Lung abscess is a nonspecific inflammatory disease of the respiratory system, as a result of which a thin-walled cavity filled with pus forms in the lung cavity. An abscess most often occurs as a result of incomplete recovery after focal pneumonia, when melting and necrotization of the lung tissue occurs in a limited area.

Less commonly, such a cavity may appear after blockage of a small bronchus by some foreign body, in this case, oxygen does not enter the blocked area, the tissue “falls off, atelectasis is formed, which can easily become infected with the formation of an abscess. Even less often, a lung abscess is formed as a result of infection from the focus of inflammation in the lung tissue by the hematogenous route.

Etiology of the disease

Abscess and gangrene of the lung occur when pathogenic microorganisms that can release toxins and tissue-destroying enzymes enter the patient's lungs. The following microorganisms can cause damage to the lung tissue:

Not every inflammatory process in the lungs is complicated by tissue necrosis and the development of a lung abscess; this can be caused by a massive introduction of the infectious agent into the lungs, a general weakening of the body, a decrease in immunity, or a number of chronic diseases. The risk group includes patients suffering from diabetes mellitus, hormonal disorders, bronchiectasis, older patients, premature babies and pregnant women.

Symptoms

There are two forms of the disease: acute lung abscess and chronic lung abscess.

If a small cavity has formed on the periphery of the organ, then such a lung abscess does not give characteristic symptoms and therefore is not diagnosed in time, which can lead to a chronic process or, less often, to an independent resolution of the disease.

Acute abscess

In acute lung abscess, 2 clinical stages are distinguished:

1. Abscess formation period
2. Opening period

Abscess formation period

During the period of formation, an acute lung abscess causes severe intoxication of the body, the patient complains of high body temperature - up to 41-42 degrees, loss of appetite, weakness, headache, general deterioration. In addition, difficulty in breathing, shortness of breath, dry cough, pain in the chest are characteristic, while breathing there is an asymmetry of the chest - the affected side lags behind the healthy one.

The severity of the patient's condition depends on the size, number of abscesses and the type of pathogen that caused the disease. This period lasts about 7-10 days, but can proceed quickly - up to 2-3 days, or, conversely, slow down - up to 2-3 weeks. The time of formation of an abscess also depends on the size, type of pathogen and on the state of health and immunity of the patient - in weak, malnourished patients, this process can drag on for several weeks.

Opening period

At this time, the abscess "ripens" and breaks through its shell, pus is released out through the respiratory tract and the patient's condition improves dramatically. The main symptom of the resolution of the process is sputum, which, with a lung abscess, is sudden, the patient's cough becomes wet and a large amount of purulent sputum is released - up to 1 liter, "expectorates sputum with a full mouth."

After that, the symptoms of intoxication decrease, body temperature drops, fever and sweating stop, appetite is restored. During this period, the patient remains weak, short of breath and pain in the chest.

The duration of the disease depends on the condition of bronchial drainage and the availability of adequate treatment. If the sputum is well excreted, the patient receives everything necessary, then within a few weeks the disease almost completely disappears, and then, within a few years, the abscess cavity is scarred and complete recovery occurs. If the bronchial drainage is too narrow, sputum stagnates in the lung, the healing process slows down greatly, then improvement occurs, then the condition worsens and the disease can become chronic.

Chronic lung abscess

Occurs if the acute process does not end in 2 months. This is facilitated by the features of the abscess itself - large sizes (more than 6 cm in diameter), poor sputum drainage, localization of the focus in the lower part of the lung; weakening of the body - a violation of the immune system, chronic diseases, and so on; errors in the treatment of acute abscess - incorrectly selected antibiotic or too small doses, late or insufficient treatment.

With a chronic abscess, the patient suffers from shortness of breath, cough with fetid sputum, alternating deterioration and normalization of the condition, increased fatigue, weakness, exhaustion, sweating. Gradually, due to lack of oxygen and constant intoxication of the body, bronchiectasis, pneumosclerosis, emphysema, respiratory failure and other complications develop. The appearance of the patient changes - the chest increases in size, the skin is pale, cyanotic, the terminal phalanges of the fingers thicken, take the form of "drumsticks".

Treatment of lung abscess

Treatment of a lung abscess must begin with hospitalization and the appointment of a powerful course of antibiotic therapy.

The patient should observe bed rest, changing body position several times a day to improve the drainage function of the lungs. They also carry out therapeutic measures aimed at improving the drainage function of the lungs and restoring the general condition of the body.

Antibiotics are prescribed immediately after diagnosis, drugs with a wide spectrum of action are chosen and large doses are administered intramuscularly or intravenously. Most often, drugs of the penicillin series, cephalosporins or macrolides are prescribed. In addition to antibiotics, bronchoscopy is performed with aspiration of the contents and washing of the abscess cavities and, if necessary, with the introduction of antibiotics directly into the lung. To reduce intoxication, solutions of glucose and sodium chloride are administered intravenously, and to improve the drainage function of the bronchi - aminofillin and other mucolytics.

If the therapeutic measures are not effective or in the treatment of a chronic lung abscess, surgical treatment is performed - the affected part of the lung is removed.

Interview a patient with a lung abscess and identify complaints cough with scanty sputum of a mucopurulent nature, chills, fever, initially remitting, then hectic with large temperature fluctuations during the day, general weakness, mixed dyspnea, sometimes chest pain (with a superficial location of the abscess), characteristic of the I stage of abscess to its opening. Identify complaints on a strong cough with a large amount of discharge (“full mouth”) of purulent sputum, a slight decrease in the symptoms of intoxication (fever, chills, etc.), which is typical for stage II of an abscess after it is opened.

Take a history of a patient with a lung abscess: the development of a purulent process in the lungs is observed as a complication of pneumonia or bronchiectasis, as well as with chest injuries, aspiration of foreign bodies, and operations on the respiratory tract. It is possible to develop an abscess by the hematogenous or lymphogenous route due to the introduction of infection into the lungs from a distant purulent focus in the body. The cavity syndrome is also observed in pulmonary tuberculosis, polycystic lung disease, SLE with a predominant lesion of the lungs. In the development of a lung abscess, two periods are distinguished: the initial (stage I) - before the opening of the abscess, when the cavity surrounded by a zone of perifocal inflammation is filled with pus, and the second period (stage II) - after opening, measles has an air cavity (may be partially filled with pus), communicating with bronchus.

Conduct a general examination of the patient: in patients with lung abscess, febrisremittens is determined, then febrishectica; the face of a febrile patient is observed; cyanosis; in stage II of the disease, pallor of the skin sometimes appears due to the development of iron deficiency anemia. There may be exhaustion of the patient, a forced position on the sore side, as well as a symptom of "drum sticks" and "watch glasses" (with chronic lung abscess).

Do a respiratory exam. To identify the cavity syndrome by objective methods, the following data must take place:

1) the cavity in the lungs must be at least 5 cm in diameter;

2) the cavity should be located near the chest wall no deeper than 7 cm from the surface;

3) the lung tissue surrounding the cavity must be compacted;

4) the walls of the cavity must be thin;

5) the cavity must communicate with the bronchus and contain air.

On examination chest revealed lagging of the affected side in the act of breathing.

