Your SlideShare is downloading. ×
0
Introduction   0 Pneumonia is an inflammation of the lung parenchyma     (i.e. alveoli rather than the bronchi) of infecti...
0 It is the most common infectious cause of death.   0 It is usually characterized by consolidation.   0 Consolidation is ...
EPIDEMIOLOGY      0Occurs throughout the year      0Results from different etiological agents       varying with the seaso...
CLASSIFICATION  Classified based on two types  1. Type 1  0 Lobar pneumonia  0 Bronchopneumonia  2. Type 2  0 Community- a...
Lobar pneumonia   0 Lobar pneumonia is acute bacterial infection of a part of     lobe the entire lobe, or even two lobes ...
Bronchopneumonia   0 Bronchopneumonia is infection of the terminal     bronchioles that extends into the surrounding alveo...
Community Acquired              Pneumonia (CAP)   Pneumonia which develops in an otherwise healthy    person outside of ho...
Nosocomial pneumonia                    (HAP)   Pneumonia that was not incubating upon admission    developing in a patien...
PATHOPHYSIOLOGY   Microbial invasion of the normally sterile lower respiratory    tract   Three routes-   0 Inhaled as aer...
Various defence mechanisms      that protects lung from             infection   0 Anatomic barriers –epiglottis, larynx   ...
Invasion occurs as a result of         0   Defect in host defence mechanism         0 Overwhelming inocculum   0 Lung inf...
Clinical Manifestations   0 Indolent to fulminant in presentation   0 Mild to fatal in severity   0 Typical symptoms –   •...
Chest X-ray             For Lobar Pneumonia Consolidation confined to one or more lobes (or segments of lobes) of lungs.  ...
Chest X-ray             For Bronchopneumonia             •Patchy             consolidation             usually in the     ...
Diagnosis   Clinical diagnosis   0                History   0                Signs & symptoms   0                Chest x-r...
Diagnosis   Etiological diagnosis   0              Grams Stain and Culture of Sputum   0              Blood Cultures   0  ...
Complications   Possible complications include:   0 Acute respiratory distress syndrome (ARDS)   0 Fluid around the lung (...
COMMUNITY ACQUIRED            PNEUMONIA   Pneumonia is most common in winter because of seasonal    increase in viral infe...
Risk factors   1.    Comorbidity- Neoplastic disease, neurological         problem   2.    Alcoholism   3.    Advanced age...
Etiology   Potential etiologic agents in CAP - Bacteria                                       Viruses                     ...
Typical bacterial pathogens   0 Streptococcus pneumoniae – 30% to 60% ,Severe     illness, death   0 Haemophilus influenza...
Atypical bacterial pathogens   0 Mycoplasma pneumoniae   0 Chlamydophila pneumoniae   0 Legionella pneumophillia   0 These...
HOSPITAL ACQUIRED                PNEUMONIA   0 Pneumonia that was not incubating upon admission     developing in a patien...
Predisposing features   Reduced host defence against bacteria   0 Reduced immune defences (Corticosteroid treatment,     d...
0 Most bacterial nosocomial infection occur by     microaspiration of bacteria colonizing the patients     oropharynx or u...
Bacterial introduction into LRT   Endotracheal intubation   Infected ventillatiors / nebuliser /bronchoscopy   Dental or s...
Causative organisms   Common organisms   Gram negative bacteria-   0        Escherichia coli   0          Klebsiella sp.  ...
Less common organisms   1.     Gram negative bacilli        other coliforms:Enterobacter sp.   0                        Pr...
Treatment   Goals of therapy-   0         Eradication of the offending organism.   0         Selection of an appropriate a...
General approach to treatment   0 Adequacy of respiratory function   0 Humidified oxygen for hypoxemia   0 Bronchodilators...
Selection of an antimicrobial                agent   0 Empirical use of relatively broad spectrum antibiotic   0 Narrow sp...
Antibiotic doses for treating pneumonia12/12/2011       Pneumonia            33
Treatment for special cases   1. Patient less than 60 years & without comorbidities:-    Azithromycine ( 500mg OD) *1day  ...
Macrolides like Azithromycin ( 500mg OD) *1day                                   ( 250mg OD) *4days3. Patient is hospitali...
5. Patient hospitalised & severely ill:-       Combination of 3rd gen cefalosporins + Macrolides            Ceftriaxone + ...
7. For HAP:-         Cephalosporins + Aminoglycocides   8. For antipseudomons cephalosporins:-        Ceftazidime + Cefexi...
Drugs with usual doses12/12/2011        Pneumonia       38
12/12/2011   Pneumonia   39
12/12/2011   Pneumonia   40
12/12/2011   Pneumonia   41
Pneumonia Diagnosis and treatment
Upcoming SlideShare
Loading in...5
×

