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Approach to Pneumonia.pptx importangathan
- 1. Clinical Approach to Community Acquired Pneumonia Dr. S.S.Akash Kumar 1st year PG Department of General Medicine
- 2. COMMUNITY ACQUIRED PNEUMONIA WHAT IS CAP? Pneumoniathat occurs in community dwelling individuals is termed CAP
- 3. Community Acquired Pneumonia •Affects all ages • Droplet infection spread • M/c cause- Streptococcus pneumoniae • Causative agents- Bacterial, Fungi, Viruses and Protozoa
- 4. How to approacha case of CAP? • Detailed History Taking • Clinical Examination • Investigations • Severity Assesment • Management
- 5. Bedside History in Pneumonia • Fever:Chills, rigors • Cough: Dry or productive (purulent, rusty, or foul-smelling sputum) • Chest Pain: Pleuritic in nature • Dyspnoea: Ranges from mild to severe • Constitutional Symptoms: Malaise, fatigue, anorexia • Associated Symptoms
- 6. FEVER High grade in typical pneumonia Lowgrade in Atypical Pneumonia or TB
- 7. COUGH Key symptom • Productivecough: Bacterial • Dry cough: Viral or Atypical Sputum colour Green or yellow thick sputum - Bacterial infection (Myeloperoxidase) • Rusty- Pneumococcal Pneumonia • Green- Pseudomonas • Red currant Jelly sputum – Klebsiella Pneumoniae Foul smelling sputum- Anaerobic Infection
- 8. HEMOPTYSIS • Gross Hemoptysis– Necrotising Pneumonia (CA MRSA) • Pseudohemoptysis- Serratia ( Prodigiosin )
- 9. Other Symptoms • PleuriticChest pain • Dyspnoea • Constitutional symptoms • Extra pulmonary features
- 10. EXTRA PULMONARY SYMPTOMS • Myalgia, Arthralgiaand Malaise • Headache, abdominal pain, vomiting, diarrhoea • Erythema multiforme and erythema nodosum
- 11. Additional History Points Past Medical History: COPD,diabetes, immunosuppression Medication History: Immunosuppressants, antipsychotics (aspiration risk) Exposure History: TB contact, travel, birds (psittacosis), air conditioning (Legionella) Risk Factors: Smoking, alcohol, aspiration, recent hospitalization
- 12. Past History • PreviousTB H/o • Ho Asthma, COPD, or bronchiectasis • Immunocompromised State- Diabetes, CKD, HIV/AIDS • Steroids or recent antibiotics
- 13. RISK FACTORS Alcoholism • Strep pneumoniae •Klebsiella • Oral Anaerobes Smoking/ COPD •Hemophilus influenzae •Moraxella •Pseudomonas • Strep Pneumonia •Chlamydia Structural lung disease Eg. Bronchiectasis -Pseudomonas -Burkholderia Cepacia -Staph aureus
- 14. Environmental history 1. Exposureto contaminated air conditioners, recent hotel stay– Legionella 2. Exposure to infected humans - SARS-CoV2 3. Outbreak in shelters for homeless men- Strep Pneumoniae; Mycobacterium Tuberculosis
- 15. Animal contact history 1. Exposure toparturient cats, goat, sheep- Coxiella burnetti 2. Exposure to birds- Chlamydia psitacci, 3. Exposure to mouse dropping – Hanta virus 4. Exposure to rabits- Francisella Tularensis
- 16. Travel History 1. Travel tosoutheast asia- Avian Influenza, Melioidosis 2. Immigrants from Asia- TB 3. Travel to Ohio- Histoplasma 4. Travel anywhere - Legionella
- 17. Occupational History 1. Pneumoniain healthcare worker – M. Tb
- 18. General Examination Fever, tachypnea,tachycardia Cyanosis, use of accessory muscles Hypoxia • Signs of sepsis: hypotension, altered mental status • Anemia – Massive Hemoptysis ( Necrotising Pneumonia) • Jaundice - Pneumococcal Pneumonia
- 19. RS Examination INSPECTION • Tracheain Midline • Chest expansion reduced on the affected side
- 20. RS EXAMINATION PALPATION • Reducedchest expansion on the affected side • ↑ vocal fremitus PERCUSSION • Woody dull note
- 21. RS EXAMINATION AUSCULTATION Bronchial breathsounds (Tubular) • Late inspiratory crackles – Early Pneumonia • Expiratory coarse crackles- Resolving Pneumonia • Bronchophony, Aeogophony, Whispering Pectorloquy, ↑ vocal resonance
- 22. Clues to theEtiology of Pneumonia from History and Physical Examination • Prior mild respiratory illness with improvement and then rapid deterioration - Bacterial super infection of viral Pneumonia ( S.aureus ) • Pneumococcal Pneumonia – Fever with severe rigors • Abrupt onset, recurrent chills, mild diarrhoea - Legionnaires
- 23. Variations in Clinical Features :CAP • Often acute onset • High fever, productive cough • Pleuritic chest pain • Lobar consolidation common • Common pathogens: Streptococcus pneumoniae, Haemophilus influenzae
- 24. Variations HAP / VAP •Develops ≥48 hours after admission/intubation • Often subtle symptoms due to underlying illness • New/worsening infiltrate on imaging • Common pathogens: Gram-negative rods, MRSA • Less pleuritic pain, more systemic signs (delirium, sepsis)
- 25. Variations – Aspiration Pneumonia Historyof vomiting, dysphagia, seizure, or stroke Foul-smelling sputum Often affects right lower lobe Anaerobic organisms common Chronic aspiration may lead to lung abscess
- 26. Variations – Atypical Pneumonia • Causedby Mycoplasma, Chlamydia, Legionella, viruses • Gradual onset, low-grade fever • Dry cough, extrapulmonary features (rash, diarrhea, myalgia) • Often minimal findings on auscultation • Chest X-ray may show more than clinical findings suggest
- 28. REFERENCES Jameson, J. L.,Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Loscalzo, J. (Eds.). (2022). Harrison’s Principles of Internal Medicine (21st ed.). McGraw Hill. • Grippi, M. A., Celli, B. R., Fuster, V., Gallagher, C. G., Hall, J. B., & Martinez, F. J. (Eds.). (2023). Fishman’s Pulmonary Diseases and Disorders (6th ed.). McGraw Hill.