Peumonia part2

1. PNEUMONIA
Dr. Manu Mohan K
Associate Professor
Pulmonary Medicine

2. Community Acquired Pneumonia
 Most common
 Streptococcus pneumonia
 Common
 Staphylococcus aureus, Legionella pneumophila,
Mycoplasma pneumoniae
 Uncommon
 Haemophilus influenzae, Klebsiella pneumoniae,
Streptococcus pyogenes, Pseudomonas aeruginosa
 Rare
 Coxiella burnetti, Chlamydia psittacci, Actinomyces
israeli, viruses

4. Pneumococcal pneumonia
 Predisposing conditions
 Splenectomized state, functional
asplenia, chronic lung, heart, renal, liver
diseases, Diabetes mellitus
 Clinical features
 Physical signs
 Radiological examination

5. Supportive treatment
 Respiratory support
 Fluid and electrolyte replacement
 Other consideration
 Pleuritic pain
 Physiotherapy
 Corticosteroids
 Inotropic agents

6. Prevention
 Vaccination
 Influenza
 Pneumococcal

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

8. Hospital acquired pneumonia
 VAP refers to pneumonia that arises more
than 48–72 hours after endotracheal
intubation

9. Hospital acquired pneumonia
 HCAP includes any patient who was
 hospitalized in an acute care hospital for
two or more days within 90 days of the
infection;
 resided in a nursing home or long-term care
facility;
 received recent intravenous antibiotic
therapy, chemotherapy, or wound care
within the past 30 days of the current
infection; or
 attended a hospital or hemodialysis clinic

10. Hospital acquired pneumonia
 Common pathogens include
 aerobic gram-negative bacilli, such as P.
aeruginosa, Escherichia coli, Klebsiella
pneumoniae, and Acinetobacter species.
 Infections due to gram-positive cocci,
such as Staphylococcus aureus,
particularly methicillin resistant S. aureus
(MRSA)

11. Predisposing factors for HAP
 Reduced host defense
 Aspiration of nasopharyngeal or gastric
secretions
 Bacteria introduced into lower respiratory
tract
 Bacteremia

12. Hospital acquired pneumonia
 Clinical features
 Investigations
 Management
 Prevention
 Good hygiene
 Minimize aspiration
 limit stress ulcer prophylaxis

13. Aspiration Pneumonia
 Mainly oropharyngeal flora
 Nosocomial case – polymicrobial

14. Suppurative pneumonia –
clinical features
 Symptoms
 Cough with expectoration
 Pleural pain
 Sudden expectoration
 Clinical signs
 Fever
 Systemic upset
 Clubbing
 Signs of consolidation, rub

15.  Investigations
 Management

16. Pneumonia - immunocompromised
 Etiology
 Defective phagocytosis
 Defective cell-mediated immunity
 Defective antibody production
 Clinical features
 Investigation
 Treatment

17. Pneumonitis
 Radiation pneumonitis
 Chemical pneumonitis