Caseous pneumonia

By Makarova Elena Alexandrovna

Caseous pneumonia
Caseous pneumonia is characterized by
the development of inflammatory reaction
of the lung tissue with prevalence of
caseation, in which, caseous-pneumonic
foci occupy a lobe or even a whole lung.
Caseous pneumonia is a separate form in
the clas­sification of lung tuberculosis.
In recent years, caseous pneumonia has
been observed in 3-5% of newly
diagnosed tuberculosis patients.
 PATH0M0RPH0L0GICAL CHARACTERISTICS

• The caseous pneumonia arises more often as a result of progression of

the infiltrative pulmonary tuberculosis, but can aggravate the
development of any form of pulmonary tuberculosis.
• The basic morphological attribute of the caseous pneumonia is prevalent
of caseous changes above unspecific perifocal inflammation.
• The basic morphological attribute of the caseous pneumonia is
prevalence of caseous changes above unspecific perifocal. Depending
on the size of the lung volume the following caseous pneumonia are
distinguished:
• 1. acinous;
• 2. lobular confluent;
• 3. segmental;
• 4. lobar caseous.
• During the progression of caseous pneumonia, the pulmonary
tuberculosis develops with numerous cavities.
PATH0M0RPH0L0GICAL PICTURE
 Adverse factors
• bad nutrition,
• HIV-infected,
• alcoholics,
• long-term treatment with glucocorticoids, cytostatic drugs,
• pregnancy,
• diabetes,
• massive infection by highly virulent МВТ.
Clinical signs
The start of the caseous pneumonia is acute.

The syndrome of endogenous intoxication prevails, which is manifested by a complex of
objective signs such as pallor of the skin, almost all have a body weight deficit, and 1/3 have
exhaustion, fever, and night sweats. Body temperature rises to 30-40°C and becomes hectic
in the future.

Functional, dystrophic and inflammatory changes in the myocardium that lead to heart
failure.

Disorders of the respiratory tract of a large area of the lungs lead to hypoxia and
myocardial ischemia. Patients have a rapid pulse, low filling; blood pressure is lowered.
There is a tendency to collapse, microcirculation disorders, and transient edema of the
extremities.

Acute cardiovascular failure is the main cause of death in the first 2 weeks of the disease.

Pronounced respiratory symptoms are characteristic: shortness of breath, cough, first dry,
then, with the release of copious purulent sputum, sometimes with an ichorous smell.

Many patients (25%) have neuropsychiatric symptoms: inappropriate behavior and
psychomotor agitation, deafness, confusion
Physical examination

lagging of the chest part were the infiltration is

located,
painful chest muscles and strengthening of vocal
vibrations.
The data of percussion and aus­cultation have more
expressed character:
dullness of percussion sounds, bronchophony;
bronchial breathing, and crackles;
moist rales of various characters.
 Clinical forms of caseous
pneumonia

1. Lobar caseous pneumonia usually

develops as an independent
clinical and anatomical form of
tuberculosis;
2. Lobular pneumonia often
complicates other forms of
pulmonary tuberculosis
 X-RAY CHARACTERISTICS
• On X-ray examination of the chest organs, common gross changes are
detected .
• In patients with lobar caseous pneumonia, the darkening of the entire or
most part of the lung lobe is determined, initially uniform. As the disease
progresses, areas of irregular illumination with indistinct contours appear.
With computed tomography, the lumen of the enlarged medium and large
bronchi can be clearly distinguished in the compacted lobe of the lung ("air
bronchography») In the future, as the caseous masses are isolated, the
cavities acquire the characteristic features of a cavern with a gradually
forming wall. In the adjacent segments and in the other lung, foci of
bronchogenic dropout are often visible. The affected portion of the lung
decreases as a result of loss of elasticity.
• In patients with lobular caseous pneumonia, large focal shadows and
small foci with a diameter of about 1.5 cm are visible on the x-ray in a
direct projection. Shadows have an irregular shape, medium or high
intensity, and fuzzy contours. Tomography shows multiple decay cavities
in the lungs .
Lobular caseous pneumonia
Lobar caseous pneumonia
 Laboratory methods for
diagnosis
• A feature of acute caseous pneumonia that
makes it difficult to diagnose is the absence
of MBT in sputum in the first 3 weeks of the
disease, even if there are multiple cavities in
the lungs.
• In the future, there is an abundant bacterial
release.
• There is a high frequency of drug resistance.
 Immunodiagnostics

• negative reaction in 50% of patients

(this is a bad prognostic sign),
• in the rest-normergic or hopoergic
tests.
 Treatment
 Chemotherapy according to regime №I with changes after
receiving information about the drug sensitivity of MBT;
Option 1-start with small doses of anti-TB drugs
Option 2-gradual administration of anti-TB drugs
 Sanitary-hygienic regime and therapeutic nutrition;
 Pathogenical therapy- detoxification; anti-inflammatory
therapy (Prednisolone 5 mg/kg with subsequent
reduction), and others;
 Surgical intervention: timely removal of the lung affected
by caseous pneumonia;
 Outcomes of caseous
pneumonia
• The forecast is doubtful.
• Fatal outcome is observed in 6.9-50% of
patients with caseous pneumonia.
• The ability to work of such patients is
permanently lost. As a rule, they are
disabled people of group II.