Overview
Inflammatory changes that occur in some lung segments or lobes as a result of exudation from the alveolar cavities. Usually acute, characterized by high fever, chills, cough, bloody sputum and chest pain. Usually caused by Streptococcus pneumoniae, but Staphylococcus aureus, Klebsiella pneumoniae, etc. can also cause the disease. The main measures taken are to reduce fever, stop coughing, and antibiotic treatment.
Definition
Lobar pneumonia, also known as alveolar pneumonia, is a type of pneumonia classified anatomically and characterized by exudation from the alveolar spaces.
The pathogen first causes inflammation in the alveoli and spreads to other alveoli, resulting in inflammatory changes in some lung segments or lobes, usually without spreading to the bronchi. It often occurs unilaterally in the lung, mostly in the left lung or the lower lobe of the right lung, and can also occur simultaneously or sequentially in two or more lobes.
The alveoli are the site of gas exchange, there is a rich capillary network around the alveoli, each alveolus has 1 to 2 alveolar pores, and the gas and liquid between neighboring alveoli can be communicated through the alveolar pores.
Lobar pneumonia is an important type of community-acquired pneumonia. Severe patients have a high case fatality rate of 4% to 40%.
Classification
Classification according to disease
Mild pneumonia
In addition to respiratory symptoms, other systems are only slightly damaged and there are no symptoms of systemic toxicity.
Severe pneumonia
In addition to serious damage to the respiratory system, other systems are also seriously damaged, and systemic toxicity symptoms are obvious and even life-threatening.
Classification according to the place of infection
Community-acquired pneumonia (CAP)
Pneumonia that occurs outside the hospital or within 48 hours of hospitalization in a patient without significant immunosuppression.
Hospital-acquired pneumonia (HAP)
Refers to pneumonia that is not present at the time of admission and is not in the incubation period of infection, but occurs after 48 hours of hospitalization.
Morbidity
The disease is common in young adults and occurs most often in winter and spring.
It is more common in males.
Etiology
Causes
More than 90% of lobar pneumonia is caused by Streptococcus pneumoniae. Streptococcus pneumoniae can be categorized into 86 serotypes, of which types 1, 2, 3 and 7 are common, but type 3 is the most virulent.
Staphylococcus aureus and Klebsiella pneumoniae can also cause lobar pneumonia.
High risk factors
The risk of the disease generally increases after exposure to cold, exertion, smoking, alcoholism, and upper respiratory tract infections.
People with impaired immune function, such as diabetes, tumors, long-term use of immunosuppressive drugs, or diseases such as acquired immunodeficiency syndrome (AIDS).
Patients with structural lesions in the lungs, such as chronic obstructive pulmonary disease (COPD), bronchiectasis, and chronic left heart failure.
Pathogenesis
When the body’s immunity is lowered, pathogens can enter the alveoli through air inhalation, bloodstream dissemination, etc., grow and multiply rapidly and trigger the reaction of lung tissues, resulting in dilatation of alveolar septal capillaries, elevation of permeability, and massive exudation of plasma and fibrinogen and spreading of some or the whole lung lobes through the interalveolar foramina or respiratory bronchioles together with the bacteria.
Symptoms
Main Symptoms
Acute onset of lobar pneumonia.
High fever
Body temperature can reach 39℃～40℃, mostly in the afternoon and evening, often accompanied by chills.
Cough and sputum
Early cough is not heavy, no sputum, later there may be sputum in rust color.
Chest pain
Chest pain on the affected side, radiating to the shoulder or abdomen, chest pain aggravated by deep breathing and coughing.
Shortness of breath
Mostly appear after fever, cough, manifested as shortness of breath, effort, and in severe cases, flaring of the nose.
Other symptoms
Cyanosis
Related to hypoxia, the skin of lips and fingers is cyanotic.
Gastrointestinal symptoms
Occasionally nausea, vomiting, abdominal pain or diarrhea.
Acute febrile appearance
Flushing of the face, flaring of the nose, often with herpes on the lips and around the mouth.
Other
Fatigue, muscle aches, and in severe cases, irritability or confusion.