On palpation chest, soreness can be detected along the intercostal space on the diseased side with a superficial location of the abscess due to the involvement of the rest of the pleura in the inflammatory process. Voice trembling in the I stage of an abscess, with its large size and superficial location, is weakened, and in the presence of pronounced, perifocal inflammation, it can be increased, with a deep location - it is not changed. After the opening of the abscess, voice trembling is intensified.

With percussion the chest is determined by a dull or dull sound (before the opening of the abscess), a tympanic sound or its varieties (the sound of a cracked pot, a metallic sound) - after the opening of the abscess.

ausculpative in stage I of the abscess, weakened vesicular breathing is heard (with a large superficially located abscess), hard breathing (with severe perifocal inflammation) or unchanged vesicular breathing with a deep abscess. After the opening of the abscess, amphoric (bronchial) breathing is heard, a large number of moist voiced medium and large bubbling rales in a limited area. In the presence of air and liquid in the cavity, the noise of Hippocrates splashing and the noise of a falling drop can be determined. Bronchophony will change similarly to voice trembling.

In a laboratory study:

In blood revealed neutrophilic leukocytosis 15-25x109 /l with a shift to the left, a sharp acceleration of ESR up to 50-60 mm/h, toxic granularity of neutrophils. In the II stage of an abscess, in severe cases of the disease, iron deficiency anemia develops (decrease in hemoglobin, erythrocytes, color index, microcytosis, hypochromia, anisocytosis, poikilocytosis, etc.).

Sputum has a purulent character, three-layer, microscopic examination reveals a large number of leukocytes, erythrocytes, elastic fibers, crystals of fatty acids, hematoidin, cholesterol, Dietrich's plug.

In the analysis of urine moderate proteinuria up to 0.33% can be observed.

X-ray picture an abscess in the first period before its opening is no different from ordinary pneumonia and is characterized by large-focal blackouts with jagged edges and fuzzy contours. X-ray examination after emptying the abscess gives a picture of enlightenment (often with a horizontal level of fluid), against the background of darkening (pneumonic infiltration) with fuzzy external contours.

Page 7 of 11

Fever may precede the appearance of specific or local signs in the early stages of suppuration. Each doctor has repeatedly had to examine patients with relapsing fever and high leukocytosis, in whom, on the basis of clinical data, the formation of an abscess is expected and in whom persistent searches for it for a long time are unsuccessful. A classic example of this can be considered paranephritis, in which the formation of even a large abscess sometimes proceeds without pain and other signs of local inflammation.

In the past, there has been a tendency to attribute a prolonged fever of unknown origin to a focal infection in the tonsils, in the roots of the teeth, in the gallbladder. Without entering into a discussion with respected doctors of the past, it should still be borne in mind that apical abscesses can be asymptomatic for many months and even years. Sometimes they can be diagnosed only after an X-ray examination of the teeth. The body temperature in these patients often remains normal, sometimes they have subfebrile condition and only in rare cases a higher fever. When such abscesses are found, they must be removed. If, after their removal, the fever still continues, it is necessary to look for other foci of infection. Most often, such foci are found in organs located below the diaphragm. It is especially difficult to diagnose inflammatory processes located under the diaphragm and under the liver.

Subdiaphragmatic abscess is one of the rare diseases. It can occur acutely or develop imperceptibly. Most abscesses are a complication of other diseases. Most often, a subphrenic abscess develops after surgery for gastric and duodenal ulcers, after acute appendicitis, pancreatitis. In about 10% of cases, its causes remain unknown.
The clinical picture of the disease depends on the location of the abscess. It can be located under the top of the diaphragmatic dome, under its right or left, front or back.

Approximately 1/2 of all abscesses are located under the right dome of the diaphragm. More than 1/3 of them is located on the left above the spleen. In rare cases, bilateral abscesses are observed.
The diagnosis of a subdiaphragmatic abscess is one of the most difficult, especially if the purulent exudate is located between the liver and the diaphragm in the form of a thin layer and if the X-ray examination does not reveal a characteristic level of liquid with a gas bubble above it.

In most cases, the disease begins with fever, vomiting and pain in the hypochondrium. Tapping on the hypochondrium is sharply painful. Pain usually radiates to the back or lower back. Irradiation to the shoulder and supraclavicular region is much less common. Body temperature rises in the evening with chills. High leukocytosis and accelerated erythrocyte sedimentation are found in the blood. A physical examination already at the beginning of the disease reveals weakened breathing and dullness of percussion sound on the affected side. In some cases, this is due to the high standing of the diaphragm, and in some cases, the accumulation of exudate in the pleural cavity. X-ray examination easily distinguishes these syndromes from each other. The localization of the abscess is determined by the level of the liquid with a gas bubble above it. The diagnosis of a subdiaphragmatic abscess is confirmed by the extraction of pus from its cavity during a test puncture.

According to Miller, Talman (1968), the diagnosis of subdiaphragmatic abscess is made, as a rule, with great delay. From the moment of the operation, after which a subdiaphragmatic abscess develops, an average of 34 days pass until the diagnosis is established.

It is even more difficult to diagnose a subhepatic abscess, which develops as one of the complications of purulent cholecystitis or an atypical perforation of a stomach ulcer. The clinical picture of subhepatic abscesses consists of fever, pain in the pit of the stomach and in the right hypochondrium, severe intoxication, subicteric skin. Leukocytosis with a shift to the left, accelerated erythrocyte sedimentation are found in the blood. With cholecystogenic origin of the subhepatic abscess, the results of a laparoscopic examination are of great help, during which it is possible to assess the condition of the gallbladder and detect fresh adhesions in the upper floor of the abdominal cavity.

Cholangitis and liver abscess. The clinical picture of cholangitis consists of pain, jaundice and fever. Usually these three syndromes occur simultaneously, but in rare cases, fever for a long time is the only manifestation of the disease.

Acute purulent cholangitis is based on the same reasons as chronic: blockage of the common bile duct by a stone, narrowing of its scar tissue or tumor. The possibility of acute suppurative cholangitis should be discussed in every patient with a high fever accompanied by chills, right hypochondrium pain, leukocytosis, and severe symptoms of intoxication. The diagnosis of acute purulent cholangitis seems very likely if the use of antibiotics for 5-6 days is not accompanied by an improvement in the general condition of the patient and the disappearance of chills and fever. Physical examination always reveals liver enlargement, tenderness, and some degree of jaundice.

The severe general condition of the patient and the tremendous chills repeated during the day are explained by sepsis. Blood cultures are necessary not only to detect bacteremia, but also to determine the sensitivity of the pathogen to antibiotics. The disease is often complicated by liver abscesses, sometimes small and multiple, sometimes single and extensive. Acute purulent cholangitis and liver abscesses in the therapeutic department are most often encountered as complications that develop in the late stages of pancreatic head cancer or other diseases that compress the common bile duct. Sometimes a liver abscess turns out to be one of the complications of pylephlebitis that occurs after a long-term operation in the abdominal cavity. In the southern regions of Russia, there are liver abscesses caused by intestinal amoeba. In the northern regions, this complication is extremely rare. For many years of work, we observed it only once.

