Pleurisy is called inflammation of the pleura - the serous layer enveloping the lungs. The shell has the form of translucent parts of pulmonary matter, one of which is adjacent to the lungs, and the second wraps the cavity inside. There is fluid inside, which guarantees the movement of two layers of pleura during inhalation and exhalation. Its number normally does not exceed 10 ml. With such a disease, fluid accumulates in excess.
This manifestation is often referred to as pleural effusion. A similar form of pleurisy is called effusion, or exudative. She is more common. The disease can also have a dry form - in this case, fibrin protein is deposited in the pleural plane, the film thickens. But, as a rule, fibrinous pleurisy is only the first stage of the disease, which precedes the subsequent formation of exudate. In addition, when the intestines are infected, the exudate can also be purulent. More details about the treatment and symptoms in children with lung pleurisy can be found in the article.
Causes
Pleurisy is not a primary disease. From a medical point of view, this condition can be called a complication that occurs against the background of some other diseases and pathologies. What causes can cause pleurisy in children?
One of the most common reasons is the ingestion of various microbes, which, in turn, lead to the appearance of the inflammatory process of the pleural leaves. The causative agents of infections can be representatives of the specific tuberculosis flora, as well as all kinds of viruses, hemophilus bacillus and staphylococci. The causative agents of a particular infectious disease can enter the body in various ways, for example, through contact, with lymph or blood.
Naturally, one cannot fail to mention that there is the development of infectious diseases and their subsequent complications in the form of pleurisy with increased vascular permeability, as well as against the background of a decrease in immunity. Metapneumonic pleurisy in children can occur due to frequent infections, with hypothermia, as well as a lack of any specific trace elements, the lack of which can affect the lungs in the most negative way. In addition, this ailment can be caused by sunstroke or mechanical damage to the chest.
Symptoms
Diagnosis of the presence of pleurisy in a small patient can be quite difficult, since the symptoms are varied. What symptoms are observed with pleurisy in children?
As soon as the inflammatory process begins in the lungs, this leads to a gradual accumulation of fluid, the nature of which will depend on the stage of development of the disease, as well as on the type of pleurisy pathogen. In addition, purulent exudate is observed with unilateral pleurisy, while serous fluid often affects two parts of the lungs in children. However, it is possible to identify the onset of pleurisy by other symptoms, for example, by constant shortness of breath, as well as by a deterioration in the general condition and an increase in body temperature.
If we talk about body temperature, then it can change or remain at a certain level, in some cases, such a symptom may be absent altogether. So, in children with pleurisy under the age of one year, the temperature can be at the usual level, and if its increase occurs, it will be small. It should also be noted that in very young children all the symptoms of pleurisy can be expressed not very clearly, so specialists use special diagnostic methods.
Diagnostics
Pleurisy is inherently a secondary disease against the background of an already existing pathological process in the lungs. Therefore, the preparation of the history of a sick child must begin with clarification of the facts about the underlying diseases (for example, pneumonia, tuberculosis, rheumatism). Any diagnostic measures for exudative pleurisy in children begin with an external examination and collection of patient complaints. With an ailment, the attending physician should pay attention to pain during breathing, uneven chest raising with a sigh, shortness of breath, general signs of intoxication and the inflammatory process in the body.
For the diagnosis of pleurisy in a child, there are special medical methods that will confirm a diagnosis that is suspected during examination, namely:
- A general blood test, which will give information about the number of leukocytes, the accelerated reaction of erythrocyte sedimentation, and a decrease in hemoglobin.
- X-ray and ultrasound examination for pleurisy show the presence and localization of accumulation of fluid (or air) in the pleura, and also help to determine the degree of mobility of the ribs and diaphragm, to see the degree of thickening of the inflamed pleura.
- If during an x-ray examination in the pleura and lungs pathological processes were detected, pleural puncture is necessary to obtain exudate in order to study for biochemical and bacteriological composition.
Treatment
In connection with the formation of pleurisy against the background of other diseases, its extent, signs, methods of therapy largely depend on the initial factor of the painful process in the pleura. Thus, the initial clinical recommendations of pleurisy in children are focused on eliminating the primary disease, and the treatment of the disease of interest to us is already reduced to normalizing the course of the pathology - relieving pain, normalizing the decrease in exudate, suppressing infection, normalizing respiratory function, etc.
Eliminating the infection
Bacteria themselves become a frequent pathology factor, for this reason antibacterial treatment of pleurisy in children (antibiotic therapy) is more popular. At first, as a rule, medications of a wide range of action are prescribed, and already after receiving the results of the diagnosis, a certain drug is prescribed to determine the infection and its susceptibility to a particular substance that is part of the drug. The dose and system of administration of the substance depend on the established diagnosis and the danger of the disease process.
