Absentee pneumonia

It occurs most often in sepsis, mainly as a complication of staphylococcal pneumonia.

Staphylococcal pneumonia

 * Now rare, more common in infants than older children,
 * is serious for a progressive course with a tendency to complications - abscessy and pyopneumothorax,
 * Staphylococcus aureus, has various toxins and enzymes (hemolysin, leukocidin, staphylokinase, plasma coagulase),
 * routes of spread of infection are bronchogenic or hematogenous.

Pathophysiology

 * The foci of inflammation merge together, aureus multiplies rapidly, destroys the surroundings, causes the formation of small abscesses,
 * pyopneumothorax results from the rupture of abscesses located subpleurally,
 * partial obstruction of small bronchi can lead to the formation of pneumatoceles,
 * septic thrombi can form in the pulmonary veins.

Clinical picture

 * Sudden high fever, shortness of breath,
 * can be simultaneously staphyloderma,
 * in infants, it occurs peracutely as a septicotoxic form,
 * physical finding: initially a finding typical of pneumonia, when empyema or pyopneumothorax then weakens breathing,
 * laboratory examination: marked leukocytosis, neutrophilia, left shift, anemia, high sedimentation and CRP, often a positive blood culture ,
 * 'heart+lung x-ray: initially small bronchopneumonic foci, they quickly expand and gradually merge,
 * formation of effusion,
 * abscesses – they form cavities with a wide rim (they are filled with air after emptying the contents into the bronchus),
 * complications: only rare with targeted ATB therapy, in younger infants – staphylococcal pericarditis, meningitis, osteomyelitis, metastatic abscesses, sepsis.

Diagnostics

 * In the initial stage, heavy,
 * in the anamnesis, information about the mother's history of staphyloderma or mastitis helps us,
 * further: clinical picture, x-ray S+P, culture,
 * differential diagnosis: pneumonia, which can be complicated by empyema (causing agents: streptococcus, klebsiella, hemophilus).

Therapy

 * Antistaphylococcal ATB – oxacillin', vancomycin' (3-4 weeks),
 * i.v. helps to cope application of Ig or antistaphylococcal serum,
 * empyema – cavity drainage (max. 7 days),
 * prognosis – serious, high mortality – is influenced by the patient's premorbid condition and complications.

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