Destructive pneumonia is an inflammation that affects the lungs and pleura and is of bacterial origin. This disease is a complication of pneumonia and is characterized by the development of purulent processes and necrosis of lung tissue, leading to significant morphological transformations of the lung parenchyma.
Destructive pneumonia is often seen in male patients between the ages of 25 and 45. In children, the inflammatory process in the lungs is complicated by bacterial destruction in every tenth case. In 65% of cases, destructive pneumonia affects the right lung, in the rest – the left. The bilateral course of this severe pathology is extremely rare (1-4% of cases).
Features of symptoms
In the pathogenesis of the disease, three stages of development are distinguished:
- pre-destruction (proceeds with damage to several segments or a whole lobe of the lung);
- destruction (a necrotic process proceeds, lung tissues disintegrate, a purulent cavity is formed);
- the final stage, the outcome (this can be recovery, the development of complications or the death of the patient).
As a rule, the destruction of the lungs begins to manifest itself during the period when the symptoms of the acute phase of pneumonia subside. The patient shows signs of improvement in well-being when the clinical picture of destructive pneumonia suddenly begins to unfold. It is characterized by the following manifestations:
- a significant increase in temperature (up to 39-39.5 degrees);
- general malaise, severe weakness;
- febrile symptoms, chills;
- heavy sweating;
- chest pain;
- unproductive cough;
- shortness of breath, shortness of breath;
- severe pallor of the skin up to cyanosis.
Even before the manifestation of the main symptoms, a destructive process in the lungs can be suspected by the characteristic putrid odor from the mouth, signs of severe intoxication of the body. When the abscess breaks out, the patient’s condition improves significantly, the temperature drops, the soreness in the chest subsides, and purulent sputum with an unpleasant odor begins to discharge.
Most often, destructive pneumonia is provoked by staphylococcus, Proteus, Escherichia coli, green streptococcus. Staphylococcus predominates among the causative agents of this disease, therefore pulmonologists distinguish staphylococcal destruction into a separate group. Slightly less common is destruction provoked by Klebsiella and Haemophilus influenzae. As a rule, the start of a purulent-necrotic process occurs with the simultaneous effect of several types of bacteria.
The provoking factors of destructive pneumonia can be:
- postponed respiratory infections;
- aspiration of the contents of the stomach, oropharynx, nose into the lungs;
- gastroesophageal reflux;
- the presence of purulent foci of any localization (for example, furunculosis);
- the presence of foreign bodies in the branches of the windpipe.
The risk group includes people who have the following problems:
- excessive passion for alcohol, smoking, drug use;
- suffered a stroke;
- traumatic brain injury;
- viral hepatitis;
Contribute to the development of the destructive-inflammatory process of hypothermia, injuries to the lungs, the influence of occupational hazards. In early childhood, lung destruction can develop due to improper treatment of pneumonia, prematurity, birth trauma, asphyxia during childbirth.
To make a diagnosis, a number of laboratory and instrumental studies are carried out. Blood and sputum tests are done. In a general blood test, an increased ESR is found, an increase in the number of immature neutrophils. Microscopy of sputum reveals its purulent nature, an increase in the number of leukocytes, elastic fibers. Also, a bacteriological inoculation of the biological material separated with a cough is done to determine the pathogen and prescribe the necessary antibiotic therapy. Sputum for examination is obtained in the usual way or with the help of bronchoscopy.
To determine the localization of the pathological process, an x-ray of the lungs is prescribed. In typical cases, the radiograph clearly shows cavities filled with fluid and surrounded by an inflammatory infiltrate. If the destructive process gives complications to the pleura, then in the images the shadow of the mediastinum is displaced to the side opposite to the lesion, you can see the collapse of the lung. In severe cases, the doctor may prescribe additional studies: pleural puncture, ultrasound examination of the pleural cavity, laboratory analysis of exudate.
Destructive pneumonia is differentiated from the cavernous form of tuberculosis, lung cancer.
How to treat a disease
Treatment of destructive pneumonia is carried out in a hospital (in the department of pulmonology or thoracic surgery). Depending on the form and nature of the course of the disease, conservative methods of treatment or surgery are used.
Drug therapy is effective for pyothorax (acute purulent pleurisy), abscesses of a mild uncomplicated course. Prescribed drugs, the action of which is aimed at detoxifying the body, antibiotics, immunostimulants. Antibacterial drugs are injected intravenously, directly into the bronchi (during bronchoscopy) or into the pleural cavity (when performing a medical puncture or drainage). Massive antibiotic therapy for both adults and children is prescribed for a period of at least 10 days (sometimes longer).
Infusion detoxification is prescribed (glucose solutions, Rheopolyglucin). Destructive pneumonia is well treated by methods such as intravenous laser cleansing and ultraviolet irradiation of blood, hemosorption, plasmapheresis.
In severe cases, the patient needs surgery to avoid the negative consequences of the purulent process. Such types of interventions can be applied as:
- pneumotomy (dissection of the lung to open an abscess);
- lobectomy or bilobectomy (removal of one or more lobes of the lung);
- pulmonectomy (pneumonectomy) – complete excision of the lung;
- thoracoplasty (an operation aimed at removing ribs in order to reduce the volume of the chest);
- pleurectomy (excision of the visceral or parietal pleura).
To prevent primary pneumonia, it is necessary to adhere to the norms of a healthy lifestyle, give up bad habits, and take measures against respiratory infections. In order to prevent necrotic and destructive processes in the lungs, the following recommendations must be followed:
- timely treat pneumonia of bacterial origin;
- timely and adequately carry out therapy of purulent processes of any localization;
- clinically monitor the process of curing pneumonia, regularly do X-ray examinations;
- vaccinate and take other measures to prevent destruction in patients at risk for the development of purulent-necrotic processes in the lungs.
After recovery, in order to prevent relapse, it is recommended to undergo regular dispensary examinations at a frequency of once a quarter. Also shown is spa treatment.
Predictions for the development of purulent and necrotic processes depend on the nature and severity of the course of the disease, the addition of complications, and the general state of health of the patient. Death occurs in about 5% of cases. In a fifth of patients, the destructive process takes on a chronic course. In 50% of cases, patients are cured, but they still have irreversible changes in the lungs.