
rapid breathing;
blood pressure rises, the pulse quickens, resulting in heart overload (tachycardia is diagnosed, systolic murmur is noted, symptoms of diffuse myocardial damage are observed, etc.);
the appearance of herpes on the lips, nose and cheeks;
in the stage of progression of pneumonia, patients’ breathing is hard and hoarse, after which it becomes bronchial;
when the temperature drops (due to the lack of proper treatment with special micropreparations and macropreparations), patients experience hypotension, increased sweating, weakness throughout the body, cardiac arrhythmia, etc.;
when the temperature rises in patients, a pseudo-crisis begins (at this stage antibiotics, sulfonamide drugs and other micropreparations are prescribed);
in the initial stage of the disease, patients produce sputum, which has a viscous, glassy and viscous structure;
a day after the onset of the disease, the patients’ sputum acquires a rusty tint, as red blood cells and hemoglobin disintegrate in it;
at a later stage of inflammation, the sputum becomes bloody, and laboratory examination reveals the presence of a large number of red blood cells, leukocytes and fibrin threads (when expectorating, the patient may experience acute pain in the chest area), etc.

Causes of this type of pneumonia

Lobar pneumonia most often develops against the background of overwork, hypothermia, lack of vitamins and minerals, and disruption of the immune system. The causes of this lung disease include the following factors:

Previous illnesses (colds or infections).
Intoxication of the body.
Harmful working conditions.
Living in premises with an unfavorable microclimate and severe dampness.
Penetration of pathogens of lobar pneumonia (streptococci, pneumococci, staphylococci, Friendler's bacillus) into the patient's body, which, entering the pulmonary parenchyma, provoke the development of an acute inflammatory process and the appearance of the first symptoms of the disease.

How can lobar pneumonia be cured?

Croupous type of pneumonia is treated only in a hospital setting. This is due to the fact that it is often possible to identify the disease not at the very beginning, but at its peak; it develops too quickly. If a person refuses to go to hospital immediately, he must be aware that such a decision could cost him his life.

The therapeutic course is always comprehensive and includes the following effective techniques:

oxygen therapy – normalizes gas exchange rates;
taking antibiotics - first a broad-spectrum antibiotic is used, and a little later, after receiving the results of bacterial culture, it makes sense to replace it with a low-potency drug, to which the bacteria also shows sensitivity;
physiotherapy;
medications with anti-inflammatory effects;
treatment prescribed according to the appearance of symptoms. This item includes mucolytics, antiherpes drugs, and vascular medications.