Pneumonia
Definition
Acute respiratory illness associated with
recently developed radiological pulmonary
shadowing which may be segm...
Epidemiology
Occurs throughout the year
 Results from different etiological agents
varying with the seasons
 Can occur i...
Clinical features






Fever
Rigors
Shivering
Vomiting
Loss of appetite

Pulmonary symptoms include:
 Cough [short,...
Classification
Type 1
 Lobar pneumonia
 Bronchopneumonia

Type 2
 Community acquired
 Hospital acquired
 Suppurative ...
Lobar pneumonia
Radiological and pathological term applied to
homogenous consolidation of one or more
lung lobes
 Associa...
Bronchopneumonia


Patchy alveolar consolidation



Associated with bronchial and bronchiolar
inflammation often affecti...
Community acquired pneumonia
(CAP)
Spread by droplet infection
 Occurs in previously healthy patients
 Once the organism...
Predisposing factors
Old age
 Cigarette smoking
 Upper respiratory tract infection
 Recent influenza infection
 Pre ex...
Related organisms
Majority of CAP are due to S. pneumonie
Young adults
 Mycoplasma pneumoniae
 Chlamydia pneumoniae
Elde...
Investigations
Radiological examination
Chest x-ray helps in differentiating between lobar and broncho
Spotting complicati...
CURB-65 score
Management
Oxygen
Administered to patients with tachypnea, hypoxemia,
hypotension or acidosis. Maintain PaO2 >8kPa or SaO2...
Complications
Para pneumonic effusion
 Empyema
 Retention of sputum causing lobar collapse
 Development of thromboembol...
Prevention


Influenza vaccination reduce the risk of
influenza and death in elderly



Polysacchride pneumococcal vacci...
Hospital acquired pneumonia


Refers to new episode of pneumonia
occurring 2days after admission



Post operation



A...
Predisposing factors
Reduced immune defences
 Reduced cough reflex
 Disordered mucociliary clearance
 Bulbar or vocal c...
Related organisms
Gram negative bacteria
 Escherichia, pseudomonas and klebsiella
 Staph aureus
Management
Adequate gram negative coverage
 3rd gen cephalosporins (eg cefotaxime) plus
an aminoglycoside (eg gentamicin)...
Suppurative and aspirational
pneumonia
Consolidation in which there is destruction of
lung parenchyma by inflammatory proc...
Clinical features








Productive cough
Pleural pain
Sudden expectoration of copious sputum
High pyrexia
Profoun...
Management


Oral amoxicillin 500mg 6hourly



For anaerobic bacteria, oral metronidazole
400mg 8hourly



For lung abs...
Pneumonia in
immunocompromised patients


Patients receiving immunosupressive drugs
and those with diseases causing defec...
Clinical features
Fever
 Cough
 Breathlessness


Infiltrations on chest x-ray
Management


Broad spectrum antibiotic (eg 3rd gen
cephalosporin or quinolone plus
antistaphylococcal antibiotic or
antip...
Thank you

Reference
 Davidson’s principles and practice of
medicine 20th edition
pneumonia
pneumonia
pneumonia
pneumonia
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pneumonia

