Signs of respiratory disease in young people. Pneumonia in children and adolescents

Doctor of Medical Sciences, Prof. Samsygina G.A., head. Department of Childhood Diseases No. 1, Faculty of Pediatrics, Russian State Medical University named after. N.I. Pirogova, Honored Doctor of Russia

Pneumonia, an acute infectious disease, predominantly of a bacterial nature, is an old, long-known and ever-new, or rather renewing, disease. Pneumonia is characterized by focal lesions respiratory departments lungs, presence respiratory disorders and intra-alveolar exudation, as well as infiltrative changes on radiographs of the lungs.

Currently, pneumonia is usually divided depending on the conditions of its occurrence into community-acquired (home-acquired) and hospital-acquired (hospital-acquired, nosocomial). Community-acquired pneumonia, which, by the way, predominates, is understood as an acute infectious disease of the lung parenchyma that develops under normal conditions of existence of a child or adolescent. This article is devoted to the problems of community-acquired pneumonia, or, as they are commonly called, simply pneumonia, in children.

Pneumonia occurs in various age periods childhood since different frequency. There are two peaks for diagnosing pneumonia. The first and highest peak occurs in early childhood and preschool age, when pneumonia is diagnosed in approximately 40 out of 1000 children. The second, lower level, is determined in high school and adolescence. The diagnosis of pneumonia is established in approximately 10 cases per 1000 children /1, 2/. This morbidity dynamics is not accidental. She reflects critical period development of the pulmonary system (begins from the age of 18 months and occurs at the age of 2-3 years /3/), expansion of the child’s contacts with the outside world, which contributes to infection and, in high school and adolescence, coincides with the endocrinological and immunological restructuring of the body teenager

Mortality from pneumonia (together with influenza) in Russian Federation the average is 13.1 per 100 thousand population. Moreover, the highest mortality rate is observed in the first four years of children’s lives (30.4 per 100 thousand population), the lowest (0.8 per 100 thousand population) is recorded at the age of 10-14 years. During the period of the second rise in incidence, i.e. at the age of 15-19 years, there is a slight increase in mortality from pneumonia (up to 2.3 per 100 thousand population) /4/.

According to clinical and radiological data, pneumonia can affect a lobe (lobar), segment or segments (segmental or polysegmental), alveoli or groups of alveoli (focal pneumonia), incl. adjacent to the bronchi (bronchopneumonia) or interstitial tissue ( interstitial pneumonia). Mainly, these differences are revealed during X-ray examination of patients /5, 6, 7/.

Based on the severity of the course, the severity of lung damage, manifestations of toxicosis and complications, mild and severe pneumonia, uncomplicated and complicated are distinguished. Complications of pneumonia can be infectious-toxic shock with the development of multiple organ failure, destruction of the pulmonary parenchyma (bullas, abscesses), involvement in infectious process pleura with the development of pleurisy, empyema, pneumothorax, the occurrence of mediastenitis, etc.

The most common causative agents of pneumonia in children and adolescents are Streptococcus pneumoniae(in 20-60% of cases); Mycoplasma pneumoniae (in 5-50% of cases); Chlamydia pneumoniae(in 5-15% of cases); Chlamydia trachomatis(in 3-10% of cases); Haemophilus influenzae (in 3-10% of cases); Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli etc.) (in 3-10% of cases); Staphylococcus aureus (in 3-10% of cases); Streptococcus pyogenes, Chlamydia psittaci, Coxiella burneti etc. (rarely). It should be noted that the etiology of pneumonia in children and adolescents is closely related to the age of the child /7-10/.

In the first six months of life, the etiological role of pneumococcus and Haemophilus influenzae is insignificant, because antibodies to these pathogens are transmitted from the mother in utero. In this age E. coli, K. pneumoniae And S. aureus play a leading role as a cause of pneumonia. They cause the most severe forms of the disease in children, complicated by the development of infectious-toxic shock and lung destruction. Another group of pneumonia at this age is pneumonia caused by atypical pathogens, mainly C. trachomatis, infection of which occurs from the mother either intranatally/antenatally (rarely), or in the first days of life. Infection is also possible P. carinii, especially premature babies.

Starting from 6 months of age and up to 6-7 years inclusive, pneumonia is mainly caused by S. pneumoniae which accounts for up to 60% of all cases of pneumonia. Often, non-capsular hemophilus influenzae is also sown. H. influenzae type b is detected less frequently, in 7-10% of cases, and usually causes severe pneumonia, complicated by lung destruction and pleurisy.

Diseases caused by S. aureus And S. pyogenis usually complicated by severe viral infections such as influenza, chicken pox, measles, herpetic infection, and do not exceed 2-3% in frequency. Pneumonia caused by atypical pathogens in children of this age is mainly due to M. pneumoniae And C. pneumoniae. It should be noted that the role M. pneumoniae as a cause of pneumonia in children has clearly increased in recent years. Basically, mycoplasma infection begins to be diagnosed in the second or third year of life. C. pneumoniae as a cause of pneumonia, it is detected mainly after five years.

Viruses can be either an independent cause of disease or create viral-bacterial associations. The most important is the respiratory syncytial (RS) virus, which occurs in approximately half of cases of viral and viral-bacterial disease; in a quarter of cases, the cause of the disease is parainfluenza viruses types 3 and 1. Influenza A and B viruses and adenoviruses play a minor role. Rhinoviruses, enteroviruses, and coronaviruses are rarely detected. Pneumonia caused by measles, rubella, and chickenpox viruses has also been described. It should be emphasized that in addition to its independent etiological significance, respiratory viral infection is an almost obligatory background for the development of bacterial inflammation in children of early and preschool age.

The etiology of pneumonia in children over seven years of age is practically no different from that in adults. The most common cause of pneumonia is S. pneumoniae(up to 35-40% of cases), M. pneumoniae(23-44% of all cases), C. pneumoniae(15-30% of cases). H. influenzae type b and pathogens such as and etc.). S. aureus are practically not detected.

Particularly worth mentioning is pneumonia in immunocompromised patients /12/. In children with primary cellular immunodeficiencies, HIV-infected patients and children with AIDS, pneumonia is more often caused P. carinii and mushrooms of the genus Candida, and M. avium-intracellare and cytomegalovirus. In case of humoral immunodeficiencies, pneumonia is more often caused S. pneumoniae as well as staphylococci and enterobacteria, and in case of neutropenia - gram-negative enterobacteria and fungi (Table 1).

Table 1

Etiology of pneumonia in immunocompromised patients

In the development of pneumonia in children and adolescents, two main routes of infection are important: aspiration of oropharyngeal secretions and inhalation of an aerosol containing microorganisms. Microaspiration of oropharyngeal secretions in children is of greatest importance. Obstruction of the respiratory tract is of greater importance in the mechanisms of microaspiration, especially in the presence of broncho-obstructive syndrome, which is so common in children of early and preschool age. Aspiration of large amounts of contents from the upper respiratory tract and/or stomach is typical for newborns and children in the first months of life and occurs during feeding and/or vomiting and regurgitation.

When microaspiration/aspiration or inhalation of an aerosol containing microorganisms occurs against the background of a violation of the mechanisms of nonspecific resistance of the child’s body, for example during ARVI, the most favorable conditions are created for the development of pneumonia.

Clinical manifestations of pneumonia include: shortness of breath, cough, fever, weakness, impairment of the child’s general condition and symptoms of intoxication. Thus, the diagnosis of pneumonia should be assumed if a child develops a cough and/or shortness of breath with a number of respiratory movements of more than 60 per minute for children under three months, more than 50 per minute for children under one year, more than 40 per minute for children under five years of age, especially in combination with retraction of the compliant areas of the chest and fever of more than 38 °C for three days or more /12/.

