Pneumonia – status and sputum

Pneumonia - Is an inflammatory process in lung tissue. Anatomically pneumonia divided into equity, segmental, etc.. At bilateral pneumonia are often observed localization.

Most of the pneumonia It has an infectious origin, although they can occur toxic and allergic pneumonia. The causative agent of pneumonia can be pneumococcus (Streptococcus pneumonia), streptokokk, aurococcus, Klebsiella pneumonia, mycobacterium tuberculosis, viruses, etc..

Pneumococcal pneumonia

Clinic pneumococcal pneumonia is characterized by sudden onset, chills, headache, flank pain, growing with a deep breath, shortness of breath, high fever (up to 39-40 ° C), dry cough.

In classic cases of pneumococcal pneumonia lobar in the early stages of the disease (Stage tide) pathologically marked redness and swelling spread, wherein a fluid is detected much microorganisms. Mezhalveolyarnyh capillaries walls expanded and filled with blood, alveolar cavity filled with serous fluid with a mixture of red blood cells, white blood cells and epithelial cells. This step, is an acute inflammation of the serous, the amplification diapedesis of erythrocytes and fibrin deposition is characterized by the release of a thick viscous and sticky mucus with a reddish or brownish tint. On microscopic examination, it is possible to identify a small number of red blood cells and white blood cells, alveolocytes with fatty infiltration, individual epithelial cells of the bronchi, voloknistыy fibrin and many marten.

Stage tide moves into a phase of red hepatization, in which the affected lobe of the lung becomes brownish-red, dense. Along with hyperemia found alveoli, filled with a mass of fibrin mesh with abundant admixture of red blood cells, single leukocytes and alveolar cells. During the stage of red hepatization patient coughs scant amount of rust-colored sputum (impurities gemosiderina). On microscopic examination, it is found a lot of fibrin, a small amount of preserved red blood cells, alveolocytes, of which with fatty infiltration. Gradually increasing the number of leukocytes. Further, the accumulation of fluid in the alveoli, redness disappears (partially, apparently, as a result of compression of the capillary exudate), diapedesis of red blood cells is stopped, and the remaining red blood cells in the alveoli undergo hemolysis and decay.

With the cessation of hyperemia and disappearance of exudate, an increase of red blood cells white blood cell count (step gray hepatization). Sputum in this period contains many white blood cells, which undergo fatty degeneration and partially break, forming detritus. Also found reticular fibrin, separate red blood cells and alveolocytes with fatty infiltration.

During the period of authorization of the alveoli are filled with macrophages, which absorb leukocytes with the contained Streptococcus pneumoniae. Released at the death of white blood cells proteolytic enzymes liquefied fibrin, and exudate becomes liquid, standing out in various amounts as pus. Further, the number of white blood cells and fibrin gradually decreases, until the end of sputum.

At present, it proved the absence of the disease in the strict classical staging. Stage gray hepatization can be observed on 2-3rd day of illness, and red hepatization - at a later date.

Staphylococcal pneumonia

Rarely, usually in connection with the influenza epidemic. Develops acutely, heavily, often lightning. The body temperature rises to 39-40 ° C, confused mind, chest pain, breathlessness, cough. Bronchial mucosa becomes inflamed and partially peeled. Microscopically determined by its destructive changes with abundant infiltration of neutrophilic granulocytes. In less severe cases, the bronchi and the alveoli are filled with pus.

Expectoration muco-purulent or purulent, It may contain a different number of erythrocytes. Lots of pneumonia may be subject to decay with the formation of abscesses of different sizes. Sputum in such cases sometimes contains elastic fibers. In the study of blood in half of the patients revealed a slight leukocytosis. There have neutrophilic shift to the left, increased erythrocyte sedimentation rate. In severe disease can occur eosinopenia. Urine protein is marked, mikrogematuriâ, cylinders.

Streptococcal pneumonia

Streptococcus pneumoniae is rare. Develop against measles, pertussis, influenza and other acute and chronic respiratory infections. The disease begins with the appearance of small foci of pneumonia and quickly progresses to form a confluent foci. Mainly affects the lower lobe of the lung. During acute pneumonia, heavy, with repeated chills and fever. The 50- 70 % cases of pneumonia complicated by exudative pleurisy. Sputum purulent mucous or muco-purulent, streaked with blood, It contains a large number of streptococci. Alveolocytes occur in greater or lesser amounts depending on the nature of inflammation, they may be observed fatty. In the blood, there is a high leukocytosis (20-30 T in 1 l) with a shift to the left. The 10-151 cases detected bacteremia.

Chronic pneumonia

The disease is the result of uncured acute pneumonia infectious nature. The diagnosis of chronic pneumonia is safe to put through prolonged observation of patients, which periodically repeat radiologically confirmed outbreak of inflammation in the same region of the lung. In the period of acute illness other than sweating, weakness, fever in patients with a cough with phlegm increase, which becomes purulent. Microscopic sputum are found in such a large number of dilapidated neutrophilic granulocytes, individual epithelial cells of the bronchi and alveoli.

In peripheral blood observed a moderate leukocytosis with a left shift, increased erythrocyte sedimentation rate. By biochemical indicators of activity, his acute concern hyperglobulinemia, increase in α1, b- и c-глобулинов, gaptoglobina, fibrinogen and sialic acids.