  1. 1. Pneumonia
  2. 2. Definition Acute respiratory illness associated with recently developed radiological pulmonary shadowing which may be segmental, lobar or multi-lobar.  It is usually characterized by consolidation, in which the alveoli are filled with a mixture of exudates, bacteria and leukocytes. 
  3. 3. Epidemiology Occurs throughout the year  Results from different etiological agents varying with the seasons  Can occur in all ages  Clinical manifestations severe in very young, elderly and in chronically ill patients 
  4. 4. Clinical features      Fever Rigors Shivering Vomiting Loss of appetite Pulmonary symptoms include:  Cough [short, painful, dry, later accompanied with mucopurulent sputum]  Hemoptysis [in patients with Streptococcus pneumonie]  Pleuretic chest pain, referred to shoulder or anterior abdomen  Upper abdominal tenderness
  5. 5. Classification Type 1  Lobar pneumonia  Bronchopneumonia Type 2  Community acquired  Hospital acquired  Suppurative and aspirational  Immunocompromised hosts
  6. 6. Lobar pneumonia Radiological and pathological term applied to homogenous consolidation of one or more lung lobes  Associated with pleural inflammation 
  7. 7. Bronchopneumonia  Patchy alveolar consolidation  Associated with bronchial and bronchiolar inflammation often affecting both lower lobes
  8. 8. Community acquired pneumonia (CAP) Spread by droplet infection  Occurs in previously healthy patients  Once the organism settles in alveoli an inflammatory response is stimulated  Classical pathological response: 1. Congestion 2. Red and then grey hepatisation 3. Resolution with little or no scarring 
  9. 9. Predisposing factors Old age  Cigarette smoking  Upper respiratory tract infection  Recent influenza infection  Pre existing lung disease  Corticosteroid therapy  Alcohol 
  10. 10. Related organisms Majority of CAP are due to S. pneumonie Young adults  Mycoplasma pneumoniae  Chlamydia pneumoniae Elderly  Haemophilus influenza Foreign travels  Legionella  Staph aureus
  11. 11. Investigations Radiological examination Chest x-ray helps in differentiating between lobar and broncho Spotting complications such as intrapleural abscess, empyema   Microbiological investigations Assessment of gas exchange Measures SaO2, assists in monitoring response to oxygen therapy. Arterial blood gas sampled for SaO2 <92% or with severe pneumonia to assess for ventilatory failure  General blood tests A very high WBC count is seen in severe pneumonia. Urea, electrolytes and LFTs. C-reactive protein is raised 
  12. 12. CURB-65 score
  13. 13. Management Oxygen Administered to patients with tachypnea, hypoxemia, hypotension or acidosis. Maintain PaO2 >8kPa or SaO2 >92%. Humidified high concentratiom for patients without hypercapnia.  Fluid balance Oral intake of fluids, IV for severe cases. Inotropic support for patients with shock  Treatment of pleuretic pain Analgesics such as paracetamol   Physiotherapy
  14. 14. Complications Para pneumonic effusion  Empyema  Retention of sputum causing lobar collapse  Development of thromboembolic disease  Pneumothroax  Lung abscess  ARDS  Hepatitis, pericarditis, myocarditis  Pyrexia due to drug hypersensitivity 
  15. 15. Prevention  Influenza vaccination reduce the risk of influenza and death in elderly  Polysacchride pneumococcal vaccines do not appear to reduce the incidence of pneumonia or death but may reduce the incidence of invasive pneumoccocal disease
  16. 16. Hospital acquired pneumonia  Refers to new episode of pneumonia occurring 2days after admission  Post operation  Aspiration pneumonia  Bronchopneumonia developing in patients with lung disease
  17. 17. Predisposing factors Reduced immune defences  Reduced cough reflex  Disordered mucociliary clearance  Bulbar or vocal cord palsy  Aspiration of gastric secretions  Bacteria introduced into lower respiratory tract (ET tube, tracheostomy, infected ventilators, nebulisers)  Bacteraemia (abdominal sepsis, IV cannula infection, infected emboli) 
  18. 18. Related organisms Gram negative bacteria  Escherichia, pseudomonas and klebsiella  Staph aureus
  19. 19. Management Adequate gram negative coverage  3rd gen cephalosporins (eg cefotaxime) plus an aminoglycoside (eg gentamicin)  Meropenem  Monocyclic β-lactam (eg aztreonam) plus flucloxacillin Aspiration pneumonia can be treated with coamoxiclav 8hourly plus metronidazole 500mg 8hourly Physiotherapy
  20. 20. Suppurative and aspirational pneumonia Consolidation in which there is destruction of lung parenchyma by inflammatory process  Micro abscess formation with pus that may rupture and escape into bronchus  Caused by staph aureus, klebsiella pneumoniae, strep pyogenes, h. influenza  After aspiration of septic material during operation on nose, mouth or throat under GA. Vomitus during anesthesia or coma 
  21. 21. Clinical features        Productive cough Pleural pain Sudden expectoration of copious sputum High pyrexia Profound systemic upset Pleural rub Signs of consolidation On chest x-ray homogenous lobar or segmental opacity consistent with consolidation or collapse A large dense opacity which may cavitate and show fluid level, shows in lung abscess
  22. 22. Management  Oral amoxicillin 500mg 6hourly  For anaerobic bacteria, oral metronidazole 400mg 8hourly  For lung abscess prolonged treatment for 46weeks
  23. 23. Pneumonia in immunocompromised patients  Patients receiving immunosupressive drugs and those with diseases causing defects of cellular or humoral immune mechanisms  Gram negative bacteria; pseudomonas aeruginosa
  24. 24. Clinical features Fever  Cough  Breathlessness  Infiltrations on chest x-ray
  25. 25. Management  Broad spectrum antibiotic (eg 3rd gen cephalosporin or quinolone plus antistaphylococcal antibiotic or antipseudomonal penicillin)
  26. 26. Thank you Reference  Davidson’s principles and practice of medicine 20th edition
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