COMMUNITY ACQUIRED PNEUMONIA WHAT IT IS AND CURE

1. BY: RON CHRISTIANGAYANILO

2.  Introduction
 Aetiology
 Viral pneumonias
 Pathology
 Clinical features
 Examination findings
 Investigations
 Treatment
 Complications
 Poor prognostic factors
 Prevention

3.  Definition inflammation of the lung parenchyma,
which is characterized by consolidation of the
affected part and a filling of the alveolar air
spaces with exudate, inflammatory cells, and
fibrin
 Community acquired or Health care associated.
 Lobar /Focal/ nonsegmental pneumonia
 Multifocal/lobular (bronchopneumonia)
 Interstitial (focal diffuse)
 Important cause of morbidity and mortality
worldwide.
 Usually acquired through inhalation or aspiration
of pulmonary pathogenic organisms into a lung
segment or lobe less common is the haematogenous
route

4.  Typical or atypical organisms
 Typical organisms- commonest organisms
are Strep.
pneumoniae, H. influenzae, M.
catarrhalisaccount
for approximately 85 of CAP cases.
 Less common S. aureus, E.coli, K.
pneumoniae, S.
faecalis

5.  Most commonLegionella species,
Mycoplasma
pneumoniae, Chlamydophila spp.
 Less common viruses (influenza virus,
adenovirus, respiratory syncytial virus,
human
parainfluenza virus, measles, varicella zoster)
mycobacteria, parasites


6.  Can vary from a mild, self-limited illness to a
life-threatening disease.
 The commonest causes are influenza virus,
respiratory syncytial virus, adenovirus, and
parainfluenza virus. Less common are
varicella-zoster virus and measles virus.
 Routes include large-droplet spread over short
distances, hand contact with contaminated skin
and fomites with subsequent inoculation onto
the
nasal mucosa or conjunctiva, and small-particle
aerosol spread

7.  Pathogenesis of most viral pneumonias is not well
known.
 After contamination, viruses multiply in the
epithelium of the upper airway, destroy
respiratory cilia, cause disruption of the
respiratory epithelium, clearing the way for
bacterial infection
 Severe pneumonias may result in extensive
consolidation of the lungs
 They also generally cause impairment ofT cells,
macrophages, and neutrophil function and thus
increase risk of bacterial super-infection

8.  Incubation period depends on the specific
virus.
 Symptoms fever, chills, dry cough,
rhinitis/rhinorrhoea, myalgias, headache,
fatigue
 Travel history is important.
 With bacterial superinfection, symptoms last
longer, cough becomes productive of sputum
and
the patients becomes more ill.

9.  Fever and/or chills
 Cough
 Tachypnoea and/or dyspnoea
 Tachycardia or bradycardia
 Wheezing/ Rhonchi
 Crepitations
 Dullness to percussion
 Decreased breath sounds
 Hypoxia

10.  Full blood count anaemia, leucocytosis
(lymphocytosis or neutrophilia)
 Sputum for microscopy, culture, sensitivity
 Chest x-ray
 Rapid antigen detection on nasal swabs by ELISA
and immunofluorescence
 Serologic tests
 Gene amplification by RT-PCR
 Blood culture
 Examination of bronchoalveolar lavage samples
 Viral culture of tissue from the respiratory
tract, sputum, and samples obtained by
nasopharyngeal washing, bronchoalveolar lavage
 Lung biopsy for histopathologic studies and viral
culture


11.  General measures Oxygen, bed rest,
antipyretics, analgesics, fluids, respiratory
isolation

 Specific measures mechanical ventilation if
respiratory failure is present or impending,
antibiotics (if infiltrate is seen on the chest
radiograph)


12.  Acyclovir for varicella or herpes pneumonia
 Respiratory syncythial virus ribavirin,
immunoglobulin only for severe disease
 Adenovirus cidofovir
 Parainfluenza virus ribavirin
 Influenza virusAcyclovir,Oseltamivir,
Zanamir

13.  Complications of CAP include empyema,
cavitation,
precipitation of myocardial infarction or heart
failure and overwhelming pneumococcal
sepsis in
asplenic/hyposplenic patients.
 Viral pneumoniasSecondary bacterial
infections,
encephalitis, hepatitis

14.  Significant co-morbidity eg cardioresp disease
 Increased respiratory rate
 Hypotension
 Fever
 Anaemia
 Hypoxia
 Multilobar involvement
 Immunosuppression eg asplenia/hyposlenia
 Elderly patients
 Virulent organisms.


15.  INFvaccination zanamivir, oseltamivir,
amantadine
 RSVRSV immunoglobulin, Palivizumab
 Measlesintravenous Ig
 VZVVZV Ig

16.  PNEUMONIA IS TREATABLE, WITH
COMPLETE BED REST AND MEDICINE. THIS
STUDIES CONDUCTED BASED ON
CURRENT SITUATION WHERE COVID-19 IS
STILL ACTIVE AND MOST AFFECTED
PATIENTS WERE OLD PEOPLE AND IS
BASED ON THE REPORT OF C.H.O. –
CAUAYAN.