During the physical examination, special attention is paid to identifying the following signs:

●shortening (dullness) of percussion sound over the affected area of ​​the lung;

●local bronchial breathing, sonorous fine rales or inspiratory crepitus during auscultation;

Percussion and auscultation changes in the lungs, namely shortening of the percussion sound, weakening or, conversely, the appearance of bronchial breathing, crepitus or fine rales in the lungs, are determined in 50-70% of cases /8, 12, 13/. However, it should be remembered that in the early childhood, especially in children in the first months of life, these manifestations are typical for almost any acute respiratory infection, and physical changes in the lungs during pneumonia in most cases (with the exception of lobar pneumonia) are practically indistinguishable from physical changes during bronchiolitis and bronchitis. In most cases, the severity clinical symptoms depends on many factors, including the severity of the disease, the extent of the process, the age of the child, the presence of concomitant diseases, etc. It should be noted that approximately 15-25% of sick children may have no physical symptoms or cough.

The gold standard for diagnosing pneumonia is chest x-ray. The following criteria are assessed, which also indicate the severity of the disease and help in choosing antibacterial therapy:

●the size of lung infiltration and its prevalence;

●presence or absence of pleural effusion;

●presence or absence of destruction of the pulmonary parenchyma.

Subsequently, with clear positive dynamics clinical manifestations pneumonia, there is no need for control radiography both upon discharge from the hospital and during treatment at home. It is advisable to carry out control radiography no earlier than 4-5 weeks from the onset of the disease. X-ray study in dynamics in acute period disease is carried out only if there is progression of symptoms of lung damage or if signs of destruction and/or involvement of the pleura in the inflammatory process appear. In cases of complicated pneumonia, mandatory X-ray monitoring is also carried out before the patient is discharged from the hospital.

A peripheral blood test should be performed in all patients with suspected pneumonia. Leukocytosis >10-12·10 9 /l and band shift >10% indicate a high probability of bacterial infection, and leukopenia<3·10 9 /л или лейкоцитоз >25·10 9 /l are unfavorable prognostic signs of the course of pneumonia.

Thus, radiological and clinical laboratory criteria for diagnosing pneumonia are the presence of infiltrative changes on the radiograph in combination with at least two of the following clinical and laboratory signs:

●acute febrile onset of the disease (body temperature >38 °C);

●cough;

●auscultatory signs of pneumonia;

●leukocytosis >10-12·10 9 /l and/or band shift >10%.

Biochemical blood test is standard method examination of children and adolescents with severe pneumonia requiring hospitalization. The activity of liver enzymes, the level of creatinine and urea, and electrolytes in the blood are determined. The acid-base status of the blood is also a standard method of examining children and adolescents with severe pneumonia. In children early age Pulse oximetry is performed.

The etiological diagnosis is established mainly in severe pneumonia. A blood culture is performed, which gives positive result in 10-40% of cases /14/. Microbiological examination of sputum in pediatrics does not have wide application due to technical difficulties in collecting sputum in the first 7-10 years of life. In cases of bronchoscopy microbiological research aspirates from the nasopharynx, tracheostomy and endotracheal tube are exposed. It is also possible to culture punctate pleural contents.

To clarify the etiology of the disease, they are also used serological methods research. An increase in titers of specific antibodies in paired sera taken during the acute period and during convalescence may indicate a mycoplasma or chlamydial etiology of pneumonia. Reliable methods for identifying antigens are latex agglutination, counter immunoelectrophoresis, ELISA, PCR, etc. All these methods, however, do not affect the choice of treatment tactics and have only epidemiological significance.

●the diagnosis of “pneumonia” should be assumed when a child or adolescent develops an acute cough and/or shortness of breath, especially in combination with fever and/or corresponding auscultatory changes in the lungs and symptoms of intoxication;

●the diagnosis criterion is the presence of characteristic changes of an infiltrative nature in the lungs on radiographs of the chest organs;

●the assumption of a diagnosis of pneumonia, and even more so its clinical and radiological substantiation, is an indication for the immediate administration of the first dose of an antibiotic and determining the place of treatment for the patient;

●Only after starting antibacterial therapy and determining the site of treatment should efforts be focused on etiological diagnosis.

The need for a differential diagnosis for pneumonia arises only in complex cases. Then they use computed tomography, which has twice as much high sensitivity when identifying foci of infiltration in the lower and upper lobes of the lungs, fibrobronchoscopy and other instrumental techniques.

The differential diagnosis of pneumonia in children and adolescents is closely related to the age of the child, because determined by the characteristics and nature of pulmonary pathology in different age periods. For example, in infancy, the need for a differential diagnosis arises for diseases that are difficult to respond to standard treatment. In these cases, it should be remembered that, firstly, pneumonia can complicate another pathology. Secondly, the clinical picture of respiratory failure may be due to conditions such as aspiration, foreign body in the bronchi, previously undiagnosed tracheoesophageal fistula, gastroesophageal reflux, defects lung development(lobar emphysema, coloboma), heart and large vessels, cystic fibrosis and α-antitrypsin deficiency.

In children of the second or third years of life and older, with pneumonia that is difficult to treat, Kartagener syndrome, pulmonary hemosiderosis, nonspecific alveolitis, and selective IgA immunodeficiency should be excluded. Differential diagnosis at this age is based on the use of endoscopic examination of the trachea and bronchi, lung scintigraphy, angiography, sweat and other tests for cystic fibrosis, determination of the concentration of α 1 -antitrypsin, etc.

In all age groups, it is necessary to exclude the diagnosis of pulmonary tuberculosis.

In patients with severe immune defects, when shortness of breath and focally infiltrative changes appear on a chest x-ray, it is necessary to exclude the involvement of the lungs in the main pathological process (for example, in systemic connective tissue diseases), as well as the consequences of the therapy (drug-induced lung injury, radiation pneumonitis, etc.) .).

Treatment of pneumonia begins with determining the place of treatment and prescribing antibacterial therapy to the patient, incl. if pneumonia is suspected.

Indications for hospitalization for pneumonia in children and adolescents are the severity of the disease and the presence of risk factors for an unfavorable course of the disease (modifying risk factors). Indicators of disease severity include:

●child’s age is less than two months, regardless of the severity and extent of the process;

●child's age up to three years with lobar lung damage;

●damage to two or more lobes of the lungs (regardless of age);

●presence of pleural effusion (regardless of age).

Modifying risk factors include:

●severe encephalopathy;

●intrauterine infection in children of the first year of life;

●hypotrophy 2-3 degrees;

● birth defects development, especially congenital heart defects and large vessels;

●chronic lung diseases (including bronchopulmonary dysplasia, bronchial asthma), of cardio-vascular system, kidney (nephritis), oncohematological diseases;

●immunocompromised patients;

●impossibility of adequate care and fulfillment of all medical prescriptions at home (socially disadvantaged families, poor social and living conditions, including dormitories, settlements of refugees, internally displaced persons, etc., religious views of parents, etc. ) and other modifying social factors.

Indications for hospitalization in the intensive care unit and intensive care(ICU), regardless of the presence or absence of modifying risk factors in the child, pneumonia is suspected if the following symptoms are present:

●shortness of breath over 80 breaths per minute for children of the first year of life and over 60 breaths per minute for children over one year of age;

●retraction of the jugular fossa when the child breathes;

●moaning breathing, irregular breathing rhythm (apnea, gasps);

●signs of acute cardiovascular failure;

●intractable hyperthermia or progressive hypothermia;

●impaired consciousness, convulsions.

Indications for hospitalization in surgery department or to a department with the ability to provide adequate surgical care is the development of pulmonary complications (sypneumonic pleurisy, metapneumonic pleurisy, pleural empyema, lung destruction, etc.). It should be emphasized that the nature of pulmonary complications is in a certain relationship with the etiology of the process. Thus, metapneumonic pleurisy is more typical for pneumococcal etiology of the disease, and pleural empyema is more typical for staphylococcal and klebsiella etiology; destruction of the pulmonary parenchyma without the formation of bullae is for hemophilus influenzae infection, and the formation of bullae is for staphylococcal infection (however, there is no direct correlation between the clinical and radiological picture and the etiological factor).

Started immediately established diagnosis pneumonia or if it is suspected in a child with a serious condition, empirical antibacterial therapy is the main method of treating pneumonia /5, 7, 8, 12/. The empirical prescription of antibacterial agents makes it important for the physician to know about the etiology of pneumonia at different ages.

