Bronchopneumonia

What is Bronchopneumonia?

Bronchopneumonia can be defined as a medical condition, in which the walls of the bronchioles suffer from an acute inflammatory process. This condition is also known as bronchial pneumonia or bronchogenic pneumonia and it should not be confused with lobar pneumonia. This type of pneumonia can affect more than one pulmonary lobules, having often a bacterial infection as underlying cause.

As opposed to the lobar pneumonia, bronchopneumonia is less likely to be found in association with the streptococcus. On the other hand, it is often found in association with the hospital-acquired pneumonia and the specific bacterial organisms that are behind it – meaning the staphylococcus aureus, E.coli, Klebsiella or pseudomonas.

Pneumonia, in general, is considered to be one of the most common causes of death due to a bacterial infection. The incidence is of 11.6 for each 1000 people each year, only in the United States. Children and older people present the highest risk for developing bronchopneumonia (especially in hospital-setting).

Pathophysiology

In the situation that a person suffers from bronchopneumonia of bacterial cause, the lung parenchyma is practically invaded by the bacteria. In response, the immune inflammatory response is triggered. Because of this response, the alveolar sacs are filled with exudate. When the air space is replaced by the exudate (fluid), this process is known as consolidation. In patients suffering from bronchopneumonia, there are multiple, isolated areas of consolidation, affecting different pulmonary lobes.

It is important to understand that lobular bronchopneumonia can lead to lobar pneumonia, this being suggestive of a progressive bacterial infection. The most common area in which the exudate starts to buildup is in the basal lobes. The affectation is bilateral in the majority of the cases. The diameter of these lesions varies between 2 and 4 cm; the lesions are yellow or grey in color, dry and centered on a bronchiole. Apart from that, their delimitation is not clear and there is a tendency for the lesions to become united (particularly in children).

When there is an inflammatory process in the bronchioles and suppurative exudate starts to gather, neutrophils (leukocytes) arrive in the area and try to clear the infection. The more bronchioles suffer from inflammation, the more extensive the congestion experienced by the patient is going to be. The parenchyma between the areas of consolidation remains, however, normal (aerated).

One has to remember that bronchopneumonia is most commonly precipitated by the inhalation or the hematogenous spread (rarely) of bacteria (infectious organism). The breach of the bacteria leads to the suppurative peribronchiolar inflammation. This can spread further into the lung bronchiole, leading to the consolidation process and the above-mentioned changes. The extensive congestion is almost always accompanied by the dilatation of the blood vessels in the respective area.

Atypical forms of pneumonia are known to be caused by viral and rickettsial infections. In infants, the most common pathological agent that leads to the appearance of bronchopneumonia is the respiratory syncytial virus.

Risk factors

These are some of the most common factors that can increase a person’s chances of developing bronchopneumonia (risk factors):

• Age – bronchopneumonia typically affects small children (under 2 years) or the elderly (over 65 years)
• Lung disease – cystic fibrosis, asthma, chronic obstructive pulmonary disease
• HIV/AIDS
• Other chronic disease – heart disease, diabetes
• Reduced immunity – chemotherapy, immunosuppressive drugs
• Assisted breathing (ventilator)
• Smoking
• Alcohol abuse
• Difficulties coughing or swallowing
• Malnourishment

Pictures of Bronchopneumonia

Bronchopneumonia Picture 1 : Diagram showing the differences between bronchopneumonia, Lobar pneumonia and Interstitial pneumonia

Symptoms

From the start, it should be mentioned that the presentation of bronchopneumonia depends on several factors, such as: how serious the bacterial infection is, what are the host factors and how many complications have appeared along the way.

In general, these are the most common symptoms that patients diagnosed with bronchopneumonia present:

• Productive cough (mucus)
• Difficulties breathing or shortness of breath (dyspnea)
• Pyrexia/fever
• Rigor
• State of general malaise
• Pleuritic pain
• Hemoptysis (coughing up blood; not in all patients)
• Chest pain
• Rapid breathing
• Sweating or chills
• Headaches
• Muscle aches
• Fatigue
• Confusion or delirium (more often encountered in the elderly population).

