pneumonia

1. Pneumonia
Dr. Sameh Ahmad Muhamad abdelghany
Lecturer Of Clinical Pharmacology
Mansura Faculty of medicine

2. Contents
Introduction
Risk Factors
Types - Causes
Diagnosis(C/P – Investigation)
Treatment

3. INTRODUCTION

4. What is pneumonia?
 Pneumonia is an infection in
one or both lungs.
 It can be caused by bacteria,
viruses, or fungi.
 Bacterial pneumonia is the most
common type in adults.

5. What is pneumonia?
 Pneumonia causes
inflammation in the air sacs
in lungs, which are called
ALVEOLI.
 The alveoli fill with fluid
or pus, making it difficult
to breathe.

6. Risk Factors

7. Factors that predispose to Pneumonia
 Cigarette smoking
 Upper respiratory tract infections
 Alcohol
 Corticosteroid therapy
 Old age
 Recent influenza infection
 Pre-existing lung disease

8. Factors that predispose to Pneumonia
 Reduced host defenses against bacteria
o Reduced immune defenses (e.g. corticosteroid
treatment, diabetes, malignancy)
o Reduced cough reflex (e.g. post-operative)
o Disordered mucociliary clearance (e.g. anaesthetic
agents)

9. Types of Pneumonia

10. ANATOMICAL CLASSIFICATION
 Lobar pneumonia is an infection
that only involves a single lobe, or
section, of a lung.
 Bronchopneumonia affects the
lungs in patches around bronchi
 Interstitial pneumonia involves
the areas in between the alveoli

11. CLINICAL CLASSIFICATION
 Community Acquired - Typical/Atypical/Aspiration
 Pneumonia in Elderly
 Nosocomial- HAP,VAP,HCAP
 Pneumonia in Immunocompromised

12. Community Acquired Pneumonia (CAP)
 An infection of the pulmonary parenchyma
 Associated with symptoms of infection
 Presence of infiltrates on CXR or auscultatory
findings consistent with Pneumonia

13. Hospital Acquired pneumonia - HAP
 HAP is defined as pneumonia that occurs 48
hours or more after admission, which was not
incubating at the time of admission.

14. Ventilator Associated Pneumonia- VAP
 VAP refers to pneumonia that arises more
than 48–72 hours after endotracheal
intubation .

15. Health Care Associated Pneumonia HCAP
 HCAP includes any patient
i. Who was hospitalized in an acute care hospital for 2 or
more days within 90 days of the infection
ii. Resided in a nursing home or long-term care facility
iii. Received recent i.v antibiotic therapy, chemotherapy,
or wound care within the past 30 days of the current
infection
iv. Attended a hospital or hemodialysis clinic

16. Causes of Pneumonia

17. Etiology
I. Bacterial
II. Viral
III. Mycobacterial
IV. Fungal
V. Parasitic

18. Etiology
 Streptococcus pneumoniae most common
 Haemophilus influenzae
 Staphylococcus aureus
 Klebsiella pneumonia
 Mycoplasma pneumoniae
 Legionella pneumophila
 Viruses

19. Clinical Picture

20. GENERAL SYMPTOMS
 High grade fever
 Cough-productive
 Pleuritic chest pain
 Breathlessness

21. Additional symptoms
 Sharp or stabbing chest pain
 Headache
 Excessive sweating and clammy skin
 Loss of appetite and fatigue
 Confusion, especially in older people

23. General Signs
 Febrile
 Tachypnoea (increase respiratory rate)
 Tachycardia(increase heart rate)
 Cyanosis-central
 Hypotension
 Use of accessory muscles of respiration
 Confusion- advanced cases

24. SIGNS OF CONSOLIDATION
 Percussion-dull
 Crackles
 Pleural Rub

25. Investigation

26. SPUTUM
 Gram Staining
 AFB(acid-fast bacillus)
 Giemsa or methenamine silver stain
 KOH (potassium hydroxide) mount
 Culture

27. X Ray
 Homogenous opacity with air bronchogram

28. LAB
 Complete white blood count
 Blood Sugar
 Electrolytes
 Creatinine
 Blood culture
 Oxygen saturation by pulse oximetry
 ABG(arterial blood gases)
 Chest Ultrasound
 Mantaux(for TB)

29. INVASIVE
 Bronchoscopy
 Thoracoscopy
 Percutaneous aspiration/biopsy
 Open lung biopsy
 Pleural asp

30. Treatment

31. CURB 65
 C onfusion – Altered mental status
 U remia – Blood urea nitrogen (BUN) level greater than 20 mg/dL
 R espiratory rate –30 breaths or more per minute
 B lood pressure – Systolic pressure less than 90 mm Hg or diastolic
pressure less than 60 mm Hg
 Age older than 65 years
 Current guidelines suggest that patients may be treated in an
outpatient setting or may require hospitalization according to their
CURB-65 score, as follows:
o Score of 0-1 – Outpatient treatment
o Score of 2 – Admission to hospital(No ICU)
o Score of 3 or higher – Admission to intensive care unit (ICU)

32. Outpatients Treatment(empirical)
 Previously healthy and no antibiotics in past 3 months:
o A macrolide (clarithromycin or azithromycin or
Doxycycline )
 Comorbidities or antibiotics in past 3 months:
o Respiratory fluoroquinolone [moxifloxacin ,levofloxacin
] or β-lactam ( high-dose amoxicillin or
amoxicillin/clavulanate)

33. Inpatients, non-ICU
 A respiratory fluoroquinolone [moxifloxacin
,levofloxacin ]
 β -lactam [cefotaxime ,ceftriaxone ,ampicillin]
PLUS a macrolide [oral clarithromycin or
azithromycin)

34. Inpatients, ICU
 β -lactam PLUS Azithromycin or a
fluoroquinolone.

35. Pseudomonas
 An antipneumococcal, antipseudomonal β-lactam
[piperacillin/tazobactam, cefepime , imipenem ,
meropenem] PLUS Flouroquinolons
 Above β-lactams PLUS an aminoglycoside and
azithromycin
 Above β-lactams PLUS an Aminoglycoside
PLUS an antipneumococcal Fluoroquinolone

36. Methicillin-resistant Staphylococcus
aureus
 If MRSA , add linezolid or vancomycin

37. Pneumonia complications
 SLAP HER (please don’t)
 S - Septicaemia
 L - Lung abcess
 A - ARDS
 P - Para-pneumonic effusions
 H - Hypotension
 E - Empyema
 R - Respiratory failure /renal failure

38. Course
 Most healthy people recover from pneumonia in one to
three weeks, but pneumonia can be life-threatening.
 The mortality rate associated with community-acquired
pneumonia (CAP) is very low in most ambulatory
patients and higher in patients requiring hospitalization,
being as high as 37 percent in patients admitted to the
intensive care unit (ICU)

39. Prevention
 Smoking cessation
 Better Nutrition
 Respiratory hygiene measures
 Pneumococcal polysaccharide vaccine
 Inactivated influenza vaccine
 Live attenuated influenza vaccine

40. Conclusion
 The presence of an infiltrate on plain chest radiograph is
considered the "gold standard" for diagnosing pneumonia
when clinical and microbiologic features are supportive
 Most initial treatment regimens for hospitalized patients with
community-acquired pneumonia (CAP) are empiric
 The mortality rate associated with community-acquired
pneumonia (CAP) is very low in most ambulatory patients
and higher in patients requiring hospitalization

41. Thank you!
Any Questions?