Basic principles involved in the traditional systems of medicine PDF.pdf
1 PNEUMONIA-.. [YR 4] APRIL 2022_102703.pptx
1. C B U - S O M / N D O L A T E A C H I N G H O S P I T A L
I N T E R N A L M E D I C I N E
A P R I L 2 0 2 2
PNEUMONIA
Dr C Nyirenda
2. Learning objectives
At the end of this unit the student will be able to:
1. Define Pneumonia
2. List the etiologic agents of Pneumonia occurring in different
settings
3. Describe the mode of transmission of Pneumonia
4. Understand the epidemiology of Pneumonia.
5. Describe the pathophysiology of Pneumonia
6. Identify the clinical manifestations of Pneumonia
7. List the complications of Pneumonia
8. Describe the most common investigations for the diagnosis of
Pneumonia
9. Make an accurate diagnosis of Pneumonia
10. Manage most cases of Pneumonia appropriately
11. Refer complicated cases of Pneumonia
3. Definition
Pneumonia is an acute infection of the lung parenchyma
including alveolar spaces and interstitial tissue.
Involvement may be confined to an entire lobe -Lobar
pneumonia
A segment of a lobe-Segmental or lobular pneumonia
Alveoli contiguous to bronchi - Bronchopneumonia
Interstitial tissue - Interstitial pneumonia
These distinctions are generally based on x-ray
observations.
4. Risk factors
Predisposing factors for pneumonia include:-
Preceding respiratory viral infections
Alcoholism
Cigarette smoking
Underlying diseases such as Heart failure, COPD
Age extremes
Immunosuppressive therapy and disorders
Decreased consciousness, comma, seizure etc.
Surgery and aspiration of secretions
5. Pathogenesis
The usual mechanisms to develop pneumonia are
either to inhale droplets small enough to reach the
alveoli, or to aspirate secretions from the upper
airways. Other means include
hematogenous dissemination, via the circulation, or
directly from contiguous infections.
6. Epidemiology
CAP versus HAP
• Community-acquired pneumonia (CAP) is defined as
an acute infection of the pulmonary parenchyma in a
patient who has acquired the infection in the
community, as distinguished from hospital-acquired
(nosocomial) pneumonia (HAP).
• CAP is a common and potentially serious illness . It
is associated with considerable morbidity and
mortality, particularly in older adult patients and
those with significant comorbidities.
7. Pneumonia in special populations
aspiration pneumonia,
Hypostatic pneumonia
Pneumonia in the immunocompromised patients,
ventilator-associated pneumonia (VAP) etc.
8. Etiopathogenetic basis
CAP; Streptococcus pneumonia, Haemophilus
influenza and Mycoplasma pneumoniae. Others-
Staph. Aureus, Legionella species
HAP; Pseudomonas, Klebsiella, Bacteroides,
Clostridia and also Staph aureus
Aspiration e.g in stroke, oesophageal disease,
myasthenia..; mainly oropharyngeal anaerobes but
also gram positives and possibly negatives
Immunocompromised; PJP, other fungal species,
viruses (e.g HSV, CMV), Strep pneumonia, H.
Influenza, M. Pneumonia also
10. Investigations
Laboratory; FBC/DC, U&E,LFT, CRP, blood cultures,
sputum m/c/s, urine Ag –legionella and
pneumococcus. Pleural fluid for culture??
Bronchoscopy and bronchoalveolar lavage
Radiological; CXR, CT or MRI in case of complicated
cases
12. Severity scale
CURB- 65 score
C- confusion, U- urea> 7 mmol/l, R- rate >=30/min,
BP < 90 systolic and /or 60 mmHg diastolic, age >
65
Scores 0-1; home treatment; 2 hospitalization, >=3
severe pneumonia
Increased mortality in co-morbidity and reduced
arterial partial pressure of oxygen e.g < 8 kpa
13. Management
Oxygen therapy depending on severity; BLS as
appropriate
IV fluids e.g in dehydration and shock.
Antibiotic therapy; oral in mild disease e.g CURB 0-1
or if not vomiting. IVs in severe disease
Empirical options:
CAP; mild-penicillins or macrolides or
fluoroquinolones. Severe-Co-amoxyclav iv or
cephalosporin iv . Erythromycin iv in case of
Mycoplasma pneumonia
14. Management contn
HAP; Aminoglycoside iv + penicillin or 3rd
generation cephalosporin iv
Aspiration; Cephalosporin iv + metronidazole iv
Others; PJP- high dose co-trimoxazole