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ABSTRACT
The author made a study of modern literature on the problems of etiopathogenesis and treatment destructive forms
of pneumonia in children.
KEYWORDS
pneumonia, bacterial destruction of the lungs, surgical infection, staphylococcus aureus.
INTRODUCTION
According to modern studies, today among the
diseases with frequent visits, hospitalization and infant
mortality, the leading place is occupied by diseases of
the respiratory system [3,10], in which the
complication in the form of the development of
destructive forms against the background of
pneumonia reaches 10%, and the mortality rate is about
2 -5.4% [21,22,27]. At the same time, the process of
development of destruction and involvement in
pathological processes of extrapulmonary organs,
such as the pleural cavity against the background of a
complication of pneumonia in children, is called
"bacterial destruction of the lungs" (BDL) [11].
One of the main clinical symptoms of BDL is the
progression of respiratory failure, chest pain, fever for
a long time, deterioration of the child's condition, and
involvement in the pathology of the pleural cavities,
Research Article
MODERN VIEW ON THE PROBLEMS OF ETIOPATOGENESIS AND
TREATMENT OF DESTRUCTIVE FORMS OF PNEUMONIA IN CHILDREN
Submission Date:
October 25, 2022,
Accepted Date:
October 30, 2022,
Published Date:
November 08, 2022
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume02Issue11-04
Mekhriddinov M.K.
Bukhara State Medical Institute, Republic Of Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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despite ongoing antimicrobial therapy [20,29]. The
presence of these clinical symptoms and signs is a
direct indication for chest computed tomography,
which should be performed, despite the absence of
signs of destruction on chest radiography in direct and
lateral positions, since this research method is less
sensitive to detecting the initial stages of lung necrosis
[3]. However, there are a number of limitations for
performing computed tomography in children, such as
high radiation exposure, high cost of the study, and the
lack of a CT machine in all regions.
Over the past decades, significant changes have
occurred in the structure of BDL pathogens [1,12,14]. In
the microbial mirror, such diverse forms of
microorganisms
as:
proteus,
streptococci,
Pseudomonas aeruginosa, pneumococci, E. coli,
Friedlander's bacilli, fungi, mixed and protozoa are
found. Recent studies have shown that strains of
staphylococcus, which in the 80s of the 20th century
was detected in 65% of cases of observation, play to a
large extent in the development of the processes of
suppuration of the lung tissue [19,20,21]. The
development of modern medicine and the emergence
of new knowledge in the field of the study of
pneumonia, and BDL, in particular, as well as the
development of technologies in the field of medicine,
have made it possible to establish new tactics and
approaches for the treatment of these pathologies.
As is already known, BDL occurs against the
background of acute respiratory diseases, the
incidence of which is 84-86% [17]. Basically, the
microbial agent enters the lungs by airborne droplets,
the so-called aerogenic route. At the same time,
viruses, causing pathological changes in the upper
parts of the respiratory system and reducing local
immunity, create conditions for the penetration and
reproduction of bacteria in the lower parts of the
respiratory system, in particular in the lung tissue
[15,16]. With the development of medicine, the
etiological view of the development of the disease also
changed, in which an increase in the role of
opportunistic gram-negative flora in the development
of pathological processes was observed [8].
Conducted studies in determining the causative agents
of surgical infections in children [3] have established a
decrease
in
the
etiological
significance
of
Staphylococcus aureus. Wherein,
In addition, an increase in the occurrence of obligate
anaerobic pathogens of surgical infections contributes
to an increase in the frequency of sterile cultures. This
process is still observed today. Therefore, it is
necessary to carry out microbiological monitoring in
this category of patients. Under the leadership of S. G.
Libov in 1962, the term "staphylococcal destruction of
the lungs" was proposed, which was recognized at the
All-Union Symposium of Pediatric Surgeons in
Dushanbe and was widely used. At that time, this term
included almost all forms of acute pulmonary
complications and suppuration processes in children,
which fully reflected the true situation. Since, at
present, staphylococcus is not the main form of the
causative agent of purulent-septic pathologies of the
pulmonary parenchyma and pleura, many scientists
have abandoned this term, preferring to use the
concept of "bacterial destruction of the lungs", since
this term generalizes and combines various forms of
destructive lesions of the lungs and pleural cavity.