Pneumonia Diagnosis and treatment

36,603

Published on

Published in: Education
33 Comments
51 Likes
Statistics
Notes
No Downloads
Views
Total Views
36,603
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
1,318
Comments
33
Likes
51
Embeds 0
No embeds

No notes for slide

Transcript of "Pneumonia Diagnosis and treatment"

  1. 1. Introduction 0 Pneumonia is an inflammation of the lung parenchyma (i.e. alveoli rather than the bronchi) of infective origin.12/12/2011 Pneumonia 2
  2. 2. 0 It is the most common infectious cause of death. 0 It is usually characterized by consolidation. 0 Consolidation is a pathological process in which the alveoli are filled with a mixture of inflammatory exudate, bacteria & WBC12/12/2011 Pneumonia 3
  3. 3. EPIDEMIOLOGY 0Occurs throughout the year 0Results from different etiological agents varying with the seasons 0Occurs in persons of all ages 0Clinical manifestations severe in very young, elderly & in chronically ill patients12/12/2011 Pneumonia 4
  4. 4. CLASSIFICATION Classified based on two types 1. Type 1 0 Lobar pneumonia 0 Bronchopneumonia 2. Type 2 0 Community- acquired pneumonia (CAP) 0 Hospital-acquired pneumonia (HAP)12/12/2011 Pneumonia 5
  5. 5. Lobar pneumonia 0 Lobar pneumonia is acute bacterial infection of a part of lobe the entire lobe, or even two lobes of one or both the lungs.12/12/2011 Pneumonia 6
  6. 6. Bronchopneumonia 0 Bronchopneumonia is infection of the terminal bronchioles that extends into the surrounding alveoli resulting in patchy consolidation of the lung.12/12/2011 Pneumonia 7
  7. 7. Community Acquired Pneumonia (CAP) Pneumonia which develops in an otherwise healthy person outside of hospital or have been in hospital for less than 48hrs12/12/2011 Pneumonia 8
  8. 8. Nosocomial pneumonia (HAP) Pneumonia that was not incubating upon admission developing in a patient hospitalized for greater than 48 hrs.12/12/2011 Pneumonia 9
  9. 9. PATHOPHYSIOLOGY Microbial invasion of the normally sterile lower respiratory tract Three routes- 0 Inhaled as aerosolized particles 0 Haematogenous spread from an extrapulmonary site of infection 0 Aspiration of oropharyngeal contents12/12/2011 Pneumonia 10
  10. 10. Various defence mechanisms that protects lung from infection 0 Anatomic barriers –epiglottis, larynx 0 Cough reflexes 0 Tracheobronchial secretions 0 Mucocilliary lining 0 Cell & humoral mediated immunity 0 Dual phagocytic system-alveolar macrophages & neutrophils12/12/2011 Pneumonia 11
  11. 11. Invasion occurs as a result of 0 Defect in host defence mechanism 0 Overwhelming inocculum 0 Lung infection with viruses suppress the antibacterial activity of the lung by impairing alveolar macrophage function & mucocilliary clearance thus setting the stage for secondary bacterial pneumonia.12/12/2011 Pneumonia 12
  12. 12. Clinical Manifestations 0 Indolent to fulminant in presentation 0 Mild to fatal in severity 0 Typical symptoms – • Fever • Chills • Cough • Rust coloured sputum • Mucopurulent sputum • Dyspnea ( shortness of breath) • Pleuritic chest pain 0 Elevated WBC 0 Bacteraemic12/12/2011 Pneumonia 13