The indication for replacing the antibiotic/antibiotics is the lack of clinical effect within 36-72 hours, as well as the development side effects. The criteria for no effect are following symptoms: maintaining body temperature more than 38 °C and/or deterioration of the child’s condition, and/or increasing changes in the lungs or pleural cavity; with chlamydial and Pneumocystis pneumonia - an increase in shortness of breath and hypoxemia.

If there are risk factors for an unfavorable prognosis, treatment of pneumonia is carried out according to the de-escalation principle, i.e. begins with antibiotics with potentially the broadest spectrum of action, followed by a transition to antibacterial drugs with a narrower spectrum.

The peculiarities of the etiology of pneumonia in children in the first six months of life make inhibitor-protected amoxicillin (amoxicillin + clavulanate) or a 1st-2nd generation cephalosporin (cefuroxime or cefazolin) the drugs of choice for non-severe pneumonia; for severe pneumonia - cephalosporins of the 3rd-4th generation (ceftriaxone, cefotaxime and etc.) in monotherapy or in combination with aminoglycosides.

For pneumonia occurring in a child up to six months with normal or low-grade fever, especially in the presence of obstructive syndrome and indications of vaginal chlamydia in the mother, we can assume pneumonia caused by C. trachomatis. In these cases, it is advisable to immediately prescribe the child a macrolide antibiotic (azithromycin, roxithromycin or spiramycin) orally.

In premature babies, be aware of the possibility of pneumonia caused by P. carinii. If pneumocystis is suspected, children are prescribed co-trimoxazole along with antibiotics, and if the etiology of pneumonia is confirmed, only co-trimoxazole is left, which the child receives for at least three weeks.

For pneumonia aggravated by the presence of modifying risk factors or with a high risk of an unfavorable outcome, the drugs of choice are the inhibitor-protected amoxicillin in combination with aminoglycosides or cephalosporins of the III-IV generation - ceftriaxone, cefotaxime, cefepime in monotherapy or in combination with aminoglycosides, depending on the severity diseases; carbapenems (imipenem from the first month of life, imipenem and meropinem from the second month of life). If suspected or diagnosed staphylococcal etiology disease, the administration of linezolid or vancomycin is indicated, depending on the severity of the disease, alone or in combination with aminoglycosides.

Alternative drugs, especially in cases of development of destructive processes in the lungs, are linezolid, vancomycin, carbapenems (Table 2).

table 2

Choice antibacterial drugs in children in the first six months of life with pneumonia

At the age of 6-7 months to 6-7 years, when choosing initial antibiotic therapy, 3 groups of patients are distinguished:

●patients with non-severe pneumonia who do not have modifying risk factors or have modifying social risk factors;

●patients with severe pneumonia and patients with modifying risk factors that worsen the prognosis of the disease;

●patients with severe pneumonia with a high risk of unfavorable outcome.

For patients in the first group—with mild pneumonia and no modifying risk factors—it is most advisable to prescribe oral antibacterial drugs. For this purpose, amoxicillin, amoxicillin + clavulanate or the second generation cephalosporin cefuroxime axetil can be used. But in some cases (lack of confidence in fulfilling assignments, it is enough serious condition child when parents refuse hospitalization and others similar situations) a stepwise method of therapy is justified, when in the first 2-3 days treatment is carried out parenterally, and then, when the patient’s condition improves or stabilizes, the same antibiotic is prescribed orally. For this purpose, amoxicillin + clavulanate can be used, but it is administered intravenously, which is difficult at home. Therefore, cefuroxime intramuscularly and cefuroxime axetil orally are more often used.

In addition to beta-lactams, treatment can be carried out with macrolides. But, given the etiological significance of Haemophilus influenzae (up to 7-10%) in children of this age group, from wide range macrolide antibiotics, the drug of choice for initial empirical therapy is only azithromycin, which has an effect on H. influenzae. Other macrolide drugs are alternative drugs in case of intolerance to beta-lactam antibiotics or their ineffectiveness in case of pneumonia caused by atypical pathogens - M. pneumoniae, C. pneumoniae, which is quite rare at this age. In addition, if the drugs of choice are ineffective, third generation cephalosporins are used as an alternative.

For patients in the second group - severe pneumonia and pneumonia with the presence of modifying risk factors (except for social ones) - parenteral administration of antibiotics or the use of a step-by-step method of administration is indicated. The drugs of choice, depending on the severity and extent of the process and the nature of the modifying factor, are amoxicillin + clavulanate, cefuroxime or ceftriaxone, cefotaxime. Alternative drugs if initial therapy is ineffective are third or fourth generation cephalosporins, incl. in combination with aminoglycosides; carbapenems. Macrolides are rarely used in this group.

Patients with a high risk of an unfavorable outcome, severe purulent-destructive complications, are prescribed antibacterial therapy according to the de-escalation principle, which involves the use of linezolid alone or in combination with an aminoglycoside or a combination of a glycopeptide with an aminoglycoside, or a fourth generation cephalosporin with an aminoglycoside as a starting drug. Alternative therapy is the prescription of carbapenems (Table 3).

Table 3

The choice of antibacterial drugs for the treatment of pneumonia in children (age from 6-7 months to 6-7 years)

When choosing antibacterial drugs for pneumonia in children over 6-7 years of age and adolescents, 2 groups of patients are distinguished:

●with mild pneumonia;

●with severe pneumonia requiring hospitalization, or with pneumonia in a child or adolescent with modifying risk factors.

The antibiotics of choice for the first group of patients (with mild pneumonia) are amoxicillin and amoxicillin + clavulanate or macrolides. Alternative antibiotics are cefuroxime axetil or doxycycline, or macrolides if amoxicillin or amoxicillin + clavulanate was previously prescribed. The antibiotics of choice for patients of the second group with severe pneumonia requiring hospitalization, or with pneumonia in children and adolescents with modifying risk factors, are amoxicillin + clavulanate or second generation cephalosporins. Alternative antibiotics are third or fourth generation cephalosporins. Macrolides should be preferred in cases of intolerance to beta-lactam antibiotics and in cases of pneumonia presumably caused by M. pneumoniae And C. pneumoniae(Table 4).

Table 4

The choice of antibacterial drugs for the treatment of pneumonia in children and adolescents (age from 6-7 to 18 years)

For pneumonia in immunocompromised patients, empirical therapy begins with III-IV generation cephalosporins or vancomycin in combination with an aminoglycoside, or linezolid in combination with an aminoglycoside. Then, as the etiology of the disease is clarified, or the started therapy is continued, for example, if pneumonia is caused Enterobacteriaceae (K. pneumoniae, E. coli and etc.), S. aureus or S. pneumoniae or prescribe co-trimoxazole (20 mg per 1 kg of body weight according to trimethoprim) if pneumocystis is detected, or fluconazole for candidiasis or amphotericin B for other mycoses. If pneumonia is caused by viral agents, such as cytomegalovirus, ganciclovir is prescribed, if it is caused by a herpes virus, then acyclovir, etc. (Table 5).

Table 5

The choice of antibacterial drugs for pneumonia in immunocompromised patients

Table 6 shows the most commonly used antibiotics for pneumonia, their doses, routes and frequency of administration.

Table 6

Doses of the most commonly used antibiotics, routes and frequency of their administration

The duration of the course of antibiotics depends on their effectiveness, the severity of the process, the presence of complications of pneumonia and the premorbid background of the child. The usual course duration is 6-10 days and lasts 2-3 days after obtaining a lasting effect. Complicated and severe pneumonia usually require a 2-3 week course of antibiotic therapy. In immunodeficient patients, the course of antibacterial drugs is at least three weeks, but may be longer.

Recommendations for the use of immunocorrective drugs in the treatment of pneumonia are still under discussion. The most studied indications are fresh frozen plasma and immunoglobulin for intravenous administration. They are indicated in the following cases:

●children up to two months old;

●presence of modifying risk factors, with the exception of social ones;

●high risk of unfavorable outcome of pneumonia;

●complicated pneumonia, especially destructive ones.

