The combination of pneumonia and pleurisy called pleuropneumonia. Disease often begins in pneumonitis (pneumonia), and pleural effusion is a complication of the process. Most often it develops at pleuropneumonia of pneumonia Lobar pneumonia - severe course of the disease , Caused by Streptococcus pneumoniae.

How to start pleuropneumonia

Pleuropneumonia begins with a sharp decline in immunity after exposure to cold, very high physical exertion or stress. This conditionally pathogenic (particularly Streptococcus pneumoniae, which often dwells in the upper respiratory tract) is able to overcome the barrier of the mucous membrane of the alveoli and small airways and penetrate into its surface layers, causing inflammation.

The disease begins with the fact that the pneumococcus, hitting into the alveoli, releases a toxin that causes a sharp rush of blood to the entire lobe of the lung, in the region that have implemented the pathogen and tissue edema. At the same time affected and adjacent to the affected lobe of the lung pleura. Step edema lasts twelve hours to three days.

In the next phase the alveoli are filled with blood vessels propotevayuschey of liquid protein-rich fibrin, then come to the red blood cells from the bloodstream (they cause staining of lung tissue in red - red hepatization that lasts well for about three days). Fibrin and falls in the pleura - developing fibrinous pleurisy.

The next step in the alveoli rush leukocytes (gray hepatization) that contribute to the resorption of fluid - begins a gradual process of recovery. Fibrin falls in the form of films, which are then absorbed in the help enzymes secreted by white blood cells - begins the healing process.

Since the inflammatory process involved large areas of the lung is affected and adjacent pleura - serous double skin covering the lungs.

Symptoms

Pleuropneumonia begins suddenly, and all stages of the disease correspond to changes that occur in the lungs and pleura. After exposure to a factor contributing to the sudden sharp decline in immunity. The patient has high fever (up to 40-41 ° C), it is shaking chills, after a while there are strong pains in his side on the affected side. Such pain suggests involvement in the pathological process of the pleura, which is full of nerve endings. The pain is so severe that the patient tries to breathe surface: a deep breath can lead to loss of consciousness. Small dry cough Dry cough - whether to worry about it?   as the surface - much coughing impossible because of the pain.

Characteristic blush on one cheek on the affected side, there is a "cold" on the lips (herpes simplex - this agent also does not miss his chance at a lowered immunity). Frequent shallow breathing causes cyanosis nasolabial triangle, ears and fingertips, the rest pale skin.

If affects the lower lobes of the lungs, the pleura is inflamed, covering the aperture (horizontal muscle that separates the chest cavity from the abdominal), and there are severe abdominal pain Abdominal pain: Types and Symptoms . In this regard, the patient is sometimes diagnosed with acute abdomen, even some patients with this diagnosis is sent to the surgical department of a hospital.

After a period the red light comes, and then white hepatization, the patient starts to cough phlegm brownish color ("rusting").

What the doctor discovers during the inspection of the patient

If you look closely to the chest of the patient, we can see that one side of it is behind by breathing on it as you can see retraction intercostal spaces.

On examination, the doctor can detect changes rapping sound (percussion) chest. The sound initially, in step tympanic edema is (are alveolar air and liquid). With phonendoscope at that time listened characteristic crackling (crackling) - is razlipayutsya inspiratory matted alveoli.

In the phase of red and gray hepatization when the alveoli completely filled with liquid, fibrin and cellular elements, percussion over the zone of destruction is heard a dull sound, and auscultation - no wheezing. The phase resolution process reappear crepitus Crepitus - a very serious symptom   and tympanic sound above the zone of destruction. If the small bronchi is a liquid, it can be heard as finely moist rales, but they are not always. With a large number of fibrinous deposits on the pleura can be heard as pleural rub.

Pleuropneumonia - it is a serious illness that is treated only in a hospital. Before the advent of antibiotics in our lives, most patients died pleuropneumonia from complications of the disease on the part of the cardiovascular system and brain.

Galina Romanenko

Beryllium - acquired the so-called occupational lung disease caused by exposure to beryllium. Berylliosis develops, usually by inhalation of beryllium dust or fumes. According to clinical manifestation of the disease is similar to other lung granulomatous lung disease - such as sarcoidosis Sarcoidosis - how to protect themselves?   (benign granulomatosis).

Most of beryllium, enters the body, is excreted in urine, although relatively insoluble chemical forms of beryllium can persist in the body for a long period of time. Once in the lungs, beryllium particles provoke an inflammatory process, accompanied by the formation of granulomas - inflammatory nodules. The inflammatory process may lead to changes in the permeability of the lungs and trigger the production of proinflammatory cytokines - peptide molecules that stimulate the formation of granulomas. With the development of Berylliosis formed granulomas form small fibrotic nodes, resulting in a progressive loss of lung function.

Symptoms Berylliosis

Beryllium, as a chronic disease acquired, usually develops gradually over several years (the development of the disease and increase the degree of lung damage depends on the frequency and duration of contact with beryllium). The most common symptom is considered Berylliosis dyspnea - shortness of breath, difficulty breathing, which may occur at an early stage of the disease. By the way Berylliosis symptoms include:

• Cough
• Chest pain
• Arthralgia (joint pain)
• Increased fatigue
• Do not explainable other causes weight loss

Since berylliosis is chronic, the symptoms develop and aggravated gradually with the growth of pathological formations (granulomas) in the lungs.

In the later stages of the disease berylliosis can be accompanied by distinct symptoms unrelated to the condition of the lungs. For example, berylliosis may cause swelling of the lymph nodes (lymphadenopathy), skin rash (dermatitis), hepatosplenomegaly (simultaneous enlargement of the liver and spleen). The manifestation of symptoms of skin Beryllium can cause direct contact of the skin with salts of beryllium used in some industries.

Diagnostics

Because of the nature of the clinical manifestations, especially in the early stages of the disease, berylliosis is very similar to other granulomatous lung diseases (eg, sarcoidosis), the basis for the diagnosis is the direct analysis of symptoms and physical condition, some of the specific research and, without fail, fact-finding contact with beryllium. To determine the primary Berylliosis applied X-ray that can detect the presence of granulomatous formations in the lungs. To determine the exact cause of the formation of granulomas, and eliminate the possibility of other granulomatous lung diseases may require additional studies - including immunological character (for example, a specific lymphocyte proliferation test with beryllium to exclude the possibility of sarcoidosis).

Treatment

Since berylliosis, like some other occupational diseases is not fully understood, the basis for therapy are the treatments of other granulomatous diseases - for example, due to the similarity of the clinical manifestations of berylliosis and sarcoidosis selected treatments for these two illnesses are the same. The main method of treatment Berylliosis - a course of corticosteroids, the duration of which can be up to several weeks. The initial dose is twenty to forty milligrams of prednisone orally once a day or every other day. In those rare cases when corticosteroid treatment is not effective or causes severe side effects, it can be used methotrexate - a cytotoxic drug that suppresses the symptoms of inflammation and stimulating the immune system The immune system - how it works?   organism.