Complications
Infectious shock
The patient is irritable or unconscious, has shallow respiration, a rapid pulse, cold, clammy skin, cyanosis, and even less urine or even no urine.
Organic pneumonia
If the course of the disease is more than 4 weeks without complete absorption, it may be manifested as coughing, coughing up sputum, coughing up blood, blood in sputum, low-grade fever and chest pain.
Pleurisy
Often presents with chest pain on top of pre-existing fever and cough.
Lung abscess
A lung abscess occurs when a purulent infection destroys lung tissue, creating a cavity that contains bacteria, pus, and lung tissue fluid.
The onset of the disease is insidious, with symptoms such as fever, general malaise, loss of appetite, and weight loss.
Patients may have a cough with hemoptysis, dyspnea, high fever, and chest pain during the most pronounced period of symptoms.
Meningitis
Manifestations include fever, nausea, vomiting, severe headache, fear of light, and stiff neck.
Arthritis
It is characterized by pain and swelling of joints.
Consultation
Recommendations
Lobar pneumonia is mainly diagnosed and treated in respiratory medicine.
Prompt medical consultation is recommended in case of symptoms such as high fever, chills, cough, bloody sputum and chest pain.
In case of emergency such as high fever, confusion, agitation, cold and clammy extremities, it is recommended to go to the Emergency Department immediately.
Follow medical advice for repeat patients.
Preparation
Registration
Before visiting the outpatient clinic, you need to register at the hospital or through official channels (such as the hospital’s official website, official app, 114 platform, etc.).
Emergency admissions can be made directly by registering. Pre-hospital emergency admissions generally do not need to register in advance, and can be made up in the course of treatment.
Preparation of documents
Prepare your medical card, social security card (medical insurance card) and other documents.
Bring previous medical records, such as medical records, laboratory reports, and imaging reports.
If you are taking medication, prepare a list of medications.
What questions the doctor may ask
How long has the cough been there? Is the cough violent? When does it get worse?
Is there any phlegm? What does the phlegm look like?
Is there a fever? What is the highest temperature?
Have you had a cold recently?
Are there any other illnesses, such as diabetes, COPD, etc.?
Have you been taking certain medications for a long time, such as glucocorticoids, immunosuppressants, etc.?
Have you had any tests? What are the results?
Have you had any treatment? What kind of treatment? What is the effect of the treatment?
Questions you can ask your doctor
What are the possible causes?
What kind of tests are needed?
What kind of treatment is needed? Do I need to be hospitalized?
How long will it take to heal?
What should I pay attention to in my life and diet?
Do I need to be isolated? Will it be contagious to others?
Diagnosis
Diagnosis
Medical history
History of colds, etc.
Recent exposure to exertion, rain, etc.
Prolonged use of immunosuppressants, or immunodeficiency diseases.
Clinical manifestations
Symptoms
Most acute onset, characterized by high fever, chills, cough, bloody sputum and chest pain.
Physical signs
Flushing of the face, flaring of the nose, often with herpes on the lips and around the mouth.
Physical examination shows percussion pain in the chest, wet rales on inspiration, and sometimes signs of solid lung changes (tubular breath sounds, turbid sounds on percussion, and increased auditory trembling, etc.).
Laboratory tests
Blood tests
The initial diagnosis of infection and severity of the disease can be made.
The white blood cell count and neutrophil ratio are elevated.
C-reactive protein (CRP)
It is a sensitive indicator of bacterial infection and can be used to determine the severity of the disease and the effect of treatment.
Serum CRP values tend to rise.
, Calcitoninogen (PCT)
Based on the test results, it can be used to initially determine the presence of infection.
It can be elevated in bacterial infection, and can be rapidly decreased when antimicrobial drug treatment is effective.
Pathogenetic examination
Commonly used sputum culture, blood culture, pleural fluid examination can assist in pathogenic diagnosis and help to select appropriate drugs for treatment.
Bacteriologic examination
Tracheal aspirates, alveolar lavage fluid, pleural fluid, pus and blood specimens are taken for bacterial culture and identification, and drug sensitivity test is also performed, which is important for clarifying the causative bacterial species and guiding treatment.