Liver abscesses(multiple or single) are located, as a rule, in the right lobe. Their clinical picture depends largely on localization. Intrahepatic abscesses occur without pain, but with a feeling of heaviness in the right hypochondrium. Acute pain in the right half of the chest is observed with the subcapsular location of the abscess. Hectic fever with repeated chills during the day and severe intoxication appear even before the formation of the abscess. In the blood, a high leukocytosis with a shift to the left and an acceleration of erythrocyte sedimentation is detected. The liver increases both up and down. Palpation of its lower edge in most cases is painful. Its upper border rises to the V rib. The right dome of the diaphragm remains motionless during breathing. In the right pleural cavity, an effusion is often determined, and then the dullness over the right lung extends up to the IV, even III rib. The fluid in the pleural cavity may be serous or purulent. An abscess can open in any of the organs adjacent to it: the pleural cavity, stomach, abdominal cavity, retroperitoneal space, but in most cases death from intoxication occurs even before the development of these complications.

Chronic pyelonephritis can proceed both with normal temperature and with fever. If the patient has back pain, dysuria, pyuria and bacteriuria, then the cause of the fever seems fairly obvious. Unfortunately for doctors, in some cases of pyelonephritis occurring with prolonged fever, these signs are expressed so slightly that they can sometimes be detected only after a long and persistent search. Children and the elderly are particularly susceptible to such difficulties (Hart, 1973).

Paranephritis and pararenal abscess proceed with prolonged fever, accompanied by chills, leukocytosis, and accelerated erythrocyte sedimentation. Pasternatsky's symptom is usually positive. By the time an abscess forms, patients almost always complain of spontaneous pain in the lumbar region or in the lateral parts of the abdomen. In the first weeks, these pains may be absent, and then fever is the main, if not the only, syndrome of the disease. Examination of the perirenal region does not always detect a tumor, but in almost all cases it is possible to determine increased muscle tension on the affected side.
Paranephritis and perirenal abscesses in most cases occur due to the spread of purulent inflammation from the kidneys. In several cases, we had to observe paranephritis that developed after retroperitoneal (retrocecal) appendicitis. Cases of paranephritis that developed after a carbuncle in the lumbar region or after infection of a hematoma that arose under the influence of an injury are described. When collecting an anamnesis, it must be borne in mind that an abscess in the perirenal region can sometimes develop several months after the injury.

Broochectasis with suppuration. Fever, the cause of which sometimes remains unclear for a long time, may be the result of suppuration of bronchiectasis or the result of inflammation of their wall. An increase in temperature is often accompanied by a tremendous chill, and a fall is accompanied by a heavy sweat. Periods of fever in patients with bronchiectasis usually alternate with afebrile periods.
The true cause of fever is difficult to identify only in those cases of the disease that occur without sputum. The inflammatory process in such cases is localized in the wall of the bronchi or in the lung parenchyma surrounding the bronchus. The foci of this "perifocal pneumonia" may be small and therefore not always detected on plain radiographs. After a course of antibiotic therapy, fever usually disappears for quite a long time, then reappears due to hypothermia. Fever occurs, possibly in connection with the reinfection of bronchiectasis or in connection with the reactivation of already existing flora under the influence of adverse environmental conditions.

Lung abscess - inflammation of the tissue of the organ itself, formed due to purulent fusion. It forms a cavity filled with this liquid. When the first signs of the disease appear, an urgent call to the therapist at home is required.

Possible causative agents of acute lung abscess

Pathogenic bacteria usually act as the causative agent of the disease, especially Staphylococcus aureus. The disease can develop against the background of a general decrease in immunity and weakness of the body as a result of various foreign bodies entering the respiratory tract and lungs. In a state of extreme intoxication or unconsciousness, vomit, mucus and other substances can enter the lungs, causing the development of an abscess. Against the background of chronic diseases and infections, with a long course of taking antidepressants or glucocorticoids, with impaired bronchial drainage, a lung abscess develops quite often. Another way of infection is hematogenous. In this case, the infection enters the lungs with sepsis. This route of infection is extremely rare. Secondary infection can occur against the background of a pulmonary infarction. Another fairly common cause of the disease is a wound in the chest area.

The first stage of the abscess is characterized by infiltration of lung tissue in a limited area. Then the abscess melts, gradually forming a cavity. At the next stage of the disease, infiltration along the edges of the cavity disappears. The cavity at this time is covered with granulation tissue. If the disease passes in a mild form, the cavity closes, and an area of ​​pneumosclerosis forms on it. If the cavity has fibrous walls, then inside the processes of pus formation are prone to self-sustaining. In this case, a chronic lung abscess develops. This stage of the disease is more characteristic of men than women. At the same time, almost half of the patients drank alcohol in large doses.

What can be the causes of the onset of a lung abscess

1. Pneumonia provoked by anaerobes or staphylococcus aureus. Contact with a patient with a subdiaphragmatic abscess.

2. The ingress of any foreign body into the lungs or bronchi.

3. Infection of the tonsils and paranasal sinuses.

4. Numerous abscesses in history, arising against the background of septicopyemia.

5. Emboli penetrating into the lungs from various foci of diseases: prostatitis, onitis; and with the lymphogenous method - from the infected oral cavity, boils from the lips.

6. The collapse of a cancerous tumor in the lung or a complication of a pulmonary infarction.

Symptoms of the disease

Signs of a lung abscess, as a rule, are not long in coming. The disease develops rapidly - the patient feels pain in the sternum, he has a fever, chills appear. Sputum in a lung abscess is secreted through the oral cavity after a bronchus rupture. The sputum smells unpleasant, there may be blotches of blood. When listening, it is clear that breathing is weakened, after a breakthrough it becomes bronchial with accompanying moist rales. The formation of a thin-walled cyst or pneumosclerosis is an approach to a favorable end to the disease. It should be expected approximately 2 months after infection. A chronic lung abscess may occur, the reasons for this lie in improper treatment or its absence.

The first stage of the disease lasts about a week. The onset of the disease can take up to three weeks. It happens that a purulent cavity needs only 2 days to develop, such an onset of the disease is considered to be rapidly rapid.

The second stage of the abscess is characterized by a rupture of the cavity and its purulent contents. Fever develops, dry cough gives way to wet expectorant. The patient constantly coughs and expectorates pus in large quantities. The amount of pus varies depending on the volume of the cavity and can reach 1 liter or more.

The final stage of the disease is characterized by a decrease in symptoms of intoxication and fever. The patient feels much better. Blood tests taken at this stage indicate the retreat of the infection.

The difficulty lies in the fact that it is not always possible to clearly distinguish the stages of the disease. In the case of a small size of the draining bronchus, sputum will not come out in large volumes, as it should be. Although if the collected sputum will stand for some time in a glass container, it will delaminate. The top layer will become frothy, the middle layer will be liquid, and the bottom layer will be thick and grey.

Complications of lung abscess

When the pleura or its area is involved in the course of the disease, complications of an abscess may occur. Complications of the disease occur against the background of purulent pleurisy. Pulmonary bleeding can occur in the case of purulent fusion of the vascular walls. The infection can easily spread to healthy areas of the lung, forming numerous purulent foci. It is possible to pass the infection to the adjacent healthy lung. If the spread of infection occurs in a hematogenous way, foci of abscess can occur on other organs, which can cause bacteremic shock and spread of the disease throughout the body. Lung abscess is fatal in five percent of cases out of a hundred.

