Mold can cause pleurisy
Inflammation of the pleurisy (pleurisy): symptoms and treatment
- Sharp chest pain when breathing is a typical symptom of "dry" pleurisy.
- © iStock.com/champja
Pleurisy is an inflammation of the pleura, the so-called pleura. One often hears the term pleurisy as well. Doctors speak of pleurisy or pleural infection. The pleura lines the inside of the chest cavity and primarily serves to protect the sensitive lungs. In earlier times the disease was known as "side sickness" after it usually leads to severe pain in the chest and the patient holds the affected side. It often occurs as a complication of postponed respiratory infections.
What is pleurisy?
The two lungs lie in the chest under the ribs and are protected by two thin, superimposed membranes. The inner skin that directly encloses the lungs is called the lung pleura (pleura visceralis or pulmonalis). The outer skin is called Pleura (Parietal pleura). It lies directly above the first and is connected to the rib cage. The inner and outer pleural leaves together form the pleura. It packs the lungs airtight, thus maintaining the negative pressure that prevents the lungs from detaching from the chest and collapsing. There is a space between the two pleural leaves, the pleural space, which is always filled with a little fluid so that the two membranes can move well against each other when breathing.
Usually the surface of the two pleural leaves is smooth. However, if pleurisy occurs, a sticky (fibrinous) coating is created and the two leaves rub against each other. Since the outer pleura in particular is rich in sensitive nerves, this leads to extreme pain with every breath and every movement of the chest. Usually only one side of the chest is affected, as the two pleural cavities are completely separated from each other by the mediastinum. In the course of an inflammation of the rib, there may be an increased accumulation of fluid in the gap between the two pleural leaves. This is called a pleural effusion or a "wet" pleurisy (exudative pleurisy).
Inflammation of the pleura: what are the causes?
There are many causes of pleurisy, as this inflammation can be linked to many different diseases. Only in very rare cases does it develop without previous illnesses as "primary pleurisy".
Most often, pleurisy occurs as a consequence of an acute inflammation of the chest such as bronchitis or pneumonia or a virus infection that has been carried over. The causative agents of flu (influenza), mumps and Pfeiffer's glandular fever (Epstein-Barr virus) play an important role. There are also a number of viruses and bacteria that can trigger inflammation, which can possibly spread to the pleura. The infection spreads relatively often in the case of pneumonia. About 20 to 50 percent of those affected develop pleurisy with pleural effusion as a result. Doctors also speak of the fact that the pleura always "cries" with inflammation in the chest cavity.
The most common causes of pleurisy are:
Pleurisy (pleurisy tuberculosa) also occurs in the context of tuberculosis, sometimes it is also a symptom of an autoimmune disease such as rheumatoid arthritis or lupus erythematosus. It also occurs when an HIV infection (AIDS) breaks out. Pleuritides can also develop after heart surgery. Lung cancers are rare triggers. In some cases, no causes can be found, then one speaks of idiopathic pleurisy.
Inflammation of the pleura: Typical symptoms of pleurisy
There are two types of pleurisy, each characterized by typical symptoms and classic courses: dry pleurisy (pleurisy sicca) and wet pleurisy (exudative pleurisy) with pleural effusion.
Pleurisy sicca - sharp pain when inhaling
In dry or fibrinous pleurisy, there is characteristic sharp, stabbing pain in the chest and back when breathing. They are created by rubbing the glued pleural leaves together during inhalation and exhalation. They are accompanied by crackling, rattling breath noises that sound like leather creaking when they are listened to.
Depending on the location of the inflammation, the pain can be located on the side of the chest, in the front of the sternum or on the back. Usually it is particularly violent when inhaled. Many of those affected experience little or no pain between breaths, so some of the patients try to relieve the symptoms by holding their breath or making as little breathing as possible.
Often the patient holds the painful side with his arm or lies down on it, as pressure brings relief. In most cases of pleurisy sicca, only a slight to moderate fever occurs, often none at all.
The main symptoms of dry pleurisy at a glance:
- Severe chest pain or back pain
- Dry, irritating cough
- Rattling breath noises
- Easy breathing
- Relieving posture
- No fever or just slightly elevated temperature
Exudative pleurisy - chest pressure and fever
Exudative pleurisy, or moist pleurisy, usually develops from the dry form. The patient then initially feels relief as the extreme pain when breathing subsides. However, the cause lies in the increasing accumulation of fluid in the pleural space, so that the two leaves no longer stick and rub against each other. In fact, it is a worsening of the findings. The symptoms depend on the size of the pleural effusion and can range from a feeling of pressure in the chest to shortness of breath if the lungs are restricted in their function. Sometimes there is also pain that radiates into the shoulder when the effusion presses on the phrenic nerve. The body temperature now usually rises due to the progressive inflammation, sometimes leading to persistent fever.
Symptoms of pleurisy with pleural effusion:
- Shortness of breath
- Sensation of pressure on the chest
- Shoulder pain
- Elevated temperature to high fever
Depending on the cause of the pleurisy, patients may also have symptoms such as malaise, weight loss, night sweats or joint pain.
