Thursday, June 23, 2011

Lobar pneumonia in children

Lobar pneumonia is a lung disease whose etiologic agent located is the pneumococcus.The main causes of this pathology are represented by: cold weather, allergy diseases recent respiratory mucosa irritation, physical debility.
The disease has a high incidence especially in large child, but can meet and at the age of the infant. Lobar pneumonia is lobar pneumonia franca by fibrin-leukocyte alveolitis, home pneumonia, the focus may be only segmental or round.
Signs and symptoms:
The clinical picture presents an atypical appearance compared to that of an adult can manifest itself in febrile syndrome (39-40 degrees C), chills, chest pain, cough, shortness of breath. The disease begins in children after previously had an infection of the upper airway aieriene with a feverish state. May appear misleading evocative aspects of acute appendicitis with symptoms: vomiting, abdominal pain (right iliac fossa at) the absence of muscular defense, fever, tachycardia. A clinical picture manifested by vomiting, fever, headache, neck stiffness to, but Valarie normal CSF may be suggestive of a diagnosis of acute meningitis false positive. A febrile syndrome without signs of localization can Simulta a typhoid fever, although more rare.There are several signs outlined in lobar pneumonia: facies vultuos, naso-labial herpes (most commonly of the pneumonic outbreak), which is initially dry cough polipneea.During the state specifies a set of functional and physical signs: fever with high (39-40 degrees) to keep the oscillations set up 0, 5 degrees, dry cough initially, then becomes productive (rarely rusty), tachycardia can reach values ​​of 120-140 / minute.
On physical examination reveals lung Matita submatitate or limited, proper furnace condensation outbreak of rales crackles deeply perceived the end of inspiration, breath tubal exaggeration voice vibrations.
Positive diagnosis:
Positive diagnosis is based on clinical examination and performing laboratory investigations.Chest X-ray diagnosis is paramount for the issue. It shows a dense homogeneous opacity, pointing triangle to HIL (Weil-Mouriquand triangle), lobar or segmental. Right upper lobe is usually interested.Laboratory tests predict blood counts. This highlights hyperleukocytosis (20. 000/mmc) with polinucleoza (80-90%).Laboratory investigations also show a hiperfibrinemie (6-8 g 0 / 00), elevated ESR and CRP's site (C-reactive protein).
Differential diagnosis is made by clinical stage: acute appendicitis, meningitis, other pneumopathies, pleurisy. During radiological lobar pneumonia viral pneumonia will differentiate the disorders accompanied by segmentation ventilation (atelectasis).In case of an outbreak pneumonic round, it must be distinguished from a tumor or another process pneumonia with different etiology, such as the staphylococcal.
Treatment:
Treatment consists of antibiotics etiologic. In the past, penicillin was the antibiotic of choice, are given a dose of 1-2 million unitati/24h, divided in four doses at intervals of 6 hours or intra-venous infusion continues. Actualmentese antibiotics that is sensitive pneumococcus: Amoxicillin + clavulanic acid (Augumentin), ampicillin + sulbactam (Unasyn), cephalosporins (ceftriaxone Ceftriaxone 100 mg / kg / day), vancomycin, rifampicin, Imipenem dose of 50 mg / kg and . you only in special situations.Symptomatic states: controlling foot, treatment of heart failure, seizures, oxigeno therapy (oxygen wetting), cough suppressants.
The disease to establish the correct antibiotic within 24-48 hours apirexie produce, but physical and radiological signs persist for more. Healing is constant. Exceptionally lobar pneumonia complications can occur with: pleurisy, lung abscess.
Prophylaxis of pneumococcal vaccine is made with high-risk persons, such as splenectomizatii.

No comments:

Post a Comment