How to diagnose a disease

At the first signs of a disease such as a lung abscess, the diagnosis is carried out in full, it is necessary to pass all the tests: blood, urine. In the blood test, the doctor will see a pronounced leukocytosis, an increase in the permissible level of ESR, and toxic granularity of neutrophils. The analyzed blood improves by the beginning of the second stage of the abscess. When the disease becomes chronic, the level of hemoglobin in the blood decreases markedly. Blood biochemistry changes: the amount of seromucoid, haptoglobins, fibrin increases, and the amount of albumin in the blood decreases.

Urinalysis will show how the indicators of albuminuria and microhematuria change.

The more difficult the course of the disease, the higher they grow.

For a correct diagnosis, a sputum analysis is mandatory. It is checked for the presence of fatty acids, atypical cells, elastic fibers, and also for the presence of tuberculosis bacteria.

The causative agent of the disease is detected by sputum microscopy. Then sensitivity and reaction to antibiotics comes to light.

The surest and fastest way to make this diagnosis is to conduct fluoroscopy of the lungs. If diagnosis is difficult, an MRI of the lungs, CT of the lungs, bronchoscopy and other procedures prescribed by the doctor are performed. If pleurisy is suspected, a pleural puncture is required.

Treatment of lung abscess

If, according to the results of the tests, a lung abscess is confirmed, treatment is carried out immediately. Depending on the severity of the abscess, the doctor prescribes the appropriate therapy. A conservative or surgical treatment is possible. Both methods of therapy are carried out in a hospital under the supervision of pulmonologists.

To defeat a lung abscess, the disease is treated conservatively, which implies mandatory sputum drainage, i.e. the patient several times a day should take a position convenient for sputum discharge. Compliance with bed rest is necessary for a favorable outcome of the disease. As soon as the sensitivity of microorganisms is determined by the laboratory assistant, the doctor prescribes antibiotic treatment. A transfusion of the necessary components of donor blood is prescribed. In some cases, the patient is transfused with his own blood taken in advance. These procedures are prescribed to restore the functions of the immune system. Also, the attending physician decides on the advisability of prescribing globulins to the patient.

In some cases, when natural drainage slightly improves the patient's condition and sputum discharge, he is prescribed bronchoscopy with aspiration of the cavities. During this procedure, the cavity is washed and treated antiseptically. In difficult cases, the antibiotic is injected directly into the purulent cavity. Purulent lung abscess in 75-80 percent of cases is single and localized in the segments of the right lung.

In the absence of the results of conservative treatment or the occurrence of life-threatening complications, they resort to a surgical solution to the problem: the doctor removes part of the diseased lung under anesthesia.

Abscess and gangrene of the lung are the most common acute suppurative lung diseases.

Disease prevention

Preventive measures in the case of this disease are not always effective. But you should be aware of some rules:

It is necessary to treat pneumonia, bronchitis and other diseases of the respiratory system in time;

Prevention of foreign bodies entering the lungs and bronchi;

Timely treatment of purulent diseases, boils on the body and especially abscesses in the oral cavity;

Do not abuse alcoholic beverages.

Forecast

The prognosis of this disease with proper and timely treatment is favorable. Often, a lung abscess disappears with time: the infiltration around the cavity becomes thinner. Over time, the cavity is no longer defined. Within 8 weeks, the disease disappears (if it does not drag on or becomes chronic).

In the absence of proper treatment, an acute lung abscess will become chronic with corresponding exacerbations and remissions. This nosological form is characterized by the formation of a certain cavity in the affected organ, and an irreversible process of changes in the parenchyma and bronchial tree occurs around it. These metamorphoses take the form of deforming bronchitis, proliferation of connective tissue, and in the future they may flow into bronchiectasis. The transition of an acute form of lung abscess into a chronic one is observed in 2.5-8% of cases.

Pathogenesis and etiology of the disease

If a chronic lung abscess is confirmed, the patient's medical history begins long before it. Chronic abscesses occur due to the same pathogens that provoke acute suppuration in the lungs. These include staphylococcus with a predominance of strains that are resistant to most antibiotics, including the most modern ones. There are also similar, in terms of resistance to medical effects, microorganisms with a significant role in the etiology of chronic lung abscesses. These are gram-negative rods such as Proteus, Escherichia, Pseudomonas, etc. A mycological study, which has a clear focus, reveals in a larger proportion of patients the presence of pathogens of deep mycoses that are isolated from sputum. Moreover, only by identifying serological markers of an active fungal infection, it turns out to prove their etiological significance. These conditions make the etiotropic therapy of chronic abscesses a difficult task.

The transition from the acute form of pulmonary abscess to chronic is due to the following main factors:

• there is either too much destruction in the lung (more than 5 cm), or there are too many of them;
• the process of drainage of the cavity of destruction was ineffective or went inadequately, in connection with which connective tissue developed in the surrounding parenchyma, and a fibrous capsule was formed, which will subsequently prevent a decrease in the size of the cavity;
• in the cavity of the abscess there are sequesters that block the mouths of the draining bronchi, and also constantly support suppuration inside the cavity and inflammation around it;
• conservative treatment of acute lung abscess provoked the formation of a dry residual cavity, as well as its epithelialization from the mouths of the draining lungs;
• non-specific nature of the body's resistance and compromised immunity;
• in the segments of the lungs affected by the abscess, pleural adhesions formed, due to which there is no early recession and obliteration of the cavity.

Due to chronic hypoxia and purulent intoxication, due to a deficiency of non-gas exchange pulmonary functions and due to a malfunction of the endocrine, nervous and other regulatory systems of the body, a long-term chronic suppurative process is accompanied by a variety of disorders:

• compensatory and reserve possibilities of blood circulation are reduced;
• observed pulmonary hypertension;
• microcirculation in organs and tissues is disturbed;
• acquired secondary immunodeficiency;
• changes occur in energy and protein metabolism.

Clinic and diagnosis of chronic abscess

Chronic lung abscess symptoms are as follows:

• persistent cough;
• chest pain;
• prolonged feeling of lack of air;
• chronic purulent intoxication;
• possible complications from other organs and systems of the body.

It is difficult to accurately determine a chronic lung abscess, the symptoms can be expressed to any degree, it depends on the severity or stage of the disease, the phase of its course (remission or exacerbation), the nature of changes in the lung tissue, the degree of violation of bronchial drainage function. It is noteworthy that over the past 20 years, the methods of treating acute pulmonary suppurations have improved so much that the frequency of transitions to the chronic form has significantly decreased, in addition, their clinical manifestations have become much weaker.

Complications of chronic abscess

Most often, a chronic lung abscess is accompanied by the following complications:

• pulmonary bleeding;
• secondary bronchiectasis;
• sepsis.

In most cases, they appear during an exacerbation of the disease or its long-term treatment. Recently, amyloidosis of parenchymal organs has become much less common.

Treatmentchronic abscess

If a chronic lung abscess is diagnosed, treatment occurs only through surgical intervention.