Immunoglobulins for intravenous administration are prescribed as early as possible, on days 1-2 of therapy. Administered in usual therapeutic doses (from 500 to 800 mg/kg), at least 2-3 times, daily or every other day. At the same time, it is desirable to achieve an increase IgG level in the patient's blood more than 800 mg%. For destructive pneumonia, administration of immunoglobulin preparations containing IgG and IgM is indicated.

Adequate hydration is essential when treating pneumonia. But it should be remembered that, especially with parenteral administration of fluid, overhydration easily occurs due to increased release antidiuretic hormone. Therefore, for mild and uncomplicated pneumonia, oral hydration in the form of drinking juices, tea, mineral water and taking rehydrants is preferable.

Indications for infusion therapy are the presence of exicosis, collapse, and microcirculatory disorders. The infusion volume should not exceed 20-30 ml/kg, except for exicosis, in which it can reach 100-120 ml/kg, depending on the severity of exicosis.

Antitussive therapy occupies an important place in the treatment of pneumonia, being one of the main directions of symptomatic therapy. From antitussives medicines The drugs of choice are mucolytics, which dilute bronchial secretions well by changing the structure of mucus. Mucolytics are used orally and inhaled for 3-7-10 days. These are ambroxol, acetylcysteine, bromhexine, carbocysteine.

Another direction of symptomatic therapy is antipyretic, which is prescribed for febrile convulsions and metapneumonic pleurisy, often complicated by severe fever. Currently, the list of antipyretic drugs for children is limited to paracetamol and ibuprofen. At temperatures above 40 °C use lytic mixture, which includes a 2.5% solution of aminazine 0.5-1.0 ml and a solution of pipolfen 0.5-1.0 ml, the mixture is administered intramuscularly or intravenously. IN severe cases The mixture includes a 10% analgin solution - 0.2 ml per 10 kg of body weight.

It has been established that stimulating, restorative and antihistamine therapy does not affect the outcome and duration of treatment for pneumonia.

In the absence of positive dynamics of the process within 3-5 (maximum - 7) days of therapy, protracted course, resistance to therapy, it is necessary to expand the range of examination both in terms of identifying unusual pathogens (C. psittaci, Ps. aerugenozae, Leptospira, Coxiella burneti), and in terms of identifying other lung diseases.

With improper and untimely treatment of pneumonia, it is extremely rare and mainly in children with chronic lung diseases, such as cystic fibrosis or developmental defects, the formation of segmental or lobar pneumosclerosis and bronchial deformations in the affected area is possible.

With an unfavorable outcome, as recently shown by cooperative studies, pneumonia suffered in early childhood is manifested by persistent pulmonary dysfunction and the formation of chronic pulmonary pathology in adulthood /16/. The vast majority of pneumonia in childhood is completely cured, although this process takes up to 1-2 months.

Literature.

1. Health of children in Russia / Edited by A.A. Baranova.- M., 1999.- P. 66-68, 116-120.

2. Infectious morbidity in the Russian Federation for January-December 2001 / Epidemiol. Infectious Bol.- M., 2002.- 3.- P. 64.

3. Cellular biology of the lungs in normal and pathological conditions: Hand. for doctors / Edited by V.V. Erokhin, L.K. Romanova. - M.: Medicine, 2000.- 496 p.

4. Report on the state of health of children in the Russian Federation (based on the results of the All-Russian medical examination in 2002). - M.: Ministry of Health of the Russian Federation, 2003. - 46 p.

5. Antibacterial therapy of pneumonia in children: A manual for doctors / V.K. Tatochenko, E.V. Sereda, A.M. Fedorov et al. - M., 2001.

6. Sinopalnikov A.I., Strachunsky L.S., Sivaya O.V. ...Clinical microbiology and antimicrobial chemotherapy. - 2001. - T. 3. - No. 4. - P. 355-370.

7. Rational pharmacotherapy of childhood diseases: Hand. for practicing doctors in 2 books / Under the general editorship of A.A. Baranova, N.N. Volodina, G.A. Samsygina.- M.: Litterra, 2007.- P. 451-168 (Rational pharmacotherapy: Ser. Guide for practicing physicians; Book 1).

8. Respiratory tract infections in young children / Edited by G.A. Samsygina.- M.: Miklos, 2006.- P. 187-250.

9. Buckingham S.C. Incidence and etiologies of complicated pneumonic effusion in children 1996-2001 // Pediatr. Infect. Dis. J.- 2003.- 22.- 6.- P. 499-504.

10. Juven T., Mertsola J., Waris M. et al. Etiology of community-acquired pneumonia in 254 hospitalized children // Pediatr. Infect. Dis. J.- 2000.- 19.- P. 293-296.

11. Henrickson K.J. ...Seminars in Pediatric Infection Diseases, 1998.- V. 9.- No. 3 (July).- P. 217-233.

13. Tatochenko V.K., Samsygina G.A., Sinopalnikov A.I., Uchaikin V.F. Pneumonia // Pediatric pharmacology. - 2006. - T. 3. - No. 3. - P. 38-46; No. 4.- pp. 22-31.

14. Gendrel D. Pneumonies communautaires de l`enfant: etiologie et traitement // Arch. Pediatr.- 2002.- V. 9.- 3.- P. 288-289.

15. Guidelines for management of adult community - acquired lower respiratory tract infections. European Study on Community-acquired Pneumonia (ESOCAP) Committee // Eur. Resp. J.- 1998.- 14.- 986-991.

16. Bush A., Carlsen R.-H., Zach M.S. Growing up with lung disease: the lung in transition to adult life // ERSM- 2002.- P. 189-213.

Pneumonia occurs for certain reasons, accompanied by severe deterioration in health, pain and weakness.

If treatment is not started in time, there may be serious complications. We will talk about the symptoms and treatment of pneumonia in children in the article.

Description and characteristics

According to experts, pneumonia is inflammatory process of lung tissue. It is infectious in nature, caused by viruses, fungi, and pathogenic bacteria. The official name of the disease is pneumonia.

The pathology is very dangerous as it develops quickly. In the early stages it resembles a common cold. Patients begin serious treatment, usually in the later stages.

With this disease lung tissue is significantly affected, which negatively affects the functioning of the entire pulmonary system.

When and why might it occur?

A person can get sick at any age. However Pneumonia most often affects children 2-5 years old. The disease occurs for the following reasons:

The disease occurs most often in the cold season. In autumn and winter, children become hypothermic and suffer from the flu and ARVI. Pneumonia may develop against the background of these diseases.

The risk group includes children who often catch colds. A child with low immunity has a huge chance of contracting pneumonia.

Premature babies, whose lungs are not fully developed, have defects, are also likely to get sick.

What is it caused by?

The causative agents of the disease are pathogenic bacteria, viruses, and fungi.

To the most common harmful microorganisms relate:

• pneumococci;
• streptococci;
• staphylococci;
• legionella;
• mycoplasma.

As soon as these microorganisms penetrate the child’s body, they begin to actively influence it. First symptoms may appear the next day, but they can easily be confused with a cold.

However, there are cases when pneumonia occurs due to severe hypothermia. Inhaled frosty air can damage lung tissue and lead to inflammation.

The severity of the disease depends on the following factors:

1. Extensiveness of the process. It can be focal, focal-confluent, segmental, lobar, interstitial.
2. Age child. The younger the baby, the thinner his airways. Thin airways lead to poor gas exchange in the body. This contributes to severe pneumonia.
3. Localization, the cause of the disease. If the disease has affected a small part of the lungs, it is not difficult to cure it, but if the child’s respiratory system is severely affected, it is very difficult to treat. We must not forget that when the lungs are damaged by bacteria and viruses, it is difficult to get rid of the disease. Antibiotics may be needed.
4. Immunity child. The higher the baby’s immunity and the body’s protective functions, the faster he will recover.

How to treat obstructive bronchitis in children? Find out about this from ours.

Types and classification

Experts distinguish pathology by the area affected:

• focal. Occupies a small part of the lungs;
• segmental. Affects one or several segments of the lung at once;
• shared. Spreads to the lobe of the lung;
• drain. Small lesions merge into large ones, gradually grow;
• total. The lung is affected as a whole. The most severe form of the disease.

There are two types of the disease:

• one-sided. One lung is affected;
• bilateral. Both lungs are affected.

