2. DEFINITION
Pneumonia is an infection of the pulmonary
parenchyma.
It is classified as
1.Community-acquired (CAP)
2.Hospital-acquired (HAP)
3.Ventilator-associated (VAP).
4.Health care-associated pneumonia (HCAP).
3. STAGES OF PNEUMONIA
1) Congestion :- there is presence of a proteinaceous exudate and bacteria in
the alveoli.
2) Red hepatization:- there is presence of erythrocytes in the cellular intra
alveolar exudate, neutrophil influx, Bacteria are occasionally seen
3) Gray hepatization:- no new erythrocytes are extravasating, and those
already present have been lysed and degraded. The neutrophil is the
predominant cell, fibrin deposition is abundant, and bacteria have
disappeared. This phase corresponds with successful containment of the
infection and improvement in gas exchange.
4) Resolution - the macrophage reappears as the dominant cell type in the
alveolar space, and the debris of neutrophils, bacteria, and fibrin has been
cleared, as has the inflammatory response.
4. DIAGNOSIS
CHEST X-RAY
CT THORAX
SPUTUM GRAM STAIN AND CULTURE- To be adequate for culture, a sputum sample must
have >25 neutrophils and <10 squamous epithelial cells per low-power field.
For patients admitted to the ICU and intubated, a deep-suction aspirate or
bronchoalveolar lavage sample can be examined.
BLOOD CULTURE- low yield•
Urinary Antigen Tests:- detect pneumococcal and Legionella antigen in urine.•
Polymerase Chain Reaction:- PCR of nasopharyngeal swabs has become the standard for
diagnosis of respiratory viral infection. In addition, PCR can detect the nucleic acid of
Legionella species, M. pneumoniae, C. pneumoniae, and mycobacteria.
Biomarker:- C-reactive protein (CRP) and procalcitonin (PCT) serves as markers of severe
inflammation.
10. PRIMARY PREVENTION
Education about pneumonia, good nutrition, regular exercise,
dangers of tobacco.
Regular exams & screening tests to monitor risk factors for illness.
Immunization against pneumonia.
Controlling potential hazards at home (i.e. reduce mold, clean
house).
Control work hazards (i.e. wash hands, avoid inhaling harmful
substances, good ventilation).
Prevention of low birth weight & breastfeeding education.
11. SECONDARY PREVENTION
Counsel people to take daily vitamins & minerals, and answer
any other dietary questions.
Recommend regular exams and screening tests in people with
known risk factors for pneumonia (i.e. elderly, children under 5,
smokers, people with COPD or HIV).
Encourage post-op and physically challenged patients to stay
active and cough/deep breathe to prevent pneumonia.
Provide modified diet, such as thickened liquids to people with
risk of aspiration.
12. TERTIARY PREVENTION
COPD or HIV management programs, with a
portion focusing on preventing infections such
as pneumonia.
Case management for patients who
repeatedly get pneumonia.
Patient support groups for high risk patients.
13. TREATMENT
CURB-65 criteria :- severity-of-illness score
C- Confusion
U- Urea > 7 mmol/L or 40 g/dL
R- Respiratory Rate > 30/min
B- Blood Pressure; Systolic ≤ 90 mm Hg, Diastolic ≤ 60 mm Hg.
65- Age 265 Years•
Score-0- 30 days mortality rate is 1.5 % - can be treated as OPD
Score-2- 30 days mortality rate is 9.2% - patient should be admitted
Score ≥ 3- 30 days mortality rate is 22% - requires ICU care.
14. Risk Factors for Early Deterioration in CAP
Multilobar infiltrates
Severe hypoxemia (arterial saturation <90%)
Severe acidosis (pH <7.30)
Mental confusion
Severe tachypnea (>30breaths/min)
Hypoalbuminemia
Neutropenia
Thrombocytopenia
Hyponatremia
Hypoglycemia