When studying the pathogenesis of the development
of destructive forms of pneumonia, scientists have
identified several main links:
1.
Violation of the microcirculation process due to
damage to the lung tissue by bacterial flora;
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2.
Morphological and functional dysfunctions in
the upper parts of the respiratory system against the
background of SARS;
3.
Violation in the drainage function of the
bronchial
system
with
signs
of
impaired
microcirculation at the level of bronchioles;
Among other things, in the pathogenesis of gram-
negative microflora, a special place belongs to
endotoxin, which causes degenerative changes in the
mucous membranes, as well as causing multiple
microhemorrhages in them, contribute to the
accumulation of hemorrhagic exudate in serous
cavities [2,3,12]. In most cases, researchers distinguish
between primary and secondary lesions of the lung
parenchyma [14,28]. The most widespread belong to
the classifications that distinguish pulmonary and
pulmonary-pleural forms of destructive pneumonia
[23]. The classification of M.R. Rokitsky, which includes
5 groups of complications that developed against the
background of pneumonia:
1.
Pre-destructive form, which includes confluent
infiltrative pneumonia, as well as lobitis.
2.
Pulmonary
form,
including
small-focal
destruction inside the lobules and cortical abscess)
3.
Pulmonary-pleural forms of complications,
which
include
such
pleural
pathologies
as
pneumothorax, pyothorax and pyopneumothorax.
4.
Chronic
forms,
including
fibrinothorax,
secondary cysts, pleural empyema and bronchiectasis.
5.
Complications against the background of acute
purulent destructive pneumonia. These complications
include
progressive
mediastinal
emphysema,
pericarditis, perforating pleural empyema.
The advantage of this classification is the definition of
therapy depending on the form and state of
inflammatory-destructive processes in the lungs and
pleura [26].
As a result of dysfunction of fibrinolytic indicators in
the blood at the stage of infiltration, the process of
hypercoagulation is observed, leading to the
development of thrombosis and microembolism of the
vessels of the lungs and bronchi, as a result of which
there is a violation of blood circulation and the
development of destructive processes [26]. In this
case, pathological agents penetrate into the lung
tissue by bronchogenic or hematogenous routes,
causing inflammatory processes. In young children,
this process is aggravated against the background of
low development of natural immunity and its decrease
against the background of viral processes in the upper
respiratory tract as a result of SARS. As a result of acute
respiratory viral infections in young children, catarrh of
the upper respiratory tract and nasal breathing are
often observed, which directly leads to a decrease in
lung capacity. Edema, developed against the
background of inflammatory processes and hyperemia
of the organs of the respiratory system leads to
narrowing and increased resistance of the respiratory
tract due to their obstruction. According to Poiseuille's
law, the narrowing of the bronchial lumen by half leads
to an increase in air resistance by 16 times. Also, against
the
background
of
inflammatory
processes,
hypersecretion of mucus and their accumulation in the
lumen are observed, as a result of which there is a
deterioration in the state of mucociliary clearance,
thereby reducing immune processes. These violations
occur in three stages. At the first stage, there is a
spasm, swelling and accumulation of secretion in the
lumen of the bronchi, which leads to a decrease in the
flow of air into the distally located alveoli, as a result of
which the airiness in the distal parts of the lungs
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decreases and obstructive hypoventilation occurs. In
the second stage, incomplete obturation is observed
on the basis of a developed broncho-obstructive
syndrome, leading to the formation of a valvular
process and the development of obstructive
emphysema. At the third stage, complete total
obturation is observed, leading to the development of
obstructive atelectasis. All of the above violations lead
to impaired circulation and damage to the
corresponding area of the lung tissue, the volume of
which depends on the level of obstruction (segmental,
lobar or subsegmental) [8,13,17,25].
As a result of broncho-obstructive disorders, there is
dysfunction and changes in the blood supply to these
areas of the lungs and the defeat of their pathogenic
bacterial flora [14,35].