Symptoms and clinical picture

How to determine pneumonia in a child? The clinical picture appears quite clearly. TO general symptoms diseases include:

1. Coughing. May occur when taking a deep breath. He becomes stronger, more intrusive. At the early stage of the disease, it is dry, then sputum appears.
2. Dyspnea. Breathing becomes heavy, shortness of breath torments the baby even without physical activity.
3. Fever. It is difficult to lower it, it stays around 39 degrees.
4. Runny nose. Happening copious discharge mucus from the nose.
5. Dizziness, nausea. The child refuses to eat and vomits. The baby turns pale and weakens.
6. Sleep disturbance. Frequent cough prevents the child from falling asleep. He wakes up many times during the night.

Signs of the disease are also pallorskin, decreased performance, fatigue.

The baby refuses to play and lies down a lot. The disease leads to lethargy and severe weakness.

Babies under one year old the disease is very difficult to bear. Almost immediately the temperature rises to 39 degrees, there is intense fever and weakness.

How to recognize pneumonia in a baby? Infant cries, cannot sleep, refuses to eat. The baby's pulse increases, and it becomes difficult for the child to breathe. He puffs out his cheeks and stretches out his lips. Foamy discharge from the mouth is possible.

In older children there is a strong cough. The baby is capricious and feels sick. The child refuses food and turns pale. It is accompanied by fatigue and lethargy. He looks sleepy and is capricious. Nasal discharge is thin at first, but becomes thicker as the disease progresses.

Diagnostics

Diagnostics carried out in hospital. For this, the patient is examined, then the following is applied:

1. Blood analysis.
2. Sputum examination.
3. Serological tests. Helps identify the causative agent of the disease.
4. Determination of gas concentrations in arterial blood in patients with signs of respiratory failure.
5. X-ray. Identifies lesions.

These diagnostic methods help to quickly establish a diagnosis and prescribe appropriate medications.

Helps make a diagnosis faster differential diagnosis. Pneumonia is distinguished from diseases that have similar symptoms:

• tuberculosis;
• allergic pneumonitis;
• psittacosis;
• sarcoidosis

The diseases are so similar that they can only be distinguished after laboratory tests.

Thorough examination of blood and sputum the patient helps specialists determine the pathology. At the first examination of the patient, it will not be possible to distinguish the above diseases from pneumonia.

Complications and consequences

If the disease is not treated, it may occur Negative consequences, which appear as:

Indications for hospitalization

The condition during illness in children can be very serious. In some cases hospitalization is required. Indications for it are:

1. Severe fever.
2. Purulent process in the lungs.
3. High degree of intoxication of the body.
4. Serious difficulty breathing.
5. Dehydration of the body.
6. Presence of concomitant diseases. Exacerbation of chronic pathologies.

The child may also be hospitalized if high temperature, which cannot be reduced with medication, with severe cough with signs of suffocation.

Treatment

How to treat pneumonia in children? You can cure your baby different ways. There are many medications for this, but they are prescribed by doctors only after examining patients.

Drugs and antibiotics

Effective drugs against this pathology are:

• Amoxiclav;
• Azitrox;
• Klacid;
• Roxybid.

These funds fight fungi, bacteria and viruses in the child's body.

They destroy the cause of the disease and normalize the child’s condition. The dosage of drugs and duration of use are prescribed by a doctor.

If these drugs do not help, specialists prescribe antibiotics:

• Levoflox;
• Moximac;
• Unidox Solutab;
• Suprax;
• Tsedex.

They effectively fight the disease, eliminate unpleasant symptoms illness, the child’s condition returns to normal.

To treat cough and eliminate phlegm It is recommended to take ACC. The drug helps the child recover. Take the medicine one tablet 2-3 times a day.

Folk remedies

Helps eliminate the disease onion based products.

To do this, juice is extracted from a small onion. It is mixed with the same amount of honey.

The resulting product is consumed in a small spoon 2-3 times a day before meals.

Prepared to combat the disease garlic oil . To do this, grind two cloves of garlic to a paste and mix with 100 g of butter. The finished product should be consumed 2-3 times a day, spread on bread.

An effective remedy is decoction of honey and aloe. To do this, mix 300 g of honey, half a glass of water and crushed aloe leaf. The mixture is simmered over low heat for two hours. Next, cool the product and take a large spoon three times a day.

Physiotherapeutic

Includes the following methods:

• electrophoresis;
• inhalation;
• decimeter wave therapy;
• magnetic therapy;
• thermal procedures;
• inductothermy.

These procedures are performed in a hospital by experienced doctors. For this, special devices are used. The doctor prescribes a certain number of procedures. The methods are usually used while the patient is in the hospital.

With their help, you can achieve incredible results: significantly improve the child’s condition and eliminate the symptoms of the disease. The baby will recover quickly. The body will be able to recover.

Prevention measures

1. Avoidance public places in the cold season. Usually, infection occurs in public places.
2. The child needs to be taken before the walk dress warmly. In frosty weather, it is better to avoid walking.
3. Healthy eating, taking vitamins. Will help strengthen the baby's body, boost immunity. Unhealthy food excluded from the child's diet.
4. Baby no contact allowed with a sick person. The child's body may soon become ill.
5. Moderate physical activity. Helps strengthen the immune system. Exercises in the morning and gymnastic exercises help.

The disease causes great harm children's body, leads to complications if treatment is not started on time. It is recommended that at the first symptoms of the disease you consult a doctor who will prescribe the necessary medications.

Doctor Komarovsky about pneumonia in children:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

Popular on the site

Pneumonia develops quite often in adolescents of high school age. Constantly being in a group, children easily pick up viruses from each other that cause an inflammatory process. An additional risk factor can be a teenager’s reduced immunity due to hormonal changes.

Infectious pneumonia

Reasons for development

The inflammatory disease is caused by:

• viruses;
• bacteria;
• Candida mushrooms.

The development of the inflammatory process can also be caused by other viral diseases such as influenza, measles, scarlet fever and others. Pneumonia develops as a complication of ARVI, influenza, other viral disease in adolescents with weakened immune systems.

Teenagers of high school age are at risk due to hormonal changes in the body. Internal systems are finally formed, during this “window” it is easiest to develop an illness that threatens to develop chronic complications in future.

Among adolescents, atypical pneumonia is most common. The causative agents of the disease are mycoplasmas, chlamydophila, legionella and other viruses that are easily transmitted from person to person in large groups (at school, college, section). The main danger of this type of pneumonia is its non-obvious symptoms: the temperature is normal, the patient’s blood tests are in order. Diagnosis becomes more difficult, and it becomes more difficult to cope with atypical pneumonia.

Main manifestations

Signs of pneumonia can be different and directly depend on the root cause of the development of the inflammatory process. The main symptoms for adolescents are similar to those characteristic of adult patients:

• a sharp increase in temperature;
• cough;
• painful sensations in the chest area when breathing and coughing;
• wheezing is heard;
• dyspnea;
• general state weaknesses;
• headache;
• lack of appetite;
• decreased overall activity, loss of interest in everything.

If the temperature cannot be reduced for a long time with the help of antipyretic drugs, this may be a manifestation of a severe form of inflammation. But the symptoms may not coincide with the clinical picture; the disease can be practically asymptomatic. This complicates the diagnosis, and it will not be possible to start treatment in a timely manner.

Diagnostics

Diagnostic methods for suspected pneumonia in adolescents are as follows:

• radiography;
• peripheral blood test;
• blood chemistry.

At the initial appointment, the doctor listens to the teenager’s lungs and asks him to take deep breaths and exhales. Each side of the chest can be heard; pneumonia can be left-sided, right-sided, or affect both lungs at once. The doctor does a survey, assesses the patient’s general health, and writes a referral for an x-ray. Foci of inflammation are shown in the image. Additionally, blood tests are carried out: peripheral analysis to detect the bacterial focus of the disease, biochemical analysis to assess the severity of inflammation. Based on the data obtained, a diagnosis is made and a decision is made on the need for hospitalization.

General symptoms of pneumonia in adolescents are differentiated from other pulmonary diseases. The main task of the doctor is to distinguish pneumonia from bronchitis and prescribe the correct treatment.