Sputum smear staining microscopic examination can also be done for bacterial primary screening test.
Other tests
For example, serology can be used to detect the antibody level of Streptococcus pneumoniae podoplanoside, and bacterial antigen tests such as Streptococcus pneumoniae podoplanoside antigen and hemolysin antigen can be performed.
Imaging examination
It can determine the site and area of inflammation, which can help to diagnose the disease and evaluate the condition, commonly used X-ray and CT examination. The disease is mainly characterized by signs of lung solidity with uniform density, and air bronchial sign can be seen. Metal objects should not be worn during the examination.
X-ray
In the early stage, localized increase in lung texture and decrease in lung field translucency can be seen.
In the stage of solid lesion, there is a large hyperdense shadow in the lung lobe or lung segment, with uniform density, and the air bronchial sign can be seen in the shadow.
Chest X-ray returns to normal in the dissipative stage.
CT
In the congestive phase, the lesion is characterized by diffusely distributed striated and patchy exudative changes with uneven density.
In the solid phase, there is a uniform solid lesion distributed by segments or lobes, and bronchial shadows are seen in the inflated bronchioles.
In the dissipative phase, the density of the original homogeneous solid lesion becomes uneven, and the shadow shrinks, becomes pale, and is patchy.
Differential diagnosis
Tuberculosis
Similarities: Both may present with fever, fatigue, cough and other symptoms.
Differences: the condition of tuberculosis is more moderate, the fever is mostly low in the afternoon, and there may be night sweats, weight loss, insomnia, palpitation and other symptoms; Mycobacterium tuberculosis can be differentiated by the discovery of Mycobacterium antacidum smear, mycobacterium culture, and nucleic acid test.
Upper respiratory tract infection
Similarity: cough, sputum, fever and other symptoms.
Differences: The symptoms of upper respiratory tract infections are often more limited, such as acute rhinitis, which may present with symptoms such as runny nose. The absence of lung parenchymal infiltration on chest X-ray or CT examination can be used as a basis for differentiation.
Pulmonary thromboembolism
Similarity: both may present with symptoms such as dyspnea and hemoptysis.
Differences: People with pulmonary thromboembolism often have a history of braking, trauma, surgery, tumor, lower extremity venous thrombosis, etc. D-dimer examination can reveal a tendency to thrombosis, X-ray can reveal regional reduction of pulmonary vascular texture, etc. CT pulmonary arteriography, radionuclide lung ventilation/perfusion scanning, and MRI can help to differentiate.
Lung cancer
Similarity: Both can present with a prolonged cough, fever and coughing up sputum.
Differences: Lung cancer often occurs in people who have been smoking for a long time and are older; it may also present with chest pain and hemoptysis. Imaging examination can find nodules, enlarged hilar lymph nodes and other changes; sputum exfoliative cells and histopathological examination can find malignant tumor cells, which can make a clear diagnosis.
Treatment
General treatment
Rest
Pay attention to rest, avoid strenuous activities and reduce physical exertion.
Create a good rest environment, maintain air circulation, and frequently open windows for ventilation.
For those who are on bed rest, attention should be paid to changing the position of the body frequently.
Oxygen intake
Oxygen inhalation is needed when there are symptoms of hypoxia such as irritability and bruising of the lips and mouth.
Oxygen can be given by nasal plug, face mask or head mask.
Pay attention to respiratory hygiene when inhaling oxygen, and remove nasal crusts and nasal secretions in time.
Nutritional supplementation
Diet should be balanced and rich in nutrients.
When severe patients have difficulty in eating, parenteral nutrition (i.e. nutrient solution is directly fed into the body through the vein) can be given.
Drug treatment
During the drug treatment, the treatment should be insisted on in strict accordance with the doctor’s instruction, and the drug dosage should not be changed without authorization or suddenly stopped.
Drug therapy against pathogens
Antibiotics
Different antibiotics should be used for different pathogens. Before the pathogen is clearly identified, drugs can be used according to clinical experience, and after it is clearly identified, drugs should be used according to the drug sensitivity test.
