Lung fever

Description:

Lung fever – the inflammatory and allergic disease of pulmonary fabric which is characterized by localization of the center in one or several shares and caused most often by a pneumococcus. The lung fever is diagnosed practically always for adults, is very rare – at children. Specific changes in pulmonary fabric – the consolidation covering one and pulmonarier shares with formation of exudate in a gleam of alveoluses are a characteristic sign of a lung fever.  Pulmonary fabric in the place of defeat loses the properties and cannot perform physiological functions.
The lung fever everywhere is widespread, meets in all age groups, however is the most frequent in 18-40 years.

Reasons of the Lung fever:

The contributing factors for emergence of a lung fever are the general or local overcooling of an organism, hypo - and avitaminosis, catarrhal diseases postponed the day before, decrease in the general reactivity against the background of the accompanying pathology (intoxication, overfatigue, etc.).
Seasonality, with increase in frequency of cases and is characteristic in the winter of incidence of a lung fever in the early spring. The reason of development of a lung fever – penetration of disease-producing bacteria into a pulmonary parenchyma. Can act as the activator streptococci, staphylococcus, but pneumococci 1 and 2 types are most often identified.
The lung fever can be also klebsiyelezny etiology, in that case it is called Friedlander's pneumonia.

Symptoms of the Lung fever:

The beginning of a disease acute with characteristic temperature reaction and oznoba. Most often clinical signs begin to be shown in the second half of day. The prodromal stage short is also followed by an adynamy, slackness, a headache, sharp weakness. The periods of a fever are replaced by feeling of heat, nausea and vomiting is possible. Temperature quickly increases and reaches febrile figures – till 39-40 °, fever can accept gektichesky character.
At the beginning of development of a disease of the patient feels pain of the having character a stitch in the side, and localization of pain indicates the center of damage of a pleura. Morbidity amplifies at the movement, cough, breath. Unproductive cough joins, in 2-3 days the dense phlegm begins to separate. Allocation of a "rusty" phlegm which is characteristic of a lung fever indicates emigration of erythrocytes in a gleam of alveoluses. The quantity of a phlegm various,  fluctuates from 50 to 100 - 200 ml a day. The patient is uneasy, on cheeks a feverish flush, more on the party of damage of lungs, feverish gloss of eyes is noted. Breath is complicated, an asthma with the complicated breath, inflating of wings of a nose is noticeable. Shallow breathing develops against the background of morbidity at a deep breath because of dry pleurisy. Quite often there is herpetic rash about lips or a nose which is also localized on the party of defeat.
At survey lag in the act of breath of that half of a thorax where the center of a lung fever is localized quite clearly is noticeable.

It is possible to define voice trembling most. For this purpose palms investigated serially are put on symmetric sites of a thorax (over, under shovels and in medical scapular area) and ask to pronounce the patient words with a letter of river. At a palpation of a thorax it is possible to define strengthening of voice trembling (bronchophony) over the struck share. Over accompanying the center of exudative pleurisy weakening of a bronchophony is defined. Results of percussion and auscultation depend on a stage of development of an inflammation of a lung. In the first day of a disease owing to a hyperemia of walls of alveoluses the tympanic shade is characteristic of a percussion sound. Auskultativno is diagnosed weakening of vesicular breath and a phenomenon of crepitation (crepitatio indux). It is well heard at height of a deep breath, especially after a tussiculation. The mechanism of development of crepitation consists in "razlipaniye" of walls of alveoluses at breath height.

In process of progressing of a disease the center in a lung is condensed, the pleura is involved in pathological process, it becomes heard at auscultation a pleural rub, bronchial breath, crepitation gains more rough character, there are small-bubbling rattles.

Patients with a lung fever have a tachycardia, arrhythmias, arterial hypotension. When carrying out an ECG ST segment shift, a low or negative tooth of T in 2 and 3 assignments is defined. At the expressed intoxication there can be a defeat of the vasomotor center located in oblong department of a brain and there occurs sharp decrease in a tone of vessels. In that case the collapse (acute vascular insufficiency) takes place. Integuments get a grayish shade, cold sweat, tachycardia to 140 — 160 in a minute appears, systolic arterial pressure decreases. Acute vascular insufficiency develops against the background of toxic shock. At injury of a myocardium heart borders extend, cordial tones are muffled. Such state is dangerous by edematization of lungs.