The conservative method of treating the lion's share of patients consists in preoperative preparation. These activities may even become the only possible way of treatment if surgery is not possible for any reason. This method is characterized by the following activities:

• sanitation of the tracheobronchial tree and destruction cavity;
• relief of exacerbation of purulent destruction;
• correction of disturbed functions of the body to increase its reserve capabilities, which will help to resist surgical aggression.

Very difficult and time-consuming is the postoperative treatment of people who have suffered a chronic lung abscess. Such patients require special attention, as there may be a whole chain of interdependent complications after surgery. Postoperative complications in this category of patients can be various:

1. Common: circulatory decompensation, thromboembolic complications.
2. Pulmonary and bronchopleural, such as pneumonia, pleural empyema, bronchial fistulas, bronchus stump failure.
3. General surgical nature: infection of the postoperative wound, postoperative bleeding.

In the postoperative period, which lasts a day or two, it is mainly necessary to provide all the conditions for the restoration and maintenance of the main life-supporting systems of the body, weakened by the disease and surgical intervention. These include the respiratory system and the circulatory system. When the respiratory process stabilized, hemodynamics improved, it was time to switch intensive therapy to the prevention of infectious complications. It should be accompanied by corrective and supportive therapy. The early stage of the postoperative period is considered to be successfully completed if the operated lung has expanded, blood counts have returned to normal, and the patient can easily get up and walk. After a longer time after the operation, after symptomatic therapy, local treatment and elimination of complications that could not be eliminated earlier are started. At the same time, the respiratory and circulatory systems stabilize, and metabolic processes return to normal.

Surgical intervention in patients with chronic lung abscesses over the past few decades has shown much better results. But even successful surgical treatment of the lungs does not exclude fatal outcomes. Unfortunately, the mortality rate of patients in this category is still high and reaches 15%. Most often, patients die due to bleeding, heart and respiratory failure, and also due to pleural empyema. Analyzing the statistics of deaths in patients with chronic lung abscesses after resections, we can conclude about methods for improving treatment outcomes. To do this, it is necessary to carefully prepare patients for surgery, improve the technique of surgical intervention, and timely prevent and treat developing postoperative complications.

Classification, pathogenesis and clinical signs of abscess. Treatment of animals with abscesses. Diagnosis and stages of development of phlegmon. Pathogenesis and main forms of sepsis, methods of therapy. Features of purulent-resistive fever as a preseptic condition.

Clinical forms of the reaction of the organism of animals to infection (abscess, phlegmon, purulent-resorptive fever, sepsis)

abscessWith - Abscessus

An abscess is a limited purulent inflammation of loose tissue, accompanied by the formation of a cavity filled with pus. With an abscess, purulent processes prevail over necrotic ones.

Classification

By etiology abscesses happen aseptic and septic or infectious.

Aseptic abscesses develop after the introduction (introduction) under the skin of some irritating chemicals, in particular, sterile turpentine, kerosene, chloral hydrate, calcium chloride, which cause tissue necrosis. Necrotized tissues are lysed by neutrophilic leukocytes with the formation of microbial-free pus.

All other abscesses are septic. They occur most often as a result of the introduction of pyogenic microorganisms into the tissues: streptococci, Escherichia coli, Pseudomonas aeruginosa, as well as pathogens of putrefactive infection.

Abscesses can also develop in common infectious diseases such as tuberculosis, actinomycosis, botryomycosis.

By the course of inflammatory processes abscesses happen hot and cold . The former are caused, as a rule, by pyogenic microorganisms, and the latter by pathogens of a specific infection.

By localization abscesses are classified into superficial and deep

Superficial abscesses can be located in the skin and subcutaneous tissue. Deep abscesses are intermuscular, subfascial, retroperitoneal. Deep abscesses are more often encapsulated (when they are overgrown with a connective tissue capsule and can be located among the muscles, in internal organs for years) and serve as foci of a dormant infection.

Depending on the ways of spreading infection distinguish abscesses:

metastatic - which spread by the hematogenous or lymphogenous route and, as a rule, occur with sepsis with metastases;

scribbled - which extend along the anatomical continuation. As a rule, in this case, the focus of infection is located above, and pus accumulates below. Pus usually gets here through the interfascial spaces. An example is the development of an infection in the croup with the formation of an abscess in the thigh and lower leg.

By intensity of the inflammatory process abscesses happen benign and malignant . Benign abscesses are well demarcated, and malignant ones are capable of transition to phlegmon due to a weak demorcation shaft. The organisms that cause such abscesses are usually highly virulent.

Depending on the stages of surgical infection distinguish between abscesses mature and maturing . Ripening abscesses are abscesses that are at the stage of fixation and localization of the pathogen, and mature ones are at the stage of removing the stimulus.

Pathogenesis and clinical signs

As you already know from the pathogenesis of surgical infection, the first stage of the first phase is the stage of pathogen fixation. At the site of the introduction of the pathogen, serous-fibrinous or fibrinous inflammation appears with all the signs - swelling, increased local temperature, redness, pain and dysfunction. All these signs are clearly expressed in skin and subcutaneous abscesses and smoothed out in the case of deep abscesses, in which a slight swelling from muscle elevation is possible, but an increase in local temperature and redness will not be observed. It is possible to assume the presence of a deep abscess by severe pain on palpation over the site of inflammation, by impaired function and by impaired general condition (increased temperature, pulse rate and respiration).

In the first stage, it is difficult to distinguish aseptic inflammation from septic. With cold abscesses of any etiology, in the first stage, inflammatory abscesses are either not expressed at all (with a swelling abscess) or weakly expressed (with abscesses caused by a specific infection).

In the second stage of septic inflammation - the stage of abscess development in skin and subcutaneous abscesses, a spherical swelling appears, hot and painful. On palpation of the swelling, fluctuation is noted. A demorcation shaft is palpated around the abscess. With deep abscesses, fluctuation is rarely palpated, but a feeling of unsteadiness is possible.

In the stage of removing the irritant with superficial abscesses, the swelling, as a rule, has the temperature of the surrounding tissues, is not painful, fluctuation is well expressed. In the center of the greatest tension, one or more foci of softening appear, which after a while ulcerate and pus pours out.

With deep abscesses, this stage is characterized by a decrease in pain over the abscess. Deep abscesses, as a rule, open into the intermuscular space, in the cavity, which can cause a deterioration in the general condition.

In the stage of a mature abscess, temperature, pulse, respiration are within the physiological norm.

With gas or anaerobic abscesses, which are quite common in cattle, there is a high body temperature, depression, poor development of the demorcation shaft and the rapid development of the process. On palpation, there is very strong tissue tension and crepitus. At autopsy - bloody exudate with gas bubbles.

Diagnostics

Diagnosis of superficial abscesses is not difficult. The diagnosis is based on clinical signs, depending on the stage of septic inflammation. Clarify the diagnosis by puncture (as punctate - pus). With deep abscesses, puncture is the main diagnostic method. A hematological examination is also carried out.

It is necessary to differentiate abscesses from phlegmon, hematoma, lymphoextravasate, neoplasms, hernia. With phlegmon, diffuse swelling is noted without a demorcation shaft. A hematoma develops very quickly, immediately after an injury, and an abscess forms within a few days. Lymphoextravasates and neoplasms develop slowly and are not accompanied by inflammatory phenomena. With hernias, there is a hernial ring, with auscultation of the swelling, peristaltic noises of the intestine are heard.