Penicillin and amoxicillin are preferred for Streptococcus pneumoniae infections, and ceftriaxone, cefotaxime, vancomycin and erythromycin can be used for penicillin-resistant or allergic patients.
Commonly used drugs for Staphylococcus aureus infection are benzoxacillin sodium, cloxacillin, vancomycin, rifampicin and so on.
Commonly used drugs for Haemophilus influenzae infection are amoxicillin/clavulanic acid, ampicillin/sulbactam.
Commonly used drugs for Escherichia coli and Klebsiella pneumoniae infections are ceftazidime, cefoperazone, imipenem, meropenem.
Commonly used drugs for Pseudomonas aeruginosa (Pseudomonas aeruginosa) infections are ticarcillin/clavulanate potassium.
Commonly used drugs for Catamonas infections are amoxicillin/clavulanate potassium.
Symptomatic treatment
Antipyretics such as ibuprofen, acetaminophen, and loxoprofen may be used for fever.
For cough and phlegm, cough suppressants and expectorants such as Glycyrrhiza glabra and Ambroxol may be used.
Prognosis
Cure
The prognosis for this disease is generally good, with a natural course of roughly 1 to 2 weeks. The use of effective antimicrobial drugs can return the body temperature to normal in 1 to 3 days.
The prognosis is relatively poor in the elderly, with extensive lesions, multilobar involvement, complications or pre-existing cardiac, pulmonary, renal and other underlying diseases, and in those with immunodeficiency.
Hazards
Lobar pneumonia may cause high fever, chills, cough, bloody sputum and chest pain, which may affect normal life.
Infectious shock can occur when the infection is severe, mostly in the elderly. In addition, it can be complicated by organic pneumonia, pleurisy, lung abscess, meningitis and arthritis. However, complications of lobar pneumonia have become rare in recent years.
Daily
Daily Management
Daily management
Rest in bed during the fever period and reduce physical exertion. After the fever subsides, activities can be resumed gradually.
Quit smoking and avoid passive smoking to prevent aggravating lung damage.
Maintain a good work routine, ensure sufficient sleep time, and avoid exertion and staying up late.
Ventilate the room, as well as pay attention to maintaining the appropriate temperature and humidity, reduce the cold air and other stimuli, and prevent cold.
People with fever treated on an outpatient basis can use warm water baths and cold compresses on towels to help lower their body temperature, and measure their body temperature regularly.
If there is coughing up sputum, pay attention to the character of the sputum, especially whether there is any blood, etc.
If you already have high blood pressure, diabetes and other diseases, you need to increase the frequency of measuring blood pressure and blood sugar on top of the existing ones.
Follow the doctor’s requirement to take medication in full dosage and on a regular basis, and follow up on time, do not stop taking medication on your own due to reduction of symptoms to avoid relapse.
Dietary management
Pay attention to balanced nutrition and eat a light diet with more protein, vegetables and fruits.
Eat less high salt and fried food.
Drink an adequate amount of water, 7 to 8 glasses (1,500 to 1,700 milliliters) per day for adults, advocate drinking plain water and tea, do not drink or drink less sugary drinks.
Prevention
Vaccination
Streptococcus pneumoniae polysaccharide vaccine can reduce the incidence of community-acquired pneumonia and the overall mortality rate, and elderly people over 60 years old can be vaccinated if there is no contraindication.
Adjustment of living habits
Do not come into close contact with people who have pneumonia and wear a mask when possible.
Keep indoor air circulating and maintain indoor relative humidity at 30% to 80%.
Avoid staying in crowded places, such as shopping malls and hospitals, for a long time during the peak of the epidemic.
Strengthen outdoor physical exercise to improve the body’s ability to resist diseases.
Pay attention to adding or subtracting clothes according to the temperature at the change of seasons, and pay attention to preventing cold and keeping warm in the fall and winter for the elderly and children.
Quit smoking and drinking to reduce the harm of tobacco and alcohol to the body, especially quit smoking, can improve lung function.