Therapy methods

Pneumonia is treated medications. To avoid complications, in most cases you will need to resort to antibiotics.

Therapeutic methods depending on the cause of inflammation:

• illness due to ARVI does not require complementary therapy, in addition to treating the underlying infection;
• if the disease is of bacterial origin, a course of antibiotics is prescribed;
• for pneumomycosis (pneumonia caused by a fungus), antifungal drugs are prescribed.

Most inflammatory processes of this nature can be treated at home. It is necessary to hospitalize a teenager in the most extreme situations; according to statistics, this happens in 8-10% of cases. In the hospital, IVs are placed, injections are administered, and the patient’s health condition is constantly monitored.

Taking medications

Accept antibacterial agents on your own initiative, and not on the recommendations of a doctor - a bad idea. Any antibiotics must be prescribed by the attending physician based on the diagnostic results; self-medication of pneumonia with the first available drug from the pharmacy is unacceptable. Pneumonia is not always bacterial in nature, this is also worth remembering.

The following antibiotics may be prescribed:

• Amoxicillin;
• Ceftriaxone;
• Erythromycin;
• Flemoxin.

The dosage and course of treatment depend on the characteristics and severity of the inflammatory process. The course of drugs does not stop, even if the patient feels better after a few days. You need to complete the treatment completely, following all the recommendations. The decision to discontinue medications is made by the doctor if the results of repeated tests and x-rays show good results.

ethnoscience

Folk remedies for pneumonia are ineffective. An acute inflammatory process cannot be stopped using the “grandmother’s” method; there is a risk of complications and fatal outcome. resort to folk medicine only possible as adjuvant therapy. It is imperative to consult a doctor before starting to use home recipes.

Forecast

With the right approach to therapy and careful attention to the doctor’s recommendations, the prognosis is positive. Only 10% of patients require hospitalization if complications occur. Pneumonia can be completely cured in 2-6 weeks. The duration depends on the severity of the disease, condition and individual characteristics of the body.

Prevention

Preventive measures may be as follows:

• ensuring the teenager’s physical activity to prevent stagnation of mucus in the respiratory tract;
• organization of a humid and cool climate in the room where the patient is located to facilitate breathing;
• drinking large amounts of fluid to thin the mucus;
• complete treatment of the primary disease;
• measures to strengthen the immune system: taking vitamins, maintaining healthy image life.

The risk of developing inflammation is significantly reduced if proper therapy is organized. primary disease: ARVI, influenza, other viral pathology. The main preventive technique will be general strengthening health of the patient.

Complications

Among possible complications:

• lung abscess;
• pulmonary edema;
• bronchial spasms;
• anemia;
• meningitis;
• inflammation of the heart muscle;
• sepsis;
• DIC syndrome.

Negative consequences can affect more than just the lungs. If the infection spreads further, dangerous situations for all internal systems.

If you suspect the development of pneumonia, you will need to consult a doctor and undergo diagnostic examination. It is necessary to make an appointment with a pediatrician; he can, if necessary, refer you to an infectious disease specialist. The doctor’s recommendations should be strictly followed, and the course of prescribed treatment should not be deviated, even if it seemed that the patient was much better. Only by adhering to a therapeutic course will you be able to cope with pneumonia and avoid complications.

Pneumonia is a disease that occurs quite often among children. According to statistics, it accounts for about 80% of all pathologies of the respiratory system. Signs of pneumonia detected in a child at an early stage make it possible to begin treatment on time and speed up recovery.

Causes of the disease

The causative agents are pathogenic viruses, bacteria, and various fungi. Depending on the nature of the disease, a treatment regimen is selected.

Provoking factors for the development of pneumonia are:

• Weakening of the immune system.
• Lack of vitamins.
• Past respiratory disease.
• Penetration foreign object into the respiratory tract.
• Stress.

Staphylococcal and streptococcal pneumonia can be associated with other diseases and occur after influenza, measles, and whooping cough. Due to underdeveloped respiratory muscles little patient it is not possible to clear the phlegm that accumulates in the bronchi. As a result, ventilation of the lungs is disrupted, pathogenic microorganisms settle in them, which causes an inflammatory process.

Pathogenic bacteria also cause other diseases. Streptococcus pneumoniae in the throat often causes acute tonsillitis.

First signs

Symptoms of pneumonia in children manifest themselves in certain ways. It depends on various factors. Eg, aspiration pneumonia in children it develops gradually, initial stage its signs may not be noticed. After some time, cough, chest pain and other symptoms appear, depending on the location of the aspiration. This form of the disease is distinguished by the absence of chills and fever. With atypical pneumonia in children, the symptoms are more pronounced - there is a lump in the throat, watery eyes, headaches, and a dry cough.

By the end of the first week of the disease, the cough intensifies, and the temperature during pneumonia in children can rise to 40⁰C. Possible addition of rhinitis, tracheitis. Many parents are interested in what temperature is considered normal for pneumonia. It depends on the state of the child's immune system. Some types of pneumonia occur without fever at all.

On initial stage Pneumonia symptoms in children can manifest themselves in different ways.

Signs of pneumonia in a child under one year old:

• Cyanosis of the skin, especially in the area of ​​the nasolabial triangle.
• A sharp increase in temperature.
• Difficulty breathing due to accumulation of mucus in the lungs.
• Cough.
• Lethargy.

How pneumonia manifests itself in infants helps determine the number of respiratory movements in 1 minute. For a 2 month old child it is equal to 50 breaths. As you grow, this figure decreases. So, for a child of 3 months it is already 40, and by the year it decreases to 30 breaths. If this indicator is exceeded, you should contact your pediatrician.

Cyanosis of the skin

For pneumonia in children, symptoms and treatment differ depending on at different ages. Children of the older age group are characterized by the appearance of sputum when the pathological process reaches the bronchi. Pneumonia is suspected when wheezing and bluish lips are observed. The main symptom – shortness of breath – helps to recognize inflammation. If it does not disappear after a course of treatment, then additional examination is required.

As Dr. Evgeniy Komarovsky assures, the first symptoms do not cause as much harm as subsequent ones. Therefore, it is important to be able to distinguish the signs of the disease at the initial stage.

Symptoms characteristic of pneumonia

Each type of disease manifests itself differently depending on the location of the inflammatory focus.

Left-sided pneumonia

With this form of the disease, the pathological process develops on the left side. Left-sided pneumonia is much more dangerous compared to other types due to the irreversibility of the consequences that may occur. The lung becomes inflamed due to previous respiratory diseases when weakened immunity cannot resist the effects of pathogens. Left-sided pneumonia has mild symptoms, which makes diagnosis difficult.

Among the most characteristic:

• Pain in the left chest.
• Nausea.
• Cough with sputum production, which may contain purulent patches.
• A sharp rise in temperature, accompanied by chills.
• Feeling severe pain during inhalation.

It happens that left-sided pneumonia occurs without fever or other obvious signs. Delayed treatment in this case can cause serious complications and increases the risk of death.

Right-sided pneumonia

A form of the disease, which is characterized by the presence of a lesion in one of the lobes of the lung - upper, middle or lower. It is much more common than left-sided pneumonia. Each of the five cases are children under 3 years of age. The disease is most severe in newborns and children under 2 years of age.

It is distinguished by:

• Cough, in which there is copious sputum production.
• Tachycardia.
• Cyanosis of the skin, especially in the area of ​​the nasolabial triangle.
• Leukocytosis.

Often the right-sided form occurs with mild symptoms.

Bilateral pneumonia

A disease where both lungs become inflamed. It is very difficult, especially in children under one year old. That's why bilateral pneumonia the child is treated only in inpatient conditions.

In newborns and children of the 1st year of life characteristic feature is pale skin, shortness of breath, cough, asthenic syndrome, bloating, hypotension. Wheezing can be heard in the lungs. The disease is progressing rapidly and the little man needs urgent hospitalization.

In children 2 years of age, symptoms of inflammation often appear as a result allergic reaction. In children 3–5 years old, the disease often develops after an acute respiratory infection. When treating, you need to pay attention to elevated temperature, which lasts longer than three days.

