Bronchopneumonia in children

Bacterial pneumonia is an acute bronchopneumonia with increased frequency in infants and young children.

Signs and symptoms:
Disease characteristic lesions of broncho-alveolitis are in outbreaks (Charcot node) or disseminate.clinical syndrome includes respiratory, cardiovascular and infectious poisoning.
Bacterial determinants are only one or more (follows a viral infection): pneumococcus, staphylococcus, streptococcus, Klebsiella, Hemophilus influenzae, piocianic, anaerobic, piocianic, Proteus, Salmonella.

Bacterial infection is a viral infection commonly preagita. Contributing factor of this pathology is lung II: small infants, very biological, low immunity, dystrophy, prematurity, chronic lung disease (bronchiectasis, malformations, foreign bodies), septicemia, medical maneuvers (endoscopy, bronchoscopy, tracheostomy, intubation), prolonged corticoterpia , unbalanced diet (in terms of quantity and quality, with a low in vitamins), allergy diseases (measles, influenza, whooping cough), aspiration of fluid in the airways.

Radiography of broncho-pulmonary lesions alveolitis highlights effusion - Charcot nodules in outbreaks of pulmonary congestion, Conflu, disseminated in the parenchyma. It can be seen serous or purulent fluid accumulation in inflammatory infiltrates, adenoparie hilarious and other injuries.
In terms of clinical pulmonary tract infection begins after aieriene higher dyspnea worsens and is mixed, fever (39-40 degrees Celsius) with or without convulsions, cyanosis, digestive disorders. A special importance is given respiratory syndrome characterized by gravity sindronului functional, tachypnea (60-80respiratii/minut) with dyspnea expiratory (breathing out short gamut), inter-coastal circulation, breathing moan, cough, initially dry then wet, shallow breathing , moving the piston head.

Positive diagnosis:
The diagnosis of bronchopneumonia due to the clinical picture is pozitiveaza and laboratory investigations.
On physical examination of the special breathing condensation is found - submatitate disseminated vesicular murmur diminished breathing blower, rales crackles and bilateral subcrepitante.Cardiovascular syndrome present with symptoms: tachycardia, cardiovascular collapse (ie. toxic), hypotension, weak pulse, cold extremities, capillary recolor over 3 seconds and acute pulmonary heart: heart enlarged jugular turgor,tachycardia, edema, hepatomegaly stasis.Infectious syndrome of the pulmonary toxicities, metabolic disorders include: hypoxia, acidosis, hypercapnia, infection, all having known of general digestive disorders: anorexia, vomiting, diarrhea and dehydration paralytic ileus, renal disorders: functional renal failure (oliguria, izostenurie, hematuria discrete) and central nervous system disorders (secondary hypoxia and hipercapniei): agitation, drowsiness, dizziness progressive, convulsions, coma.Severity is increased when bronchopneumonia caused by gram negative and evolve in infants with marked biological handicaps.
Laboratory testing reveals leukocytosis, neutropenia or leukopenia, elevated ESR, marked hypoxia, hypercapnia with mixed acidosis.

Etiologic diagnosis is established by isolation of the incriminated in tracheal aspirate, pleural fluid, pleural puncture in tissue and blood cultures positive in 10-15%.Is doing: lumbar puncture, fundus (FOR) to see cerebral edema, electrolyte, urea and urine.
Chest X-ray reveals dramatically: round opacities, nodular, bilateral, confluent sometimes pseudonodulice micronoduli or images (differential diagnosis with tuberculosis), pleural reaction or frank pleurisy, pneumonia outbreaks abcedate (staphylococcus, Klebsiella, gram negative).Can take various forms pulmonary clinical-biological:- Paravertebral forms (in newborns, premature, dystrophic);- Forms of outbreaks disseminated macronodulare (infant), unilateral, bilateral or isolated;- Forms hiliobazale (hilarious and paracardiac);- Forms or pseudolobare segmentation (children eutrophic) well defined triangular opacity.
Differential Diagnosis:
The differential diagnosis is with other diseases dispneizante:- Viral pneumonia (interstitial) in the functional respiratory syndrome dispneizant poverty contrasts with the physical signs;- Edematous bronchiolitis;- Staphylococcal pleuro-pulmonary (malaise, toxic component is the foreground component of pleural fluid cvaziconstanta, this bubble of emphysema, this accident burglary: pneumothorax, pneumomediastinum);- Pulmonary tuberculosis: radiologic particular character, positive PPD, Koch bacillus present in sputum;- EPA (acute pulmonary edema), heart failure;- Organophosphorus poisoning (hence the miosis);- Acute laryngitis (inspiratory dyspnea is).

Treatment:
Treatment requires hospitalization is mandatory. Newborns will be isolated in the incubator or the ATI department.
Etiologic treatment of first intention in children less than 3 months (group B streptococcus infection or D, gram negative staphylococcus, pneumococcus) is by antibiotics: Ampicillin 100mg/kgc/zi associated with gentamicin or 5mg/kgc/zinetilmicin or amikacin or other regimens: Ampicillin + Gentamicin + oxacillin (100mg/kgc/zi).Treatment of infections caused by Hemophilus influenzae includes ampicillin or amoxicillin-generation cephalosporins or II - III alone, 7-10 days: 50mg/kgc/zi cefuroxime axetil, ceftriaxone 50-100mg/kgc/zi.Gram-negative infections treated with Timentin (ticarcillin + clavulanic acid).If the general condition improves, antibiotics continue to heal.
Treatment consists of oxygen pathogenic (to izoleta), diazepam (when no seizures), cardiac tonic and diuretic, digoxin 0. 04mg/kgc/zi, 1-2zilethen 0. 01mg/kgc/zi; Furosemide 1-3mg/kgc/zi. Transfusions when the Hb <7g/dl. If there is cerebral edema is given mannitol 1-2mg/kgc/zi, 4 hours, 30min PIV.

Symptomatic treatment includes: antipyretic (for fever scaderae) against flatulence, caution sedation (respiratory arrest occurs), support with gamma globulin i. v 0.4mg/kgc/doza (in serious infections).
Treatment complications gender, surgical drainage of abscess and pleural states.
Evolution is favorable with treatment set correctly.
Complications can be diverse:- Metabolic, comprising: syndrome of dehydration, hypoglycaemia, fluid and electrolyte imbalance;- Toxic evidenced by myocarditis, nephritis, hepatitis;- Septic evidenced by: pleurisy, lung abscess, septicemia, pericarditis, meningitis (with bulging fontanel and seizures);- Mechanical suggest pneumothorax.
The prognosis is serious pathology when complications and infants with age (recorded incidence increased mortality).Lumbar puncture in a serious condition is mandatory to rule out meningitis.