Bronchopneumonia, also known as lobar pneumonia, is a major common disease in children, especially in infants, and is the leading cause of death in infancy. Pneumonia mostly occurs in the winter and spring during the cold season and sudden climate changes, but summer is not an exception. In some areas of southern China, the disease is more common in the summer, when immunity is not sustained and the disease is easily reinfected. Bronchopneumonia is caused by bacteria or viruses.
1. Etiology
Bronchopneumonia occurs in the winter and spring seasons and sudden changes in climate, and in some areas of southern China, it is more frequent in the summer. Indoor living crowded, poor ventilation, dirty air, more pathogenic microorganisms, prone to pneumonia. Bronchopneumonia can be caused by bacteria or viruses.
2. Clinical manifestations
The onset of the disease is rapid or delayed, with most cases preceded by a mild upper respiratory tract infection. In mild cases, there is a runny nose, mild cough, low fever, poor circulation, and then a sudden high fever with a temperature of 38-39°C, increased cough, shortness of breath, and onset of disease 1 to 3 days later; there are also cases of sudden fever, cough, shortness of breath, and irritability. Most of the weak infants have a delayed onset, fever is not high, cough and pulmonary signs are not obvious, and refusal to eat, choking, vomiting or difficulty in breathing are common. Respiratory signs and symptoms: Initially, the cough is irritating and dry, in the extreme stage the wheezing is heavy while the cough is slightly reduced, and in the recovery stage it becomes a wet cough with phlegm in the throat. Respiratory rate increases to more than 40 times per minute, accompanied by nasal agitation, and even the triple concave sign (suprasternal fossa, supraclavicular fossa, and intercostal space depression). Lung auscultation: early chest signs are often not obvious, or only the breath sounds become coarse or slightly reduced, and then the lesion expands can have percussive turbid sounds, and fine vesicular sounds can be heard in both lungs, especially at the bottom of both lungs during deep inspiration; coarse wet woven grass appears in the recovery period
3.Examination
1. Blood picture
The total leukocyte count in children with bacterial pneumonia is mostly elevated, generally up to (15-30) × 109 L, occasionally up to 50 × 109 L. Granulocytes reach 0.60-0.90. However, in severe Staphylococcus aureus or Gram-negative bacillus pneumonia, the leukocytes may not be higher or lower. In viral pneumonia, the white blood cell count is mostly low or normal.
2. Bacterial tests
Pulmonary puncture bacteriology is the most reliable and is considered the “gold standard”, but is difficult to accept by physicians and children. Sputum culture, especially from secretions taken by fiberoptic bronchoscopy, is more reliable but can be contaminated.
3. Other etiological tests
Virological examination is the most reliable, reproducible and specific for virus isolation, but it takes a long time, is cumbersome and requires certain technical and equipment conditions. Serological examination of specific antibodies has diagnostic significance.
Blood gas analysis, blood lactate and ion gap (AG) determination. In severe pneumonia with respiratory failure, this can be used to understand the presence or absence and severity of hypoxia, the type and degree of electrolyte and acid-base imbalance, and help diagnose treatment and determine prognosis.
4.Diagnosis
According to the acute onset, respiratory symptoms and signs, the clinical diagnosis is generally not difficult. If necessary, X-ray fluoroscopy, chest radiography, or bacterial culture of pharyngeal swabs and tracheal secretions or virus isolation can be done. Other etiologic tests include antigen and antibody testing. Significantly elevated white blood cells and granulocytosis and elevated serum C-reactive protein are helpful in the diagnosis of bacterial pneumonia. If the leukocytes are reduced or normal, then the pneumonia is mostly viral.
5.Treatment
1.General treatment
(1) The care environment should be quiet and neat. To ensure rest and avoid excessive therapeutic measures. The room should be frequently ventilated, so that the air is relatively fresh, and must maintain a certain temperature, humidity.
(2) Diet should be maintained in sufficient quantity, give liquid food such as human milk, cow’s milk, rice soup, vegetable water, juice, etc., and can be supplemented with vitamin C, A, D, vitamin B complex, etc. For those with long duration of illness, attention should be paid to strengthening nutrition to prevent malnutrition.
2.Antibiotic therapy
Bacterial pneumonia should try to identify the pathogenic bacteria, at least after taking a specimen of body fluid for the appropriate bacterial culture, and then start to select sensitive antibiotic therapy.
3.Antiviral therapy
Antibiotic therapy in a broad sense includes antiviral therapy. If viral pneumonia is clinically considered, nucleoside nebulizer inhalation with triazol can be tried.
4.Symptomatic treatment
(1) Antipyretic and sedation generally first use physical cooling, such as cold compresses on the head, ice pillows, or injections of analgin, anacin, etc. antipyretic, for severe cases of hyperthermia can be used chlorpromazine and promethazine combination of intramuscular injection.
(2) Treatment of cough and asthma should be removed from the nasal secretions, with expectorants (such as sputum syrup) when there is phlegm, sputum can be aspirated when there is a lot of phlegm. It is best to increase the relative humidity in the room about 65%, while drinking more water. In case of heavy coughing and wheezing, the combination of chlorpromazine and promethazine (Dormant II) can be injected intramuscularly.
(3) Oxygen infusion is required for severe cases.
(4) Patients with severe pneumonia and combined congenital heart disease often experience heart failure, with accelerated heart rate, irritability, enlarged liver in a short period of time, swelling, pale and gray face, and even enlarged heart and gallop rhythm. In addition to the general treatment of heart failure such as oxygen, expectoration, cough suppression and sedation, cardiac drugs should be used early.
5.Fluid therapy
For those who can’t eat, can carry out static infusion. For patients with high fever and heavy wheezing or microcirculatory dysfunction, the total fluid volume may be high due to excessive non-obvious water loss.
6.Hormone therapy
General pneumonia does not require adrenal corticosteroids. In severe bacterial pneumonia, while controlling the infection with effective antibiotics, hormones can be added in the following cases: severe toxic symptoms, such as the appearance of shock, toxic encephalopathy, ultra-high fever (body temperature above 40℃ persistently does not subside), etc. Significant bronchospasm, or high secretion. Early pleural effusion, in order to prevent pleural adhesions can also be applied locally. Short-term treatment of no more than 3 to 5 days is appropriate. Generally, intravenous hydrocortisone or oral prednisone is used. For those who use hormones for more than 5 to 7 days, it is appropriate to gradually reduce the dosage when stopping the drug.
Viral pneumonia generally does not use hormones, and when wheezing is severe in capillary bronchitis, short-term application can also be considered.