When treating animals with abscesses, treatment should be consistent with the staging of the abscess. In the first stage, before the appearance of suppuration, it is necessary to direct the treatment to neutralize the pathogen. This stage is used:

Novocaine blockade with antibiotics (according to the principle of a short novocaine block)

Sulfanilamide preparations

General antibiotic therapy

Light warmth. But heat is used very carefully and only until suppuration appears or until a sharp increase in temperature, pulse, respiration. It is not recommended to use heat at all for deep abscesses, since it is possible to open it into the internal environment of the body and develop sepsis.

Ultraviolet irradiation in erythemal doses

Monochromatic laser radiation. After applying 1-2 sessions of laser irradiation, the resulting abscess is relieved and even resorbed.

With the appearance of suppuration, pus is removed from the abscess cavity as early as possible so that the demarcation shaft does not dissolve and phlegmon or sepsis does not develop. This is especially true for deep abscesses. Those. it is necessary to follow the rules of ancient doctors: "Ubi pus, ibi evacvia citissime": - where there is pus, remove it faster. Remove pus from abscesses in different ways.

For large superficial abscesses, it is recommended to first use a needle with a rubber tube to puncture and aspirate part of the pus. After that, the abscess is opened with a wide incision, without affecting the demarcation shaft. The abscess cavity is washed with antiseptic liquids, which are better oxidizing - these are 3% solutions of hydrogen peroxide, solutions of potassium permanganate or sodium hypochlorite at a concentration of more than 1000 ng / l. It is possible to use preparations of the nitrofuran series, in particular, furatsilin 1:5000, ethocridinalactate 1:500 (1000). In the future, the abscess cavity is powdered with antibiotics or other bacteriostatic powders. It is possible to introduce loose drainage with hypertonic saline solutions or Vishnevsky ointment into the abscess cavity

Pus can be aspirated from small abscesses, the cavity can be washed with antiseptic solutions, novocaine with antibiotics can be injected inside. As a result, resorption of the abscess wall may occur, but this is extremely rare.

For superficial encapsulated abscesses. if they are located in the operable area, then they can be extirpated, and stitches can be applied to the wound. Extirpation must be carried out very carefully, since the abscess capsule can be of various thicknesses and can be torn.

abscess treatment diagnosis phlegmon sepsis

In case of malignant abscesses, they are opened, dead tissues are partially excised, and prolonged washing with antiseptics is used. To enhance the rejection of dead tissues, enzymes are used by impregnating drains - trypsin, fibrinolysin, procel. It is possible to treat the inner surface of the abscess with a defocused beam of a high-energy laser.

Phlegmon

PHLEGMON ( Phlegmona )-- this is a diffuse spreading acute purulent, less often putrefactive, inflammation of loose fiber with a predominance of necrotic processes over suppurative ones.

You see, already in the definition there is a very big difference between an abscess and phlegmon. In the first case - limited, in the second diffuse - inflammation.

Classification

According to the etiology of phlegmon are divided into:

aerobic putrid

anaerobic mixed

In addition, there may be aseptic phlegmon, which is caused by the introduction of acutely irritating substances under the skin, in particular calcium chloride, chloral hydrate, turpentine. Distinguish also primary and secondary e phlegmon.

Primary ones occur after injuries, after injections of medicinal substances without observing the sterility of the instrument. Secondary phlegmons develop as a complication of a localized, acute infection (furuncle, abscess, osteomyelitis, etc.), and can also occur metastatically and as a result of a dormant infection.

By the nature of the exudate, phlegmons are:

serous - with purulent infection

gas - with anaerobic infection

purulent putrefactive.

According to the distribution of phlegmon are:

limited

progressive

According to the localization of phlegmon are divided:

subcutaneous

submucosal

intermuscular

subfascial

pararectal

perechondrial

paraarticular

pararenal

Pathogenesis and clinical picture

The development of phlegmon occurs according to the general scheme for the development of septic inflammation.

To the first stage Phase I is diffuse impregnation of tissues with serous exudate. The connective tissue is especially impregnated. The exudate is first transparent, and then cloudy, since a large number of leukocytes appear in its composition. At this stage, a diffuse swelling is noted, which has an indistinct configuration, its borders are uneven, but in the form of protrusions. There is severe pain, tissue tension. The general condition is depressed, high body temperature, especially with anaerobic phlegmon.

To the second stage- the stage of localization in many places of aerobic swelling, which is strongly compacted, foci of suppuration and progressive tissue necrosis are formed. A demarcation barrier is formed along the periphery. The general condition is even more oppressed. The temperature is very high and breathing is rapid. In the blood, hyperleukocytosis.

In the case of anaerobic or gaseous phlegmon, due to the formation of gases, the central part of the swelling becomes cold, painful, gaseous crypitation is felt on palpation. In the presence of a wound or an incision, a liquid, unpleasant odor, foaming exudate is released from them. The demarcation shaft is missing. If a putrefactive infection is mixed with an anaerobic infection, then the exudate has a fetid odor, there are many scraps of tissue in it.

In the stage of removing the stimulus with aerobic phlegmon, abscesses are formed. With a large area of ​​phlegmon, there may be several abscesses. The skin in these places becomes thinner, and pus breaks out or into the body cavity. The general condition improves somewhat.

With spreading phlegmon, as well as gas - there is no pus. Edematous tissues - loose connective tissue and muscles, necrotic. Muscle tissue turns into a brownish-red mass of an unpleasant odor. The skin also undergoes necrosis.

The diagnosis of phlegmon is made on the basis of clinical signs, hematological examination and puncture results.

The prognosis for serous, subcutaneous purulent and submucosal purulent with appropriate treatment is favorable. With deep purulent phlegmon, spreading purulent, gaseous and putrefactive, it is often unfavorable, less often cautious. Since sepsis is possible.

Treatment. In the first stage, with serous and purulent phlegmon, the same treatment is used as with abscesses. The only difference is that if it is impossible to make a short novocaine blockade with extensive phlegmon, novocaine is administered intravenously.

At the same stage, with a high tissue tension, skin incisions are made to reduce interstitial pressure.

In the second and third stages, as soon as foci of abscess formation appear, they are opened. The incisions should be multiple, not very wide, but deep enough.

With a large surface of the lesion, the incisions should be staggered or parallel to each other - the so-called "lamp incisions". Dead tissues are removed, inflows are eliminated, counter-opening holes are made. Then apply topical antimicrobial therapy, as in abscesses. At the first appearance of signs of anaerobic and putrefactive phlegmon, they are immediately opened. Since anaerobes have a strong virulence, phlegmons are opened in a separate room and with personal hygiene. An autopsy is performed to healthy tissue - until signs of bleeding appear. This is necessary for the access of oxygen. You can apply the introduction of oxygen under the skin in the affected area and into the muscles, as well as around the phlegmon.

In addition to local treatment, intensive general therapy is used:

antibiotic therapy 20-30 thousand units per kg of live weight

intravenous administration of alcohol

antitoxic substances (urotropine, caffeine, calcium chloride)

drugs that increase the body's resistance: prodiglozan, T-activin, pyrogenal, auto- and heterohemotherapy, blood irradiation with ultraviolet rays 1 mg/kg of body weight.