Warning signs of pleurisy
Severe, persistent, or sudden chest pain should be clarified by a doctor. Acute shortness of breath or shortness of breath as well as blue discoloration of the skin are also reasons to consult a doctor as quickly as possible, a high fever another. Because the symptoms mentioned can also hide serious illnesses such as a heart attack, pneumonia caused by bacteria or an occlusion of a pulmonary vessel.
Diagnosis of pleurisy: How to recognize pleurisy
The diagnosis of pleurisy can involve several tests because the causes of pleurisy are so diverse.
At the beginning of the diagnosis, as with other diseases, there is a detailed questioning of the patient by the doctor (anamnesis). The doctor asks about the patient's existing complaints, for example how long they have existed, whether they have appeared suddenly or slowly, which makes them worse. Other aspects of the anamnesis include existing illnesses, regular medication, recent long-distance trips and others.
This is followed by a thorough physical examination of the patient with a special focus on the chest, especially the painful region. These include listening to the lungs, tapping and palpation of the chest.
First step towards diagnosis: X-raying of the chest
Chest x-rays are usually taken in patients suspected of having pleurisy. This can be used to detect accumulations of air, fluid in the pleaural space or indications of pneumonia. A pleural effusion can also be made visible by means of an ultrasound examination (sonography). Advanced imaging processes such as computed tomography, which depicts the corresponding body region in layers or sections, enable a precise examination of certain changes in the chest.
Laboratory tests can help identify pleurisy
Blood tests are other things you can do to help diagnose pleurisy. They may provide clues to inflammation or certain conditions such as rheumatoid arthritis. If there is an effusion in the pleural space, fluid can be extracted from it and examined in the laboratory. This can be used to determine whether the effusion contains pus or blood, for example. The process by which the fluid is collected is called a pleural puncture. The doctor first anaesthetizes the relevant region by injecting an anesthetic on site. Then he puts a needle through the chest wall between the ribs and takes out the liquid. Sometimes the doctor uses the ultrasound to check the process.
Depending on the (suspected) cause of the symptoms, further examinations may be considered. This includes, for example, an electrocardiogram (EKG), with which the electrical currents of the heart are derived in order to detect possible changes in the heart.
Therapy for pleurisy: treatments at a glance
The treatment of pleurisy has two main goals. On the one hand, the underlying disease and, on the other hand, the often very severe pain must be treated.
Treat the causes of pleurisy
If bacterial pneumonia is the triggering disease for pleurisy, antibiotics are the drug of choice. However, if viruses are behind the symptoms, antibiotics do not do much. Viral inflammation can heal without medication and is often only treated symptomatically. But there are also active ingredients that target viruses (antivirals).
If drugs are the trigger, they should be discontinued as far as possible. However, it is essential that you consult your doctor. If pleurisy is related to diseases such as rheumatoid arthritis, the treatment of the original disease is of primary importance.
Relieve pleurisy pain
In order to alleviate the sometimes very severe pain associated with pleurisy, those affected can resort to painkillers. These include, for example, non-steroidal anti-inflammatory drugs (NSAIDs) such as the active ingredients ibuprofen or indomethazine, which also work against inflammation.
Therapy for pleural effusion
Removing the accumulation of fluid between the leaves is useful if the pleural effusion is pressing on the lungs or even pushing the heart to one side. Possible procedures are pleural puncture or pleural drainage. However, a pleural effusion can also be triggered by other serious illnesses such as inflammation of the pericardium, a heart attack, or an occlusion of a pulmonary vessel. These usually require immediate treatment.
Home remedies can relieve symptoms of pleurisy
Pleurisy always belongs in the hands of the doctor. Nevertheless, you can do a lot yourself to relieve the pain and support the healing process:
- Important is much restso that the body can activate its self-healing powers.
- Also, you should be on adequate hydration be careful, especially if pleurisy is accompanied by fever.
- Warm chest wraps are an effective home remedy for pleurisy and can relieve pain. They relax the muscles and promote blood circulation and thus healing. Make sure to remove the chest wrap immediately after it has cooled down.
- Help after pleurisy Breathing exercisesto stretch and activate the respiratory muscles again, which are often restricted afterwards due to the restraint of breathing. Breathe in consciously and deeply to the tips of the lungs and then out again several times a day.
Good prognosis with an uncomplicated course of pleurisy
How pleurisy develops, how long it lasts, and whether it heals well depends primarily on the underlying condition. In uncomplicated pleurisy after viral infections, the pleurisy usually heals quickly and without consequences and the prognosis is accordingly good.
If the course is severe, pleurisy can also lead to serious complications. Due to the inflammation and the impaired breathing, the pleura and the pleura can stick together and grow together to form the so-called pleural rind. However, this can be resolved by a surgical procedure.
Prevent pleurisy - treat underlying disease
The most important aspect in the prevention of pleurisy is to prevent underlying diseases that cause them or to treat them promptly and consistently. This includes all measures that strengthen the immune system and thus prevent colds. But also that acute inflammation of the airways is properly cured and that it takes time for convalescence.
If the underlying disease has already broken out, the pleurisy can possibly be prevented with correct and adequate treatment. For example, pneumonia caused by bacteria should be treated with the appropriate antibiotics as early as possible. The pathogens can then no longer multiply, which means that the spread of the inflammation can be contained and the inflammation reduced. Other diseases that can be associated with pleurisy should also be treated consistently.
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