Owing to intoxication of an organism appetite is sharply reduced. Language is laid over by a plaque, dryness in an oral cavity. The meteorism and a delay of a chair takes place. The liver failure develops, scleras get an ikterichny shade. Bilirubin level in blood increases, the diuresis decreases.

Against the background of the developing infectious and toxic shock there is a consciousness disturbance, nonsense, hallucinations, a convulsive syndrome.  Quite often psychomotor excitement develops, the patient can try to get up and leave, or to jump out in a window. At the persons suffering from an alcoholism development of alcoholic psychosis (delirium tremens) is possible.

Sharp (lytic) decrease in body temperature is noted. So-called lytic crisis comes for 9-10 day in the absence of treatment by antibacterial drugs. It is possible to tear off the mechanism of development of a lung fever by means of antibiotics, medicinal and allergic crisis at which temperature falls within 2-3 days of treatment in that case takes place.  

When performing blood test increase in leukocytes (leukocytosis) to 15-20 thousand in 1 mm3 of blood comes to light, the leukocytic formula moves to the left, acceleration of SOE.

X-ray inspection of bodies of a chest cavity reveals blackout of an affected area of a lung. The shadow density, its arrangement, outlines and the sizes change depending on localization of the center of an inflammation and extent of its distribution. Disappearance of the last traces of damage of a lung occurs in 1 — 2 weeks after crisis. X-ray inspection has special value at the central pneumonia, and also for early detection of complications.

The lung fever can be one - or bilateral. The last option proceeds in a severe form with the expressed clinical manifestations of septic shock. The so-called wandering pneumonia is characterized by a long current, the inflammation gradually covers one share of lungs for another. Localization of the inflammatory center  in an upper share is diagnosed more often for children, at this option the heavy nervous symptomatology develops (a meningism, a hiccups, nonsense). The option of an abortal course of pneumonia when inflammatory process is allowed within several days is possible.

Complications of a lung fever include first of all diseases from a respiratory organs (purulent pleurisy (a pleura empyema), lung abscess, chronic pneumonia), is much more rare - from other bodies (hepatitis, nephrite, a pericardis, meningitis).

Treatment of the Lung fever:

When diagnosing at the patient of a lung fever his urgent hospitalization follows. Serious condition of the patient is the indication to establishment of an individual post. It is necessary to provide leaving, a bed rest and the round-the-clock observation of the patient. Position of the patient in a bed – with the lifted head end. The patient needs easy and rather caloric food, sufficient consumption of liquid.

Pathogenetic therapy of a lung fever assumes purpose of antibacterial drugs, first of all antibiotics and streptocides. The course of antibacterial therapy lasts for 3 days after normalization of temperature.
Among streptocides more often Norsulfazolum and Sulfadimezinum according to the scheme are appointed. For prevention of toxic effect of streptocides drugs should be washed down 1/2 glasses of liquid (better to use alkaline mineral waters).

The penicillin dosage at a lung fever makes to 200 000 PIECES each 4 hours injektsionno intramusculary. The combination of penicillin and streptomycin is possible.

Big application is found by antibiotics of a broad spectrum of activity of a tetracycline row (oxytetracycline, tetracycline). The dose of these drugs varies depending on weight of a state and can reach up to 2 000 000 PIECES a day.
Development of collateral complications – in the form of toxic or allergic reactions is connected with reception of antibiotics. Antibacterial drugs suppress growth of normal microflora what development of mycoses, first of all the sorts Candida caused by fungi is connected with. For the purpose of the prevention and treatment of these diseases it is necessary to combine use of antibiotics with purpose of antifungal drugs (nystatin).

At development of infectious and toxic shock saturation level considerably decreases (content of oxygen in blood). At this state carrying out an oxygenotherapy which is carried out by means of an individual oxygen apparatus or an oxygen tent is shown. Holding this procedure within 10 minutes helps to eliminate an anoxemia. Increase in a saturation is shown in a pulse urezheniya, reduction of an asthma, integuments get physiological coloring. Use of the drugs raising a tone of vessels, for example, Cordiaminum or camphor is for this purpose shown. In more hard cases strophanthin is entered (0,5 ml of 0,05% of solution, previously having dissolved 40% of solution of glucose on 20 ml).

Also drugs of group of steroid antiinflammatory drugs – 10 ml of Prednisolonum of courses are used 1 week. Purpose of thermal physiotherapy - a diathermy, соллюкс, an inductothermy is justified.