Sepsis or general infection

There are many definitions of sepsis, but all of them are not entirely successful, since they do not reflect all the processes occurring in the body. (In translation, sepsis means "blood poisoning")

Currently, the following definition is mainly used: sepsis is a difficultly reversible infectious-toxic process, accompanied by deep neurodystrophic shifts and a sharp deterioration in all body functions resulting from the penetration of the pathogen and the absorption of toxins from the primary infectious focus. Sepsis often results in the death of the animal.

Etiology. As can be seen from the definition, in order for sepsis to occur, a focus of surgical infection or a septic focus is necessary. Sometimes there may not be a visible septic focus. This means that sepsis arose due to the focus of a dormant infection. Such sepsis is cryptogenic. They can be purulent wounds, malignant abscesses, phlegmon, boils, carbuncles with a large amount of soft tissues, the presence of pockets and inflows.

Mandatory in the occurrence of sepsis is a strong pathogenic microorganism and a sharp decrease in the resistance of the animal organism.

A specific causative agent of sepsis has not been identified. Sepsis can be caused by various representatives of anaerobic, aerobic and putrefactive infections. most often with sepsis, hemolytic and non-hemolytic streptococcus, Staphylococcus aureus, Escherichia coli and various anaerobes are found. It should be noted that the detection of some pathogen in the blood does not yet indicate sepsis, it can also be there with a local surgical infection. Conversely, bacteremia is often not detected in sepsis.

The pathogenesis of sepsis

Microorganisms that have entered the blood, microbial toxins and cellular decay products absorbed into the blood are the strongest irritant for the nervous system, which leads to its degenerative changes. As a result of neurodystrophic changes, as well as the strongest intoxication of the body, they cause metabolic disorders - acidosis develops, the amount of gamma globulins in protein metabolism decreases - the main component of nonspecific humoral immunity. In the body, the content of vitamin C decreases, which reduces the antitoxic function of the liver. There may be degeneration of the liver and its atrophy. Hematopoiesis is impaired. With sepsis, as a result of decay products and bacteria entering the vascular bed, the body becomes sensitized. Blood circulation is disturbed, peripheral vessels overflow with blood, which means that blood pressure drops. There may be so-called septic bleeding, hemorrhage, thrombosis, phlebitis, inflammation of the lymphatic vessels.

A circulatory disorder leads to a violation of the secretory and motor function of the gastrointestinal tract. All this leads to exhaustion, muscle atrophy, degeneration of parenchymal organs. Animals are stale, bedsores appear. If left untreated, animals die.

Sepsis classification

By the nature of the pathogen

aerobic

anaerobic

putrefactive

mixed

According to the localization of the primary septic focus, sepsis is divided into:

arthrogenic (primary focus in the joints)

osteogenic

odontogenic (for dental caries)

pyogenic (furuncle, carbuncle, abscess, phlegmon)

ungulatory (with purulent-necrotic lesions of the hooves)

gangrenous

peritoneal (due to purulent peritonitis)

gynecological, urogenic, oral, cryptogenic.

Sepsis according to the clinical picture and pathoanatomical changes is divided into:

pyemia - or general purulent infection with metastasis;

septicemia or general purulent infection without metastases;

and septic-pyemia - a mixed form of sepsis.

Downstream, sepsis can be lightning fast - the death of the animal occurs on the first day; acute, subacute and chronic. Some authors distinguish: chronic sepsis into a separate clinical form of sepsis - chroniosepsis.

Consider now the main forms of sepsis.

Pyemia ( Piaemia ) - or general purulent infection with metastases. With this form in the blood, bacterioemia is purulent blood. This is the mildest form of sepsis. With it, the body still has protective reserve forces and tries to localize the infection in various organs in the form of abscesses.

Pyemia is most common in cattle, small cattle, dogs, pigs, and less frequently in horses. Sepsis with metastasis in cattle often occurs with open bone fractures, infection associated with hard work, traumatic pericarditis and endometritis.

In horses when washed and injured. In pigs, sepsis with metastases can be after castration, in dogs after open fractures, crushing of soft tissues.

Metastasis or infection to other organs and tissues in cattle and pigs usually occurs via the lymphatic route. Microbes settle in tissues where there is a slow blood flow - skin, joints, internal organs.

Clinical signs

Changes in the septic focus (abscess, phlegmon) are a picture of a progressive infection. There are inlets and pockets, a lot of dead tissue. Local foci of infection spread to deeper tissues. For example, if the phlegmon is subcutaneous, then it turns into interfascial, then into intermuscular.

Characteristic shifts are noted in the general state of the organism. It is the heaviest. The animal lies, refuses to feed. Breathing fast, pulse small and frequent. High body temperature. It takes on the appearance of a relapsing fever. In the evening, the temperature rises above 40 C, and in the morning it can drop to normal. A sharp rise in temperature is preceded by trembling, and a decrease is preceded by sweating of the animal. Fever can be of intermittent type - the temperature can be normal for 2-3 days. This suggests that at this time, toxins and microbes do not enter the bloodstream. Each new attack of fever and muscle trembling indicates the entry into the blood of new portions of microbes and their toxins. If there is continuous absorption from metastatic foci, a constant type of fever is observed with daily fluctuations in 1C. When the body's defenses are depleted, a perverted type of fever is possible - the temperature is within normal limits, and blood pressure is lowered, the pulse is quickened.

A sharp drop in the temperature curve down while the pulse curve rises at the same time is a reliable sign of the approach of death, therefore the intersection of these curves is called the death cross (crux mortis).

In the blood, hyperleukocytosis, shift of the leukogram to the left. the number of eosinophils and monocytes decreases. Young forms of leukocytes appear. The number of erythrocytes decreases.

The mucous membranes, as a rule, are icteric, as the function of the liver is disturbed and hemolytic processes are taking place.

With metastases in the intestine, profuse diarrhea may occur.

The presence of convulsions and paralysis indicates metastases in the nervous tissue, and the appearance of signs of bronchopneumonia indicates metastases in the lungs.

Septicemia or general purulent infection without metastases. Sometimes it is called rottenness.

With septicemia in the blood, as a rule, microbes are not detected. There is a general poisoning of the body with the waste products of microorganisms and toxic substances formed as a result of tissue breakdown. With this form of sepsis, the body's defenses are completely suppressed.

Septicemia is observed with penetrating wounds of the abdominal wall, postpartum infection, septic peritonitis, purulent-putrefactive and purulent arthritis, deep intermuscular phlegmon.

Clinical signs. First of all, a serious general condition - the animal lies, refuses to feed and quickly loses weight.

Persistent fever. The high temperature persists throughout the illness and may decrease only before death.

the pulse is greatly accelerated, thready and may not be palpable to death, the heart beat is pounding.

The extremities are cold due to impaired peripheral circulation.

The skin becomes dry, its elasticity disappears, skin folds straighten out slowly. The mucous membrane of the eyes is brick red due to multiple hemorrhages, or dirty yellow due to the high content of bilirubin in the blood.

The general weakness, an asthma is sharply expressed. Bedsores appear early.