According to clinical recommendations, with pleurisy in children, the most common medications are as follows:
- "Ampicillin" - belong to penicillins. Influencing the wall of microorganisms, overlap their reproduction. It is used intravenously or intramuscularly. The daily norm is - 1.5 ml (easy level), 3 ml (average), 12 ml (severe level of the disease), but not more. Used with Sulbactam.
- Imipenem is a beta-lactam antibacterial drug with a wide range of effects. Destroys the wall of microorganisms, initiating their death. The daily norm is 1-3 g in 2-3 doses. Use with Cilastatin.
- “Clindamycin” blocks the combination of bacterial protein, as a result of which its increase and reproduction are suppressed. The dose intravenously and intramuscularly is 300-2700 mg per day, inside - 150-350 mg.
- "Ceftriaxone" - destroys the wall of microorganisms, initiating their death. The daily dose is 1-2 g per day, intravenously or intramuscularly.
Relieve inflammation
The passage of the disease during the processes of friction of the pleural sheets with each other is accompanied by pain. Non-steroidal anti-inflammatory substances (NSAIDs) and hormones are used to relieve pain.
Among the NSAIDs, Diclofenac, Nurofen, Nimesil, and Meloxicam can be noted. The most effective glucorticoid is Prednisolone.
Detox
Bacteria in the period of their presence in the body poison it with products of their own vital activity, which are represented by toxins (poison) for humans. At the same time, dead pathogenic bacteria contribute to the development of sources of decomposition from within the person. These two conditions lead to signs of intoxication of the body, initiating the disappearance of appetite, nausea and a general painful condition.
For the removal of dead microorganisms and toxins of living representatives of the infection, detoxification treatment is used, which contains:
- intravenous administration of glucose solutions, polysaccharides (Dextran) and water-salt solutions;
- the use of diuretic substances (diuretics) - "Furosemide";
- the use of detoxification pharmaceutical substances - Atoxil, Albumin.
An abundant drink with pleurisy is not prescribed, since excess fluid will increase the volume of effusion in the pleural cavity.
We strengthen immunity
The development of infectious diseases and pathologies, as a rule, is associated with weak immunity, since the immune system is directly responsible for the confrontation of the body with pathogenic microflora. In addition, intoxication of the body with an infection in addition weakens the immune system.
To maintain the immune system, immunomodulators are prescribed - Imudon, IRS-19, Timogen. Vitamin C (ascorbic acid) is considered to be a natural stimulator of the functioning of immunity, a huge amount of which can be found in rosehips, cranberries, lemon, cornel, mountain ash, currants, and viburnum.
Restore microflora
With a good state of health, the human intestinal tract contains the necessary microflora - bacteria that are involved in the digestion and assimilation of food, as well as in the conversion of certain necessary elements from food products and their subsequent absorption by the body.
The use of antibacterial therapy negatively affects the desired microflora, partially absorbing it. For this reason, taking medication is often accompanied by various minor drugs. To resume the intestinal microflora, probiotics are prescribed - Linex, Bifiform, Acipol.
Surgical intervention
In many cases, with such a disease, a pleural puncture is made, which is also referred to as thoracocentesis. The essence of thoracocentesis is the introduction of a needle into the pleural cavity under anesthesia, through which a specific volume of water is removed from the body. This action is carried out for two purposes - taking exudate for diagnosis, as well as removing excess exudate, if the main treatment did not lead to the required consequences, or in combination with the goal of instantly releasing the pleural cavity. The result of this type of manipulation for therapeutic purposes is the elimination of pressure from the lung, which improves its respiratory mobility, and in accordance with this the patient’s condition.
Eating
There are no special nutritional requirements for pleurisy. The diet is prescribed in connection with a particular disease, because of which a pathology in the pleura was created. Nevertheless, it is possible to note that nutrition for various, especially infectious diseases must be composed of products that are full of vitamins and minerals. This will strengthen not only the immune system, but the whole body.
Complications
Timely pleurisy therapy can help to avoid numerous complications:
- pneumonia with pleurisy in children;
- proliferation of adhesions in the pleural cavity;
- obliteration of interlobar fissures;
- adhesive pleurisy;
- scarring of the pleural cavities;
- compaction of pleura;
- development of pleurosclerosis;
- empyema;
- respiratory failure;
- decreased physical activity of the diaphragm.
The presence or absence of complications is directly related to the pathology formation factor.
Pathology Prevention
Preventive measures for this disease are as follows:
- timely access to a treating doctor for various pathologies in order to get ahead of the transition of the disease into a chronic form;
- compliance with rehabilitation advice after surgery on the affected area;
- try not to be in crowded places during the period of epidemics of influenza, SARS, ARI;
- compliance with the rules of individual hygiene;
- Do not neglect rest and sleep;
- daily air the place in which you are;
- give up smoking and alcohol;
- Avoid hypothermia.