Hemorrhagic pneumonia is an inflammation of the lung tissue that occurs with the presence of a large number of red blood cells in the alveolar exudate and bronchial secretions. Hemorrhagic pneumonia often has a lightning course, accompanied by respiratory failure, hemoptysis, pulmonary edema, DIC syndrome, multiple organ failure. The diagnosis is established on the basis of radiological and bronchological data, as well as the connection of hemorrhagic pneumonia with the underlying disease. In case of hemorrhagic pneumonia, intensive therapy is carried out, antiviral / antibacterial drugs, human immunoglobulin, oxygen therapy, etc. are prescribed.
ICD 10
J18 Pneumonia without specifying the causative agent
Meaning
Hemorrhagic pneumonia is acute viral or bacterial pneumonia with the presence of serous hemorrhagic or hemorrhagic exudate in the alveoli and interstitial lung tissue. It refers to severe forms of pneumonia with a high mortality rate. Epidemiological data are not available. It develops more often in people with concomitant bronchopulmonary and cardiovascular diseases. Most cases of hemorrhagic pneumonia are recorded during outbreaks of respiratory viral diseases, as well as particularly dangerous infections.
Causes
Hemorrhagic pneumonia usually complicates the course of severe bacterial (plague, pulmonary septic form of anthrax) or viral infections (smallpox, influenza, especially caused by the A/H1N1 virus). The possibility of hemorrhagic inflammation in staphylococcal infection is not excluded. The most severe course of hemorrhagic pneumonia is observed in smoking patients, pregnant women; persons suffering from chronic bronchitis, emphysema of the lungs, coronary heart disease, obesity, immunodeficiency.
Pathogenesis
Toxic waste products of pathogens damage the vascular membrane, there is a violation of blood flow, fullness and thrombosis of blood vessels. As a result of a sharp increase in the permeability of blood vessels, a significant number of red blood cells sweats into the alveoli, which causes the hemorrhagic nature of the exudate. The macroscopically inflamed area of the lung has a dense consistency, dark red color, resembles a hemorrhage in appearance; a bloody fluid is released from the incision. Histological examination of the drug determines diffuse impregnation of the pulmonary parenchyma with hemorrhagic exudate, hemorrhages in the lumen of the alveoli, sometimes destruction (necrosis, gangrene) of the lung tissue.
Symptoms
The clinic of hemorrhagic pneumonia develops against the background of the symptoms of the primary disease (ARI, especially dangerous infections). After a few days, cyanosis, shortness of breath, hemoptysis, arterial hypotension, tachycardia, nosebleeds suddenly join the infectious disease. Due to the high body temperature and pronounced general intoxication, the patient’s condition is assessed as extremely severe. A pronounced degree of respiratory insufficiency develops, pulmonary edema. Hemorrhagic pleurisy, hemorrhagic encephalitis, lung abscess may join the course of pneumonia.
Hemorrhagic pneumonia has a lightning course and can lead to the death of the patient within 3-4 days from DIC syndrome, multiple organ failure. With a favorable outcome, the period of pneumonia resolution is delayed; residual phenomena in the form of weakness, subfebrility, sweating, shortness of breath, persistent cough persist for a long time.
Diagnostics
All diagnostic measures in case of suspected hemorrhagic pneumonia should be organized as soon as possible. In order to confirm the alleged diagnosis, lung radiography, bronchoscopy with a study of bronchial flushing waters, consultations of the patient with a pulmonologist and an infectious disease specialist are carried out. To identify the etiology of disease allows its connection with the underlying disease.
Radiologically, extensive darkening of the pulmonary fields, strengthening and deformation of the vascular pattern due to the fullness of the bloodstream is determined in the lungs. When examining bronchoalveolar exudate, erythrocytes, alveolar epithelium, single neutrophils and macrophages are detected. In pulmonology, differential diagnosis is performed with atypical pneumonia, bronchiolitis, pulmonary tuberculosis, lung infarction, etc.
Treatment
Treatment of hemorrhagic pneumonia should begin immediately after diagnosis and be carried out in the intensive care unit. The package of measures includes the appointment of etiotropic (antiviral, antibacterial) drugs in high doses, human immunoglobulin, interferons, glucocorticoids; infusion therapy, transfusion of freshly frozen plasma. Oxygen support is provided; if necessary, the patient is transferred to hardware breathing.
Prognosis and prevention
The prognosis depends on the cause of hemorrhagic pneumonia, the initial status of the patient and the rate of initiation of specialized treatment. With timely intensive care, improvements can be expected in 1-2 weeks, but radiological changes are resolved within a few months. Under unfavorable conditions, a fatal outcome may occur within the first 3 days from the onset of hemorrhagic pneumonia. The preventive direction includes vaccination against influenza and other infections, timely access to a doctor at the first signs of trouble, exclusion of self-medication.
Literature
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- Santagati M, Spanu T, Scillato M, et al. Rapidly fatal hemorrhagic pneumonia and group A streptococcus serotype M1. Emerg Infect Dis. 2014;20(1):98–101. link
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