In animals, symptoms of intoxication of the central nervous system quickly increase - anxiety appears, in dogs - aggressiveness, animals can eat food that is not characteristic of them. Then comes a deep depression.

In the blood, unlike sepsis with metastases, there is no leukocytosis. This indicates the complete suppression of the entire resistance of the organism. At the same time, a sharp neutrophilic shift to the left is observed in the leukogram. The number of erythrocytes decreases sharply, hemoglobin falls, because toxic hemolysis occurs. Eosinophils and monocytes completely disappear. The content of Y-globulins in the blood falls sharply, the content of bilirubin increases. In the primary septic focus, purulent-necrotic, putrefactive or gangrenous tissue decay occurs.

The prognosis for septicemia is unfavorable. With a lightning-fast form, the animal dies after 1-2 days, with an acute form - after 5-7. Death occurs with the phenomena of a drop in temperature, or vice versa - its excessive increase.

Septic-pyemia - a mixed form of sepsis is characterized by the formation of metastases and severe intoxication. The clinical picture shows signs of both pyemia and septicemia.

Treatment for sepsis. It is a very difficult task, but a necessary one. A doctor with sepsis is put in a hopeless situation - he must treat the animal, because forced cutting is excluded. The meat is not suitable for human and even animal consumption.

Treatment for sepsis should be comprehensive: general and local if there is a septic focus. In this case, all types of treatment should begin at the same time and as early as possible.

Local treatment is carried out in the same way as for a local surgical infection, trying to use the strongest antimicrobial drugs. Sometimes it is necessary to amputate parts of the body with a septic focus to save the animal (a finger in cattle and pigs, a limb in dogs and cats)

General treatment should pursue the following goals: suppression of the vital activity of microorganisms (antimicrobial therapy), neutralization and elimination of toxins from the body, increasing the body's resistance.

Antimicrobial therapy includes:

The use of antibiotics, both in / m and / in. In sepsis, antibiotics of the penicillin, gentomycin, polymyxin, and erythromycin groups are recommended.

The use of sulfa drugs - norsulfozol and nitrofurans.

Intravenous administration of 33-40% alcohol.

From the means of removing intoxication of the body and accelerating the introduction of toxins, the following can be used:

In / in the introduction of fluids that reduce intoxication: - Polydez, Hemodez, Polygemodez in a 30% concentration per 300-500 ml IV.

The use of agents that enhance the excretion of toxins from the body - in particular hexamethylenetetraamine or urotropine in / in a 40% concentration of 50-60 ml per animal.

Therapy aimed at increasing the body's defenses (or resistance)

Providing rest and complete food. Exclude concentrates from the diet, and introduce easily digestible foods rich in carbohydrates and vitamins.

2. In / in the introduction of glucose to increase the antitoxic function of the liver in conventional doses. The introduction of glucose is best combined with the introduction of calcium chloride at a dose of 150-200 ml to large animals. Calcium normalizes the ratio of potassium and calcium, acts antitoxic and antihistamine.

Vitamin therapy. Particularly indicated is the intravenous administration of 5% ascorbic acid at a dose of 200-300 ml, the intramuscular administration of B vitamins.

Horses are shown the introduction of liquid according to Kadykov.

camphor 4.0

ethyl alcohol 200.0

glucose 120.0

isotonic NaCL solution 700 ml

In/in administered 200 ml daily:

Transfusion of compatible blood gives good results. It reduces intoxication, reduces anemia, activates the immune system and hematopoiesis.

At present, we widely use ultraviolet and laser blood irradiation in the clinic at doses of 1 ml per kg of live weight.

To combat dehydration, the introduction of an isotonic solution of NaCL and plasma substitutes (polyglucin) is used.

In order to relieve sensitization and re-irritation of the nervous system, 0.25-0.5% novocaine is used intravenously.

Symptomatic treatment is prescribed according to the manifestation of symptoms characterizing the defeat of a particular organ.

Purulent-resistive fever (PRF)

This can be said to be a preseptic condition, but it differs from sepsis.

Purulent-resistive fever develops as a result of the absorption of microbial toxins and tissue breakdown products. As a result of this, the body temperature steadily rises, the pulse and respiration become more frequent. But unlike sepsis, there are no functional changes in the leukogram. Sometimes there may be a neutrophilic shift to the left, but monocytes and eosinophils do not disappear. If you eliminate the septic focus, then HRL disappears. If left, then sepsis develops.

Aseptic resistive fever should be distinguished from RHF. It occurs as a result of closed injuries without the intervention of infection. And it is the result of the absorption of cell decay products as a result of death under the influence of a traumatic factor. The body temperature rises, but the pulse and respiration are within normal limits.

Similar Documents

The main causes of vaginitis in animals. The development of purulent-catarrhal vaginitis as a complication of postpartum purulent-catarrhal endometritis. Stages of the inflammatory process in the disease. Pathogenesis and clinical signs, prognosis and treatment.

abstract, added 12/12/2011


Etiology, pathogenesis, clinical signs, diagnosis, treatment and prevention of corolla, sole and crumb wounds in horses. Causes of corolla phlegmon in animals. Methods for the treatment of purulent inflammation of the hoof joint in cattle.

abstract, added 12/21/2011


Anamnesis of life and description of clinical signs of the pathological process in sick animals. Diagnosis of "acute purulent-catarrhal endometritis". Clinical signs of cow disease. Differential diagnosis and rationale for treatment methods.

term paper, added 03/26/2014


An infectious disease characterized by purulent-necrotic lesions of the skin, mucous membranes, internal organs and extremities. Several species of Fusobacterum necrophorum. bacteriological research. The main forms of the disease and the analysis of pathogens.

presentation, added 05/05/2017


Diagnosis and clinical signs of chronic endometritis. Treatment and mode of keeping animals. Pyometra as a purulent inflammation of the uterus. Classification of chronic endometritis by etiological factor. Pathogenesis of the inflammatory process in the uterus.

term paper, added 09/29/2009


The first clinical signs of mumps disease. Great thirst, rapid breathing, agitation, muscle trembling. Feed poisoning of animals. Violation of the regime of feeding and drinking. Pathogenesis and clinical signs of urea and table salt poisoning.

case history, added 02/14/2014


The history of the emergence and spread of the disease Q fever. Etiology, sources of the causative agent of infection, pathogenesis and features of the course of the disease in large horned animals. Differential diagnosis, methods of treatment and prevention of coxiellosis.

abstract, added 02/03/2012


Etiology, pathogenesis and classification of skin diseases. Their common manifestations in animals. Describe the main steps in the process of diagnosing skin diseases. Symptoms and course of a skin abscess in a dog. The causative agents of the purulent process. Methods of treatment.

term paper, added 10/20/2014


Brucellosis is an infectious chronic disease of domestic and wild animals and humans. Clinical signs and consequences of the disease, differential diagnosis. Epizootological data, pathogenesis, course of the disease and pathological changes.

abstract, added 01/26/2012


Etiology and pathogenesis of phlegmon of the neck, pathogens and varieties of the disease. The clinical picture of the course of the disease in horses, the features of the diagnosis and prognosis of recovery. The scheme of treatment in the initial stage and the postoperative period.