Popescu V, Dragomir D
Clinica de Pediatrie, Spitalul Clinica St. Pantelimon, Bucureşti.
Pediatrie (Bucur). 1991;40(1-2):85-106.
In spite of the great advances of the antibiotherapy and of the respiratory resuscitation techniques, the staphylococcal pneumonia continues to be one of the most severe bacterial pneumonias of the child, fact which may be explained not only by the poor immunogenic capacity of the infection, but especially by the virulence characteristics of the staphylococcus: necrotizing capacity, toxigenicity (complex), resistance to antibiotics, diffusion capacity of the infection (percontiguum or at distance), resistance to phagocytosis and bacterial lysis etc. The etiology (bacteriology and immunity), the epidemiological data (the disease represents 1/3 of the primitive bacterial pneumonias occurring during the first two years of life), data regarding the pathogenesis and the pathological anatomy are reviewed. The clinical picture, the radiological examination and the laboratory data are extensively analysed, after which the positive diagnosis, based on the correlation of anamnestic, clinical, radiological and bacteriological data, is discussed. Authors point out the contribution of the radiological examination that detects the typical lesions, the aspect of which changes characteristically very rapidly (from day to day), namely: aspect of frank pleurisy (common and very evocative), pyopneumothorax, pneumatocele, excavated staphylomas (abscesses), less frequently mediastinal pneumothorax or emphysema. The clinical differential diagnosis with a number of diseases: suppurative pneumonias, solitary pulmonary cyst, polycystic lung, infected pulmonary sequestration etc., and the radiological differential diagnosis with bilateral diffuse alveolar pulmonary opacities, excavated pulmonary opacities, images under the form of pulmonary "bullae" and "cysts" are discussed. The final part contains a detailed description of the treatment and its basic components: etiological (antibacterial) treatment, treatment by decompression and pleural drainage, resuscitation treatment, as well as of the course, complications and prognosis of staphylococcal pneumonia.
尽管抗生素治疗和呼吸复苏技术取得了巨大进展，但葡萄球菌肺炎仍然是儿童最严重的细菌性肺炎之一，这一事实不仅可以用感染的免疫原性差来解释，尤其是葡萄球菌的毒力特征：坏死能力、产毒性（复杂）、对抗生素的耐药性、感染的扩散能力（通过连续蔓延或远距离扩散）、对吞噬作用和细菌溶解的抵抗力等。本文回顾了病因（细菌学和免疫学）、流行病学数据（该疾病占生命最初两年发生的原发性细菌性肺炎的三分之一）、发病机制和病理解剖学数据。对临床表现、放射学检查和实验室数据进行了广泛分析，然后基于病史、临床、放射学和细菌学数据的相关性讨论了阳性诊断。作者指出放射学检查的作用，它能检测出典型病变，其表现每天都会发生显著变化，即：明显的胸膜炎表现（常见且极具提示性）、脓气胸、肺气囊、空洞性葡萄球菌瘤（脓肿），较少见的纵隔气胸或肺气肿。讨论了与多种疾病的临床鉴别诊断：化脓性肺炎、孤立性肺囊肿、多囊肺、感染性肺隔离症等，以及与双侧弥漫性肺泡性肺混浊、空洞性肺混浊、肺部“大疱”和“囊肿”形式影像的放射学鉴别诊断。最后一部分详细描述了治疗方法及其基本组成部分：病因（抗菌）治疗、减压和胸腔引流治疗、复苏治疗，以及葡萄球菌肺炎的病程、并发症和预后。