  13. 13. Chest X-ray For Lobar Pneumonia Consolidation confined to one or more lobes (or segments of lobes) of lungs. Lobarpneumonia12/12/2011 Pneumonia 14
  14. 14. Chest X-ray For Bronchopneumonia •Patchy consolidation usually in the bases of both lungs. Bronchopneumonia12/12/2011 Pneumonia 15
  15. 15. Diagnosis Clinical diagnosis 0 History 0 Signs & symptoms 0 Chest x-ray 0 CT12/12/2011 Pneumonia 16
  16. 16. Diagnosis Etiological diagnosis 0 Grams Stain and Culture of Sputum 0 Blood Cultures 0 Antigen Tests 0 Polymerase Chain Reaction 0 Serology 0 Bronchoalveolar lavage 0 Bronchoscopy12/12/2011 Pneumonia 17
  17. 17. Complications Possible complications include: 0 Acute respiratory distress syndrome (ARDS) 0 Fluid around the lung (pleural effusion) 0 Lung abscesses 0 Respiratory failure (which requires a breathing machine or ventilator) 0 Sepsis, which may lead to organ failure12/12/2011 Pneumonia 18
  18. 18. COMMUNITY ACQUIRED PNEUMONIA Pneumonia is most common in winter because of seasonal increase in viral infections Mortality 1%- Non hospitalized patients 13.7%-Hospiatalized patients 19.6%-Bacteremic patients <36.5%- Intensive care unit12/12/2011 Pneumonia 19
  19. 19. Risk factors 1. Comorbidity- Neoplastic disease, neurological problem 2. Alcoholism 3. Advanced age 4. Asthma 5. Immunosuppression12/12/2011 Pneumonia 20
  20. 20. Etiology Potential etiologic agents in CAP - Bacteria Viruses Fungi Protozoa Potential bacteriologic causes can be divided into two types 0 Typical bacterial pathogens 0 Atypical bacterial pathogens12/12/2011 Pneumonia 21
  21. 21. Typical bacterial pathogens 0 Streptococcus pneumoniae – 30% to 60% ,Severe illness, death 0 Haemophilus influenzae - 10% 0 S. aureus (in selected patients) 0 gram-negative bacilli – Klebsiella pneumoniae Pseudomonas aeruginosa12/12/2011 Pneumonia 22
  22. 22. Atypical bacterial pathogens 0 Mycoplasma pneumoniae 0 Chlamydophila pneumoniae 0 Legionella pneumophillia 0 These organisms are intrinsically resistant to all - B lactam agents macrolide, a fluoroquinolone, or a tetracycline. 0 Poor dental hygiene-anaerobes 0 HIV- p.carnii 0 Birds- Chlamydia psittaci 0 Cattle or parturient cat-Coxiella burnetti12/12/2011 Pneumonia 23
  23. 23. HOSPITAL ACQUIRED PNEUMONIA 0 Pneumonia that was not incubating upon admission developing in a patient hospitalized for greater than 48 hrs 0 10-15% of all hospital acquired pneumonia, usually presenting with sepsis or&/or respiratory failure 0 50% acquired on ICU12/12/2011 Pneumonia 24
  24. 24. Predisposing features Reduced host defence against bacteria 0 Reduced immune defences (Corticosteroid treatment, diabetes, malignancy) 0 Reduced cough reflux (Post operative) 0 Disordered mucocilliary clearance (Anaesthetic agents) Aspiration of nasopharyngeal or gastric secretions 0 Immobility or reduced conscious level 0 Vomiting, Dysphagia, 0 Nasogastric intubation12/12/2011 Pneumonia 25
  25. 25. 0 Most bacterial nosocomial infection occur by microaspiration of bacteria colonizing the patients oropharynx or upper GI tract 0 Most common pathogen – Aerobic gram negative bacilli 0 Most commonly exposed to multiresistant hospital pathogen 0 86% nosocomial infection-mechanical ventilation 0 Mortality-0 to 50%12/12/2011 Pneumonia 26
