Caseous pneumonia: symptoms, treatment, medical history, clinical course, photo, differential diagnosis

At the moment, modern society is threatened with several epidemics, which threaten to move into a pandemic. These are diseases such as HIV, hepatitis B and C and, of course, tuberculosis. A high percentage of deaths and disabling consequences do not leave a person with chances to fight the disease, but given that the diagnosis depends on the patients themselves, their trust in the doctor and the desire to be treated, we have, to put it mildly, an unpleasant picture.

Definition

Caseous pneumonia is one of the forms of development of pulmonary tuberculosis. It proceeds more malignantly than the usual pneumonia caused by the coccal flora. And is characterized by the predominance of necrotic processes in the lungs with the formation of curdled masses instead of the normal pulmonary parenchyma. Over time, they are lysed, and large cavities remain in their place. Subsequently, they can both cicatrize, which reduces the airiness of the lungs and, accordingly, the amount of incoming oxygen, and expand, pushing the parenchyma of the organ to the periphery. This process also negatively affects gas exchange and leads to the progression of exogenous hypoxia.

Classification

Depending on the area of the damaged tissue, caseous pneumonia is divided into three subtypes:

1. Lobarnaya. An independent form that captures the whole of the whole. Since the volume of damaged and necrotic tissue is large, patients have a severe intoxication symptom. As a consequence, the light melts, and caverns form.
2. Lobular form, or lobulitis. This is a complication of already existing tuberculosis. Unlike the previous one, it affects several parts, causing severe poisoning by the products of tissue decay.
3. Acinous. It is considered as a complication of miliary (loose) tuberculosis. Despite the fact that the acinus is the smallest part of the lung, the disease is extremely difficult to tolerate, as it is usually not the individual parts that are affected, but the entire parenchyma of the organ.

Epidemiology

As already noted above, tuberculosis is complicated by a disease such as caseous pneumonia. The history of the disease is more than one hundred years old, and during this time people could not come up with the treatment. The antibiotics that patients take now will become irrelevant in ten to twenty years, because the pathogen will have time to develop resistance to this chemical effect.

The disease develops rapidly, the first symptoms appear fairly quickly after infection. Toxins, which produce bacteria, adversely affect the immune system, weakening it. The main contingent, subject to caseous pneumonia, are socially disadvantaged people. And not only because of the lack of basic hygiene, poor nutrition and living conditions, but also because of the refusal to treat the underlying pathology.

Development of the disease

Because of the rapid division and growth of Mycobacterium tuberculosis in the lungs, general and local immunity is suppressed. Microorganisms produce enzymes that act toxicly on cellular immunity, triggering the process of apoptosis (programmed cell death). Thus, after the accumulation of a certain critical mass of bacteria, the protective mechanisms of the human body begin to malfunction. A significant prevalence of the pathogen in internal organs and toxicity of drugs lead to a decrease in the function of the liver, adrenal glands, cardiac muscle dystrophy and damage to the nervous system.

Locally, against the background of a decrease in immunity, necrotic processes are observed in the pulmonary parenchyma, multiple foci of inflammation with curdled masses inside. Gradually, they are dissolved by their own enzymes of the organism, and cavities appear in their place.

Symptoms

The clinical course of caseous pneumonia may have several scenarios:

1. Pneumonic, ie, similar to classical pneumonia - high fever (up to forty degrees), chills, wet cough, pain in the chest, pronounced dyspnea.
2. Grippopodobnaya - catarrhal phenomena (runny nose, lachrymation, swelling of the larynx) prevail over intoxication. There is a slight fever, there may be a cough.
3. Sepsis - a very high temperature (up to forty-forty-one degrees), intoxication, migraine, cough absent.

In the beginning, there are no alarming symptoms. A slight dry cough, a rise in temperature at night, loss of appetite. They can last long enough until the cough from the dry goes into the wet one, and a viscous greenish sputum appears. At this point, the temperature is already falling, and respiratory failure, on the contrary, is increasing. The doctor may suspect that the patient has caseous pneumonia. Symptoms are nonspecific, but in conjunction with the analysis and anamnesis of life, the diagnosis becomes clear.

Diagnostics

In addition to collecting an anamnesis of the disease and an anamnesis of life, the doctor is obliged to carefully examine the person, possibly laponadal lymph nodes, to listen to breathing. But in order to make sure that his assumptions are correct, the doctor directs the patient to laboratory and instrumental research:

1. Chest X-ray. Phthisiatricians have discovered characteristic signs that are inherent in a disease such as caseous pneumonia. A photo of the lung picture, presented above, allows you to see multiple foci of melting organ tissue.
2. A Mantoux test, or a diaskintest. A simple and relatively fast way to detect the presence of antituberculous immunity. But he does not give a one-hundred percent guarantee for the development of the disease, and can be either false-positive or false-negative.
3. Sputum microscopy. The patient is asked to collect sputum for three days in a sterile jar. Then she is taken to a laboratory, where she is placed in a special medium of Levenshtein-Jensen, containing a lot of nutrients necessary for the growth of bacteria. And only after a week it will be known whether the person selects Koch's wand or not.
4. It is compulsory to conduct standard tests for clinical diagnosis: general analysis of blood, urine, blood biochemistry, blood sugar, feces for egg egg.

Differential diagnostics

First of all, the doctor needs to make sure that the patient is really caseous pneumonia. Differential diagnosis in this case helps to exclude diseases that are clinically very similar to the pathology we are considering. And in the first row is the usual croup, or pleuropneumonia. The only difference is in the nature of the necrotic masses and in the pathogen. The other parameters are the same.

The second hypothesis may be a lung infarction. But it is enough to make an angiogram to exclude such variant of development of events. In addition, the patient should have a history of either trauma, or atherosclerosis, or the introduction of air and / or oily solutions into the bloodstream.

The third disease with which it is worth comparing is gangrene of the lung. In the process of development of this pathology there is a fever, severe intoxication, but there will be no cough and sputum.

Treatment

After the diagnosis of "caseous pneumonia" is established, the treatment is started immediately. A person is transferred to a special phthisiatric hospital, where there is an opportunity to observe a suitable bed rest and diet.

First, the doctor is engaged in coping with an acute condition, whether it is a toxic shock or respiratory failure. To do this, the patient is given infusions of sorbents and diuretics, and plasmapheresis is performed. Then comes the turn of active therapy, when antibiotics, antihypoxants, anticoagulants, hormones, interferon enter the battle. Specific therapy is the use of antibiotic regimens designed specifically for mycobacterium tuberculosis.

Forecast

Caseous pneumonia is hard enough to treat, so for life and health the consequences will most likely be irreversible. Perhaps even complete destruction of the lung, which inevitably leads to respiratory failure.

The recommendations given by phthisiatricians to people with Koch's wand identified are that you should not start a disease. It is necessary to start treatment on time and go through it completely, but because of low socialization of patients, as well as their living conditions, caseous pneumonia remains a frequent complication of tuberculosis. This is an epidemic, with which doctors in our day practically can not cope.