[Staphylococcal pneumonia].

Abstract

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.