Diagnosis

These are the most common methods used for the diagnosis of bronchopneumonia:

Physical examination

• Temperature check (fever)
• Lung auscultation (stethoscope)
  • Identification of bubbling or wheezing sounds
  • Areas where the breathing is fainter (affected by the bronchopneumonia)

Laboratory testing

• Complete blood count (CBC) – white blood cell analysis (elevated – bacterial infection)
• Bacterial cultures – identification of the infectious organism
• Sputum culture – sample of mucus (infection cause)

Imaging studies

• X-ray
  • Multiple small nodular or reticulonodular opacities
  • The opacities are patchy and/or confluent
  • Opacity – area of inflammation
  • Normal lung parenchyma can be noticed between the patches of inflammation.
• CT
  • Multiple opacities (lobular pattern)
  • Tree-in-bud appearance
  • Consolidation areas can overlap, leading a bigger area of consolidation (patchwork quilt appearance)
• Bronchoscopy
  • A small camera is guided through the bronchioles, thus allowing for the visualization of the infection area
  • Can be done to exclude other causes, besides the bacterial infection
• Pulse oximetry
  • A sensor is placed on the finger, being used to measure the amount of oxygen in the blood
  • Can be used to determine how extensive the bacterial infection actually is (whether it has affected the blood’s capacity to transport oxygen or not).

Treatment

These are the regular treatment approaches taken for patients with bronchopneumonia:

Antibiotics

• These can administered orally or intravenously, depending on the seriousness of the infection
• The entire course of antibiotics should be taken, otherwise the infection will return (with the bacteria having developed resistance to the said antibiotic)
• Probiotics are administered at the same time with the antibiotic treatment, so as to protect and maintain a healthy intestinal flora
• Recommended choices of antibiotics – amoxicillin, erythromycin

Symptomatic treatment

• Medication to reduce fever
• Cough medication

Home remedies

• Rest
• Drinking warm fluids (chicken soup, tea)
• Humidifying the air in the room (makes breathing easier)
• Drinking water

Hospital treatment (in serious cases)

• Intravenous antibiotics
• Oxygen therapy (recommended as a supportive care measure in the situation that the blood oxygen levels are low)
• Clearing the bronchioles of the secretions (improved breathing)
• The hospital admission is more recommended in patients who are older in age, with rapid breathing and a drop in the blood pressure
• It is also indicated in those who present confusion or delirium, not to mention those who require breathing assistance.

Prognosis

In the situation that there are no complications and that the patient follows the exact treatment prescribed by the doctor, the symptoms of bronchopneumonia should disappear somewhere between 4 and 6 weeks. Severe infections might take longer to heal, especially if the patient is a child or an elderly person. The pre-existing conditions can delay the healing period, as well as a compromised immune system. Even though one will start to feel better after three or four days since the beginning of the treatment, it is important to complete it as advised. Otherwise, the bacteria can develop resistance to the antibiotics and return, causing a more serious form of bronchopneumonia.

Complications

These are the complications that can occur in patients diagnosed with bronchopneumonia:

• Pleural effusion
• Emphysema
• Lung abscess
• Peripheral thrombophlebitis
• Respiratory failure
• Congestive heart failure

Prevention

The easiest way to prevent bronchopneumonia is through vaccination. At the moment, there are vaccines available against a wide range of bacterial and viral organisms, such as: bordetella pertussis, chickenpox, bacillus anthracis, diphtheria, haemophilus influenza, streptococcus pneumonia, rubella, measles, and adenoviruses.

The annual flu shot is the best way to prevent pneumonia caused by viral organisms. The vaccines are especially recommended for small children and also for the older population. For children, the vaccines have an additional purpose and that is to protect them against community-acquired infections (kindergarten, school).

There are also simple measures that can be taken in order to protect yourself from a potential infection. You should wash the hands on a regular basis, using antibacterial soap. Smoking and alcohol abuse should be avoided, as they can reduce the strength of the immune system. Avoiding contact with sick individuals is a good measure of prevention as well. Apart from that, you can build a strong immune system by taking good care of yourself – you need to maintain a healthy diet (with fresh fruits and vegetables), exercise and get plenty of rest. Getting enough hours of sleep is essential, as this is one of the main factors that contribute to a strong immune system.

In conclusion, this is a serious medical problem and it should be treated as such. Both children and the elderly should be taken to the doctor as soon as the symptoms of pneumonia become obvious, as they present a serious risk for complications (including those that are potentially life-threatening). Hospitalization remains a must for anyone who experiences difficulties breathing, suffering at the same time from confusion or delirium. The admission to the hospital is also recommended for those who suffer from other health problems – the supportive care measures that are offered within the hospital setting can reduce the risk for complications and guarantee the best road to a full recovery.