Pneumonia - Clinical aspects and management - Undergraduate Level

1. Dr Nadia Shams Associate Professor Medicine RIHS

2. COMMON UPPER RESPIRATORY TRACT INFECTIONS
Acute coryza ( common cold)
Acute pharyngitis
Sinusitis
Tracheo-bronchitis
Epiglottitis
Acute bronchitis
Influenza
Dr Nadia Shams Associate Professor Medicine RIHS

3. • Pneumonia is an acute infection
of the parenchyma of the lung,
caused by bacteria, fungi, virus,
parasite etc.
• Pneumonia may also be caused
by other factors including X-ray,
chemical, allergen .
Dr Nadia Shams Associate Professor
Medicine RIHS

4. • The morbidity and mortality of pneumonia are high especially
in children and old people.
Dr Nadia Shams Associate Professor Medicine RIHS

5. There are two factors involved in the formation of
pneumonia , including pathogens and host defenses.Dr Nadia Shams Associate Professor Medicine RIHS

6. Dr Nadia Shams Associate Professor
Medicine RIHS

7. • Congestion
• Red hepatization
• Grey hepatization
• Resolution
Dr Nadia Shams Associate Professor
Medicine RIHS

8. • By anatomy.
• Lobar Pneumonia
• Bronchopneumonia
• By pathogen
• Bacterial
• Viral
• Fungal
• Atypical
• By acquired environmental factors.
Dr Nadia Shams Associate Professor Medicine RIHS

9.  Aerobic Gram +ve
(strept. pneumoniae, staph. aureus, Group A hemolytic strept.)
 Aerobic Gram-ve
(Klebsiella pneumoniae, H influenzae, E coli)
 Anaerobic bacteria.
Dr Nadia Shams Associate Professor Medicine RIHS

10. • Adenoviruses
• Respiratory syncytial virus
• Influenza
• Cytomegalovirus
• Herpes simplex.
Dr Nadia Shams Associate Professor Medicine RIHS

11. • Candida
• Aspergilosis
• Pneumocystis jiroveci (PCP)
Dr Nadia Shams Associate Professor Medicine RIHS

12. • Legionella pneumonia
• Mycoplasmal pneumonia
• Chlamydia pneumonia.
Dr Nadia Shams Associate Professor Medicine RIHS

13.  Rickettsias
 Parasites
 Protozoa
Dr Nadia Shams Associate Professor Medicine RIHS

14. • Lobar:
Homogenous consolidation of an entire lobe
• Bronchopneumonia:
Patchy alveolar consolidation
Dr Nadia Shams Associate Professor Medicine RIHS

15. Dr Nadia Shams Associate Professor Medicine RIHS

16. Dr Nadia Shams Associate Professor Medicine RIHS

17. ◆Community acquired pneumonia-------------CAP
◆Hospital acquired pneumonia----------------HAP
◆Nursing home acquired pneumonia----------NHAP
◆Immunocompromised host pneumonia--------ICAP
◆Ventilator acquired Pneumonia--------------VAP
Dr Nadia Shams Associate Professor Medicine RIHS

18.  “CAP refers to pneumonia acquired outside of
hospitals or extended-care facilities” .
 Most commonly identified pathogen- Strept. pneumoniae
 Other pathogens include Haemophilus influenzae,
mycoplasma pneumoniae, Chlamydophilia pneumoniae,
Moraxella catarrhalis and ects.
 Drug resistance streptococcus pneumoniae(DRSP)
Dr Nadia Shams Associate Professor Medicine RIHS

19.  “HAP refers to pneumonia acquired in the hospital setting”.
1. Enteric Gram-negative organisms
2. S. aureus
3. Pseudomonas aeruginosa.
➢(Gram-ve bacteria account for 55%-85% of HAP infections & gram +ve
cocci account for 20% to 30% and some other pathogens)
Dr Nadia Shams Associate Professor Medicine RIHS

20.  General risk factors for developing HAP:
1. age more than 70 years,
2. serious comorbidities,
3. malnutrition,
4. impaired consciousness,
5. prolonged hospitalization,
6. COPD.
Dr Nadia Shams Associate Professor Medicine RIHS

21. • Aspiration :
Microaspiration of contaminated oropharyngeal secretions seems to
be the most important of these factors, as it is the most common
cause of HAP.
• Inhalation
• Contamination
Dr Nadia Shams Associate Professor Medicine RIHS