At the age of over 6 years, pneumonia occurs with alternating sluggish course and exacerbation.

Regardless of age, the following signs help to recognize bilateral pneumonia in a child: fever up to 40⁰C, rapid breathing, decreased appetite, shortness of breath, cyanosis, cough, drowsiness, weakness. Percussion sound when listening is shortened on the affected side, wheezing is heard in the lower parts of the lungs.

Bilateral pneumonia in a child threatens complications such as otitis media, sepsis, and meningitis.

For any viral pneumonia in children, the symptoms and treatment are not much different from the manifestations of the disease and treatment for adults.

Bronchopneumonia

The disease most often occurs in children under 3 years of age. It is an inflammatory process affecting the walls of the bronchioles. The disease has another name - sluggish pneumonia due to the vagueness of symptoms.

They look like slight shortness of breath, cough, arrhythmia, sometimes appearing without fever. Later they intensify, there is a rise in temperature to 39⁰C, and headaches.

Bacterial pneumonia

Pathogens that cause bacterial pneumonia– pneumococci, staphylococci, streptococci, gram-negative bacteria. The first signs of pneumonia in children are noticed earlier than in adults. They manifest themselves in the form of rapid breathing, vomiting, and pain in the abdominal area. Children with a temperature in the lower part of the lungs sometimes feel feverish.

Mycoplasma and chlamydial pneumonia

Mycoplasma infection, in addition to the main symptoms, causes a rash in the throat and pain. Chlamydia pneumonia in children infancy may provoke development dangerous shape conjunctivitis. With pneumonia caused by this intracellular bacterium, rhinitis and tracheobronchitis are often diagnosed. Chlamydia pneumonia in children also manifests itself as extrapulmonary symptoms - arthralgia, myalgia. It is believed that this disease accounts for up to 15% of all community-acquired diseases. During epidemic outbreaks, this figure increases to 25%.

The disease can develop either acutely or gradually, becoming protracted. The main symptoms are nasal congestion, breathing problems, hoarse voice, slight mucous discharge from the nose. After these signs appear, the inflammatory process lasts from 1 to 4 weeks. Cough and general malaise sometimes persist for several months. The disease can occur without fever.

Video

Video - pneumonia

Hidden pneumonia

The course of the disease without pronounced symptoms poses the greatest danger to children under 2 years of age. At this age, they cannot yet communicate what exactly is bothering them. Latent pneumonia in children can manifest itself as a barely noticeable malaise. Having noticed them, parents often attribute it to a cold or teething. Only when the child’s condition deteriorates sharply does treatment begin.

Therefore, it is important to know how to recognize pneumonia in a child, and not to lose sight of such symptoms of pneumonia in children as:

• Pallor of the skin.
• Blush on the cheeks in the form of spots.
• Shortness of breath that appears with little exertion.
• Increased sweating.
• Breathing with grunting.
• Temperature rises to 38⁰C.
• Refusal to eat.

With latent pneumonia in children, the symptoms listed above can appear either singly or in combination, sometimes without fever. Having discovered them, you should immediately show the baby to the doctor.

Diagnostics

The question of how to determine pneumonia in a child is easily solved today with the help of modern methods diagnostics When collecting anamnesis, the time of detection of the first signs of illness is determined, what diseases preceded the onset of inflammation, and whether there is an allergy. Visual inspection allows you to identify existing symptoms, wheezing, and other symptoms characteristic of pneumonia.

Laboratory methods help diagnose the disease.

A blood test for pneumonia in a child is carried out to determine the causative agent of the disease:

• Biochemical analysis determines indicators such as the number of leukocytes, ESR, and hemoglobin level.
• Thanks to two blood cultures, it is possible to exclude bacteremia and sepsis.
• Serological analysis reveals the presence of immunoglobulins.

Sputum culture and scraping are also performed back wall throats.

Establish a more accurate diagnosis by determining the degree lung lesions(as well as how to recognize bronchitis in a child and any other bronchopulmonary disease) can be done using radiography.

General principles of treatment

Treatment is usually carried out in a hospital setting. How long you stay in the hospital with pneumonia depends on the severity of the disease and the state of your immune system. The main component treatment course at inflammatory process are antibiotics.

You can cope with the disease only by strictly following all the doctor’s prescriptions. Self-medication for such a serious illness is unacceptable. The medicine is taken according to the schedule determined by the doctor. Penicillins, cephalosporins, and macrolides are usually used in treatment. The effectiveness of the use of a particular drug is assessed only after 72 hours. To avoid suffering from the effects of antibiotics intestinal microflora, probiotics are additionally prescribed. In order to cleanse the body of toxins remaining after antibacterial therapy, sorbents are used.

Proper nutrition plays an important role in the treatment process. The patient's diet should contain easily digestible food. It can be vegetable soups, liquid porridge, boiled potatoes, fresh vegetables and fruits. As a drink, it is best to give children rosehip infusion, juices, and raspberry tea.

Prevention

• Do not allow the child to become hypothermic.
• Provide quality nutrition that includes all the necessary vitamins.
• Perform hardening procedures.
• Walk more with your children in the fresh air.
• Avoid contact with a sick person who can transmit the infection.
• Do not visit during epidemic periods kindergarten and crowded places.
• Teach your child to wash their hands thoroughly, lathering them for at least 20 seconds.
• Treat infectious diseases in a timely manner.

Caring for the baby's health, starting from the first days of his life - best protection from illness.

Vaccination helps reduce the risk of infection. Vaccination forms immunity to the causative agent of pneumonia. However, the duration of such protection is no more than 5 years.

If you find an error, please highlight a piece of text and click Ctrl+Enter. We will correct the mistake, and you will receive + to karma :)

In our climate, children often get colds and cough, and this condition can last quite a long time. Sometimes there may be no temperature, or it does not rise high. If the only obvious manifestation of the disease is a cough, and the child has already reached school age, adults can try to treat him folk remedies at home.

Dr. Komarovsky, a famous pediatrician, says that the symptoms of pneumonia are often mistaken for ARVI. Parents may not realize that behind a cough and runny nose lies such a serious illness as pneumonia.

Even today, when, thanks to the invention of antibiotics, medicine has moved far ahead compared to past centuries, deaths sometimes occur due to late diagnosis or improper treatment of this disease. Therefore, it is important for adults to know the signs of pneumonia in children, its symptoms, and treatment of pneumonia.

In this material we will try to figure out how to identify pneumonia, what types of it there are and how to cure it.

Most of us are accustomed to thinking that pneumonia occurs as a result of severe hypothermia in a child. But today this happens quite rarely, since parents protect their children and do not allow such extreme circumstances. Meanwhile, pneumonia has not become a rare disease at all. It affects not only school-age children, whom adults cannot always keep track of, but also small children, even infants this disease is not at all uncommon.

This is explained by the fact that the lungs not only supply the body with oxygen, but also serve as a kind of filter that helps cleanse and remove toxins and decay products. Therefore, with a general decrease in immunity, the reasons for which may be different, it becomes difficult for the lungs to cope with this and foci of inflammation arise in them. Dr. Komarovsky says that “Almost any microorganism can cause pneumonia.”

Mostly their causative agents are well-known pathogenic bacteria - staphylococci, pneumococci or streptococci. Today, when children are increasingly living in rooms with an artificial environment, cases are not uncommon when the cause of cough and inflammation is pathogenic fungi, legionella, mycoplasma, chlamydia, etc.

Today, pneumonia most often develops in children as a complication after influenza or ARVI. Many infections have become more resistant to antiviral drugs and antibiotics, which provokes their severe course and serious complications such as pneumonia.

In newborns and children up to one year old, one of the provoking factors is weakening of the body caused by congenital pathologies, developmental defects, etc. Cases of congenital pneumonia resulting from intrauterine infection with pathogens such as herpes, cytomegalovirus, mycoplasma, or infection at the time of birth with chlamydia are becoming more frequent. coli and so on. In this case, pneumonia manifests itself on the sixth day or fourteen days after birth. It is especially difficult in premature babies.