  26. 26. Bacterial introduction into LRT Endotracheal intubation Infected ventillatiors / nebuliser /bronchoscopy Dental or sinus infection Bacteraemia Abdominal sepsis Intravenous canula12/12/2011 Pneumonia 27
  27. 27. Causative organisms Common organisms Gram negative bacteria- 0 Escherichia coli 0 Klebsiella sp. 0 Pseudomonas aeruginosa Gram positive bacteria- 0 Streptococcus pneumoniae 0 Staphylococcus aureus12/12/2011 Pneumonia 28
  28. 28. Less common organisms 1. Gram negative bacilli other coliforms:Enterobacter sp. 0 Proteus sp. 0 Seratia marcescens 0 Citrobacter sp. 0 Acinobacter sp. 0 Legionella pneumophillia 2. Anaerobic bacteria 3. Fungi- Candida albicans Aspergillus fumigatus 4. Viruses- Cytomegalovirus (CMV), Herpes simplex12/12/2011 Pneumonia 29
  29. 29. Treatment Goals of therapy- 0 Eradication of the offending organism. 0 Selection of an appropriate antibiotic. 0 To minimize associated morbidity.12/12/2011 Pneumonia 30
  30. 30. General approach to treatment 0 Adequacy of respiratory function 0 Humidified oxygen for hypoxemia 0 Bronchodilators (albuterol) 0 Chest physiotherapy with postural drainage 0 Adequate hydration if necessary 0 Expectorants such as guaifenesin 0 Chest pain- analgesics12/12/2011 Pneumonia 31
  31. 31. Selection of an antimicrobial agent 0 Empirical use of relatively broad spectrum antibiotic 0 Narrow spectrum antibiotics to cover specific pathogen 0 Potential pathogens involved 0 Age 0 Previous &current medication history 0 Underlying disease 0 Present clinical status12/12/2011 Pneumonia 32
  32. 32. Antibiotic doses for treating pneumonia12/12/2011 Pneumonia 33
  33. 33. Treatment for special cases 1. Patient less than 60 years & without comorbidities:- Azithromycine ( 500mg OD) *1day ( 250mg OD) *4days Norfloxacin/Levofloxacin (400mg OD) *7days 2. Outpatient greater than 65 years:- Norfloxacin (400mg OD) *7days or Ceftriaxon (1-2 g/day) / Cifixim (2-4 g/day) 3rd gen cefalosporins +12/12/2011 Pneumonia 34
  34. 34. Macrolides like Azithromycin ( 500mg OD) *1day ( 250mg OD) *4days3. Patient is hospitalised but not severely ill:- Combination of 3rd gen cefalosporins + Macrolides Ceftriaxone + Azithromycin OR Norfloxacin/Levofloxacin (400mg OD)4. If the patient is hospitalised but not severely ill:- Combination of 3rd gen cefalosporins + Macrolides Ceftriaxone + Azithromycin and newer fluroquinolones (Gatifloxacin)12/12/2011 Pneumonia 35
  35. 35. 5. Patient hospitalised & severely ill:- Combination of 3rd gen cefalosporins + Macrolides Ceftriaxone + Azithromycin and newer fluroquinolones (Gatifloxacin) We can add Vancomycin. 6. Patient with icu admission:- 3rd gen cefalosporins + Fluroquinolones (Gatifloxacin) + Nutritional supplements + Saline Vancomycin/Meropenam12/12/2011 Pneumonia 36
  36. 36. 7. For HAP:- Cephalosporins + Aminoglycocides 8. For antipseudomons cephalosporins:- Ceftazidime + Cefexime12/12/2011 Pneumonia 37
  37. 37. Drugs with usual doses12/12/2011 Pneumonia 38
  38. 38. 12/12/2011 Pneumonia 39
  39. 39. 12/12/2011 Pneumonia 40
  40. 40. 12/12/2011 Pneumonia 41
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×