Causes and symptoms of pneumonia in children, methods of treatment
Pneumonia, or inflammation of the lungs (the old name) is an infectious disease that affects the lung tissue and is accompanied by the mandatory release of fluid into the lung alveoli. Inflammation can be acute or chronic. The latter is the result of an acute form that was missed, or the treatment was inadequate.
Causes of pneumonia in children
Bacteria are considered the main factor in the development of the disease. Depending on the age, the lung tissue of children is affected by both pathogenic and opportunistic microorganisms:
- pneumococci;
- streptococci;
- staphylococci;
- Escherichia coli;
- Klebsiella;
- chlamydia;
- mycoplasma;
- pathogens of the TORCH group – toxoplasma, cytomegalovirus, herpes virus (causes congenital pneumonia in newborns), etc.
Pneumonia is most often a disease in childhood, caused primarily by the peculiarities of the respiratory system of children:
- wider bronchi;
- a less pronounced mucus evacuation system (mucociliary clearance);
- insufficient ability to resist adhesion of inflamed alveoli or their acute expansion.
In addition, pneumonia is common in premature children, HIV-infected children, and those who inhaled vomitus during vomiting (it happens relatively often in babies).
Symptoms of pneumonia in children
Of the clinical signs of pneumonia in a child, two are considered the most important:
- frequent breathing in the absence of signs of obstructive bronchitis;
- an increase in temperature up to 38.5, especially if it does not decrease for more than three days and is accompanied by intoxication phenomena.
Cough (usually wet, less often dry) is a frequent but not mandatory sign of pneumonia. However, if it is not there, the diagnosis becomes quite doubtful.
When examining the patient, changes in the percussion sound over the lesions, wheezing in the lungs and weakening of breathing in the areas corresponding to inflammation, bronchial breathing, bronchophonia are noted.
The general blood test shows a sharp shift of the leukocyte formula to the left, a significant increase in ESR, although these signs may not be present in a child with pneumonia.
If the viral nature of the disease is suspected, antibodies to viruses known as the causative agent of pneumonia are sought to be detected in the blood. For this, immunoenzymatic analysis, polymerase chain reaction, reaction with monoclonal antibodies are used. However, these tests do not help in establishing a diagnosis, since the time of their conduct is quite long, but they help to determine whether the sick child's contacts with the surrounding people are dangerous, and to plan the necessary sanitary and epidemiological measures.
Treatment of pneumonia in children
Not every child with pneumonia is hospitalized. Approximately 80% of children can be treated on an outpatient basis at least in the first two days after the onset of the disease. Nevertheless, in situations:
- pronounced respiratory insufficiency;
- weak response to antibiotic therapy in the first two days;
- complicated course of the disease (pleurisy, pleural empyema, pneumothorax, abscess, sepsis, infectious-toxic shock);
- impression of more than one lobe of the lungs;
- severe accompanying pathology;
- immunodeficiency states, etc.
the patient should be hospitalized immediately, and in cases of a severe course of the disease and the presence of complications immediately in the intensive care and intensive care unit.
Criteria for the effectiveness of pneumonia treatment in outpatient settings (assessed after 48 hours):
- full effect — improvement of the general condition, disappearance of shortness of breath, steady decrease in temperature to subfebrile or normal numbers;
- partial effect - lowering the temperature to 38, reducing the manifestations of intoxication and shortness of breath, improving the general condition;
- lack of effect - deterioration of the condition, increase in symptoms, refusal to eat, loss of consciousness, appearance of complications; in this case, hospitalization is mandatory for vital indications.
The main drug in the treatment of pneumonia is an antibiotic. Due to the difficulty of accurately identifying the causative agent during outpatient treatment and the too long time required to isolate the microbe, doctors are forced to use drugs of a wide spectrum of action, also not forgetting about their safety.
First-line drugs are penicillins. Medicines that are resistant to microbial enzymes are mainly used, for example, amoxicillin with clavulanic acid. It is possible to take oxacillin and piperacillin. In mild and moderate forms of pneumonia, drugs are prescribed orally. Severe and complicated forms of the disease require the appointment of injections.
Cephalosporins of the first and second generations are second-line drugs. There are some limitations in their use (toxicity to the liver, kidneys, blood, pain upon administration), which is why they are used more in hospital settings.
Macrolide drugs are used somewhat less often (except for azithromycin), since the appearance of microbes resistant to drugs of this group (erythromycin, clarithromycin, etc.) has been noted.
Aminoglycoside antibiotics and carbapenems are reserved and are used quite rarely. The drugs differ in a fairly wide range of adverse reactions. However, with complicated nosocomial pneumonias, they are often indispensable. These include gentamicin, lincomycin, carbapenem, meropenem, etc.
Antipyretic drugs are used according to strict indications: for "white" fever, malignant hyperthermia, in the first months of a child's life and in children with severe concomitant pathology.
A mandatory element of pneumonia treatment is the use of expectorants. Ambroxol, bromhexine, acetylcysteine thin sputum, improve its evacuation and reduce the phenomena of respiratory failure. With mild forms, it is possible to use herbal expectorants. Salbutamol and clenbuterol can be used to relieve bronchial blockage (obstructive syndrome), which expand the bronchi and reduce the viscosity of sputum.
Pneumonia is a serious disease that can lead to a tragic end. The site Dobrobut.com recommends to consult a doctor immediately in all cases of fever in children, symptoms of difficulty breathing and to strictly follow all the pediatrician's instructions.
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