It is quite understandable that most often pneumonia occurs in the cold season, when temperature changes, lack of sun and vitamins lead to weakened immunity, exacerbation of chronic diseases such as tonsillitis, adenoids, sinusitis, etc. But if a child has suffered poisoning, an infectious or other disease in the warm season, as a result of which his immunity has suffered, then pneumonia can manifest itself in the warm season.

How to diagnose pneumonia? – Doctor Komarovsky

Types of pneumonia

For most non-medics, a cough and high temperature are mandatory signs of pneumonia. Many parents do not know that there are different types of pneumonia; accordingly, they differ in symptoms, course and methods of treatment.

Types of pneumonia differ in two parameters - depending on the pathogen and the area affected. For example, depending on the area of ​​the lesion, it may be bilateral inflammation lungs or one-sided, it is obvious that the severity of the disease in these cases will be different.

Bacterial

Most often, preschool children become ill with it as a result of complications after ARVI. Inflammation appears in the lungs, fluid and pus accumulate.

As the name suggests, this type of pneumonia is caused by bacteria, and the course depends on what exactly caused the disease.

• Pneumococcal. It develops quickly, is characterized by a sharp deterioration in health, and the temperature persists. The child breathes frequently, his face is red, he is lethargic, and may complain of pain in the abdomen and when breathing. Cough with sputum. The fingertips and nasolabial triangle may turn blue.
• Haemophilus influenzae. This bacterium lives in all people in the epithelium of the upper respiratory tract, and if the immune system weakens as a result of a viral infection, it can cause inflammation. A preschooler does not develop immunity to the bacillus, so he can become infected with this type of pneumonia from someone who is already sick by airborne droplets or upon contact. True, thanks to maternal antibodies, newborns are rarely at risk of inflammation from Haemophilus influenzae. The disease develops slowly. The high temperature lasts a long time, the child coughs with purulent sputum, and wheezing is heard. Respiratory failure may develop
• Staphylococcus aureus. Although the temperature associated with this pathogen is usually low, the disease is severe and acute form. On Staphylococcus aureus indicates rapid breathing, gray or even bluish skin color, swollen tummy and disappearing pulse.
• Pseudomonas aeruginosa. The course of the disease is similar to the previous one, but differs in that the child has rapid heartbeat, shortness of breath, especially acute febrile attacks in the morning. Due to severe intoxication, it may be accompanied by vomiting, sweating, and confusion.

Bacterial pneumonia is treated with antibiotics.

Viral

It is caused by various viruses. It can occur in both young and school-age children. Usually it is purely viral only for the first 2-3 days, then on the fifth day a bacterial infection appears against the background of weakening of the body.

It can be difficult to recognize such pneumonia, since it disguises itself as a common cold. A high temperature that persists despite medications, shortness of breath, chills, whistling during rapid breathing, and complaints of chest pain during coughing should be of concern. The cough itself starts out as dry, but the “barking” one becomes wet over time.

Atypical

The cause of inflammation in this case is chlamydia, mycoplasma, and legionella. In addition to symptoms common to other types of pneumonia, this one is characterized by symptoms associated with the gastrointestinal tract - diarrhea, vomiting, and liver damage. Like the flu, muscles and joints ache, and you may feel dizzy.

Krupoznaya

This type of pneumonia often affects children of preschool and school age. The cause of the disease is pneumococcus, and the source of inflammation is localized within one lobe. Very rarely it can involve the second lobe or cause bilateral pneumonia. This is a very severe form, which is accompanied by severe intoxication, respiratory failure and, if treatment is delayed, can lead to death.

Aspiration

The cause of this pneumonia is the ingress of foreign substances or liquids into the bronchial tree. This provokes development pathogenic bacteria, viruses, etc. Its course depends on the cause of its occurrence and looks different. Treatment must be started immediately, as this is a fairly threatening condition.

Focal

This is one of the most common forms of pneumonia. Most often it occurs as a complication after ARVI in the form of a single small focus of inflammation in the lung. Initially it looks like a common cold with a cough and runny nose. A week after infection, the condition worsens, the symptoms of inflammation are much more noticeable. This is a high temperature for more than three days, tachycardia, weakness, shortness of breath, as a result of intoxication, vomiting, and there may be confusion.

Segmental

Second after focal in terms of frequency of diseases. It affects several segments of the lung or even all of them. The first signs appear two days after the disease. They largely coincide with the previous form.

Basal

According to Dr. Komarovsky, this is one of the forms that is quite difficult for doctors to identify due to the location of the source of inflammation at the root of the lung. Diagnosis is also complicated by the fact that the symptoms of pneumonia may or may not be pronounced. The disease is protracted.

Interstitial

The interstitium is the connective tissue of the lung, and accordingly it is the name for a form of pneumonia in which this tissue becomes inflamed. Most often it affects infants in the first year of life.

How to suspect pneumonia? – Doctor Komarovsky

How does pneumonia occur in infants?

Signs of inflammation in babies under one year old may be the same as at an older age, but the course and consequences are different.

Infants do not always show a symptom of pneumonia such as a high fever. The fact that it does not exceed 37.5 does not mean that there is nothing to worry about. The first symptoms that should alert the mother are lethargy, the child’s whims, breast refusal, restless sleep, runny nose and cough. Especially if his attacks intensify when the baby is feeding or crying. Another sign of pneumonia is a blue discoloration of the nasolabial triangle. You also need to listen to the baby's breathing. With inflammation, it becomes more frequent, and there may be shortness of breath.

At the first suspicion, you should immediately consult a doctor, since in such babies the disease can develop quite quickly. It is better to make a mistake than to miss the onset of the disease.

Symptoms in children 2 years old

In children of this age, pneumonia often results from complications after other illnesses and may not appear immediately, usually three to five days after an apparent recovery. Parents cannot always assess the danger also because two-year-old children, even when already ill, continue to be active for some time, without showing lethargy and weakness; the temperature increases gradually. This continues until the body’s defenses run out and the disease manifests itself in full force.

1. High temperature for three days, which almost does not fall even when taking antipyretic medications. At high temperatures, convulsions are possible.
2. Weakness, shortness of breath, as intoxication increases, vomiting, stool disturbances, and possible skin rashes.
3. The skin is pale, moist, hot.
4. Severe cough, sometimes even to the point of nosebleeds.

Symptoms of pneumonia in a 3 year old child

Starting at this age, the child already has sufficient speech and self-awareness to voice complaints about his well-being. Parents should listen to complaints of pain “in the sides and tummy” when coughing, dizziness, and headache. Otherwise, the symptoms are the same as in children aged two years.

Diagnosis of pneumonia

The task of parents is to immediately contact a doctor if they notice alarming signs. Only a doctor can diagnose pneumonia. And then, according to Dr. Komarovsky, in some cases it is quite difficult. If this is not bilateral pneumonia, but, for example, hilar inflammation, then even an x-ray cannot always accurately show it. Therefore, Dr. Komarovsky urges parents, if the alarm is raised at a fairly early stage of the disease, not to panic, but to insist on the most complete diagnosis possible, which should include:

1. Tapping the chest, listening to the doctor;
2. Blood analysis;
3. X-ray;
4. Biochemical indicators;
5. A complete understanding of the course of the disease, a detailed interview with parents and the patient.

However, we are still not talking about babies. In children under one year of age, the disease can develop very quickly, so in their case you cannot wait if:

• When your baby breathes, you feel that the nostrils have an increased temperature;
• Frequent breathing. The abdominal muscles work hard to provide breathing.

How to treat pneumonia

Treatment is determined primarily by the causative agent of the disease and depends on the severity. One can be cured under the supervision of doctors at home, the other only in a hospital or even surgically.

Most often, antibiotic treatment is prescribed, but if the child has viral pneumonia, then antiviral drugs may also be prescribed. Dr. Komarovsky reassures parents that today many of these medicines are available for children in the form of syrups, suppositories or tablets, so that you can do without injections.

After the peak of the disease has been overcome, physiotherapy, massage, compresses and inhalations can be added.

After recovery, parents should take care of the child’s rehabilitation and take care of strengthening the immune system:

• A course of vitamins;
• Walks in the open air;
• Good nutrition, etc.

How to treat pneumonia in a child