Also, in the development of an acute purulent-
destructive form of pneumonia, the occurrence of
violations in the drainage function of the bronchi,
which occurs against the background of viral bronchitis
and microaspiration syndrome, plays a dominant role
[3,24,31].
In children in the development of destructive
processes, there are combined factors of violations of
the ventilation and drainage functions of the lungs and
microcirculation disorders in the small circle, which
occur against the background of a hyperergic reaction
involving viral and bacterial infections. With an
infiltrative lesion, the development of purulent-
destructive processes is also negatively affected by
excessive
infusion-transfusion
therapy,
which
aggravates
microcirculation
disorders
in
the
pulmonary circulation in this group of patients [5,8,31].
All of these processes undoubtedly play a major role in
the pathomechanism of the development of acute
purulent-destructive processes, while the impact of
pathogenic bacteria, in particular, staphylococci, play a
dominant role in the destruction of lung tissue [30,32].
In early December 2019, an epidemic of COVID-19
infection (atypical pneumonia) occurred in the city of
Wuhan in China, the causative agent of which was
SARS
–
CoV
–
2 coronovirus. On December 31, 2019, an
outbreak of unknown pneumonia was reported to
WHO by the Chinese authorities. On February 11, 2020,
this disease became known as coronavirus pneumonia.
Subsequently, Chinese scientists identified a new type
of coronavirus - SARS - CoV-2, by studying the structure
of the genome of this virus. This infection is one of the
dangerous pathogens that causes acute respiratory
infections, occurring both in mild form (classic SARS)
and in more severe forms. The most common clinical
variant of this disease is the development of viral
pneumonia [18,34].
It is well known that older age and a number of chronic
diseases, including diabetes mellitus, coronary heart
disease, arterial hypertension, and chronic obstructive
pulmonary disease are considered risk factors for
pneumonia today [10,20,21]. However, inflammation of
the lungs with a new coronovirus infection is observed
against the background of acute respiratory infections
and infectious-allergic diseases, causing an immune
imbalance in the div of children [16,17].
Against the background of the effect of the virus on
the lung parenchyma, destruction of the alveolar
membranes is observed, with the filling of the alveoli
with liquid and a violation of gas transport functions.
These disorders can be seen on computed
tomography, which are called "ground glass effect", in
which the affected areas resemble "foggy seals"
[18,21].
Depending on the size and number of "ground glasses"
and seals, determined in the affected area of the lung
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on a computer thermogram, the degree of damage to
the lung tissue and the stage of the disease are
determined [18,21].
1.
Light stage - compaction zone less than 25%
2.
Average degree - compaction zone is 25-50%
3.
Severe degree - compaction zone is 50-75%
4.
Critical degree - the compaction zone is more
than 75%
Conclusions: Acute purulent destructive pneumonia in
children includes complications that have developed
against the background of pneumonia of various
etiologies, which proceeds with the destruction of the
lung tissue and the involvement of the pleural cavity in
this process against the background of exposure to
various pathological microorganisms.
Over time, there is a change in the etiological factors of
the disease. If in the middle of the last century,
staphylococcal infections were most often observed in
the structure of etiological factors, then by the 70s, a
very significant weight of gram positive and gram
negative (Streptococcus pneumoniae, Klebsiella
pneumoniae, Proteus, Pseudomonas aeruginosa and E.
coli) joined the structure of pathogens. With the
development of pharmacology, in particular the
production of broad-spectrum antibiotics, the
"pathogenization"
of
conditional
forms
of
microorganisms has led. In addition, the above factors
led to the addition of fungal microorganisms, most
often saprophytes, to the pathological process.
Based on the studied scientific literature, in recent
years there has been a significant increase in viral
infection in the development of destruction in the
lungs. Since the 2000s, mutations in various viruses
have made many scientists think about revising
traditional methods of treatment. A striking example is
the new type of coronavirus infection (Covid-19).
In this way, the treatment of inflammatory diseases of
the lung tissue requires a comprehensive measure
aimed at identifying, first of all, the causative agent of
the disease, which requires specific treatment and an
individual approach in eliminating the pathological
focus in order to prevent complications and further
destruction of the lungs.
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