22. • “Pneumonia in an immunocompromised host describes a lung
infection that occurs in a person whose ability to fight infection
is greatly impaired”.
Dr Nadia Shams Associate Professor Medicine RIHS

23. Clinical Features
Dr Nadia Shams Associate Professor Medicine RIHS

24. • Acute febrile illness with rigors, anorexia and
headache.
• Cough: dry / productive / rusty sputum / hemoptysis.
• Pleuritic chest pain
• Shortness of breath
• Non specific symptoms may be seen in
immunocomromised and elderly
Dr Nadia Shams Associate Professor Medicine RIHS

25. 1. Confusion
2. Pa02 <60mmHg.
3. Respiratory rate >30/min
4. Blood pressure <90/60mmHg
5. Chest X-ray shows bilateral
infiltration, multilobar
infiltration and the
infiltrations enlarge
>50 % within 48h.
6. Renal function: U>20ml/h
Dr Nadia Shams Associate Professor Medicine RIHS

26. • Pulmonary tuberculosis
• Pulmonary odema
• Lung cancer
• Acute lung abcess
• Pulmonary embolism
• Noninfectious pulmonary infiltration
Dr Nadia Shams Associate Professor Medicine RIHS

27. INVESTIGATIONS
Dr Nadia Shams Associate Professor Medicine RIHS

28. Blood complete picture
Serum electrolytes, renal function tests, arterial blood gases
Pathogen identification
• Sputum
• Nasotracheal suctioning
• BAL
• Blood culture or pleural effusion culture
• Serologic testing (immunological testing)
• Molecular Techniques
Dr Nadia Shams Associate Professor Medicine RIHS

29. • CXR
Infiltrates appear within 12-18 hours
Effusion, abcess, empyema
• CT scan chest
Dr Nadia Shams Associate Professor Medicine RIHS

30. Dr Nadia Shams Associate Professor Medicine RIHS

31. Decide about Admission ???
Dr Nadia Shams Associate Professor Medicine RIHS

32. CURB-65
Confusion
Urea >7 mmol/l
RR 30/min
BP< 90/60
Age>65
0-1
Home treatment
2
Consider admission
3 or more (admit)
ICU Admission if 4-5 score
Dr Nadia Shams Associate Professor Medicine RIHS

33. Empirical Treatment
Dr Nadia Shams Associate Professor Medicine RIHS

34. General measures: rest, hydration, Oxygen inhalation, Nutrition,
pain relief
CAP
-------------------------------------------------------
Amoxycillin/ erythromycin/ clarithromycin
+
Flucloxacillin (Staphylococcus isolated)
Rifampicin (Mycoplasma/ legionella)
Dr Nadia Shams Associate Professor Medicine RIHS

35. Hospital acquired/ Nosocomial Pneumonia
---------------------------------------------------------
(Gram -ve and staph. coverage is important)
3rd Gen cephalosporins
+
Meropenem
+
Flucloxacillin
Dr Nadia Shams Associate Professor Medicine RIHS

36. Aspiration Pneumonia
-------------------------------------------------------------
Co-Amoxicalv
+
Metronidazole
Dr Nadia Shams Associate Professor Medicine RIHS

37. ICAP (in immunocompromised patients)
---------------------------------------------------------
3rd gen cephalosporin/ quinolone
+
Antipseudomonal pencillin
+
Aminoglycoside
Dr Nadia Shams Associate Professor Medicine RIHS

38. 1. Sepsis
2. lung abscess/empyema
3. pleural effusion
4. ARDS
5. ARF
6. pneumothorax
7. Extra-pulmonary infections
Dr Nadia Shams Associate Professor Medicine RIHS

39. Dr Nadia Shams Associate Professor
Medicine RIHS

40. Dr Nadia Shams Associate Professor
Medicine RIHS

41. Legionellae are small,
gram-negative, obligately
aerobic baclli.
.
Dr Nadia Shams Associate Professor
Medicine RIHS

42. • 2002- china
• Corona Virus
• Fever-muscle pains-dry cough-SOB-Rapidly worsening
CXR findings
• Supportive treatment and ventilation.
Dr Nadia Shams Associate Professor Medicine RIHS

43. Polyvalent pneumococcal
vaccine
1. COPD
2. CLD
3. Splenectomy
4. Diabetes mellitus
5. Elderly patients
Dr Nadia Shams Associate Professor
Medicine RIHS