Community Aquired Pneumonia

1. Pneumonia
BY DR AZAD

2. Index :
 Difination
 Pathophysiology
 Causes
 Clinical Setting
 Sign and Symptoms
 Diagnostic Workup
 Treatment
 Prevention
 Complications

3. Difination
 Pneumonia is infection and inflammation of lung
paranchymal

4. Pathophysiology
How do we acquired infections?
 Inhalation
 Aspiration
 Hematogenous
Role of defense mechanism

5. Four stage of pneumonia
1. Congestion
2. Red hepatization
3. Gray hepatization
4. Reslotion

6. Causes
 Bacteria
 Viral
 Fungal
 others

7. Clinical Setting
1. Community Acquired Pneumonia
2. Nosocomial Pneumonia
 Hospital Acquired Pneumonia
 Ventilator Acquired Pneumonia
 Health care associated pneumonia
3. Aspiration Pneumonia

8. Sign and Symptoms
Signs :
 General signs
 Upper Respiratory Signs
 Pulmonary Signs
 GI Signs

9. Symptoms
Fever
Tachypnea
Hypotension

10. Diagnostic Workup
 Physical examination
 Laboratory examination

11. Physical examination
 Inspection
 Palpation
 Percussion
 Auscultation

12. Inspection
• Increase PR
• Use accessory respiratory muscles
• Intercostal retraction
• Pleuritic chest pain

13. Palpation
 Respiratory expansion
 Increase tactile fremitus

14. Percussion
Dullness

15. Auscultation
 Bronchial breathing sounds
 Crackles or Ralls
 Positive bronchophony
 Positive Egophony
 Positive Whispering piqtoriloqy

16. Lab Exam
 Chest X-ray
 CT Scan
 Sputum cytology
 Blood exam

17. Treatment
CAP
1_ OPD
✓ CAP + No comorbidities or No treat ABX
✓ CAP + comorbidities or treat ABX
2_ Inpatient
✓ Ward
✓ ICU
HAP

18. Treatment of CAP
OPD :
CAP + No comorbidities or No treat ABX
✓ Macrolides
✓ Doxycycline

19. Countinuse...
OPD:
CAP + comorbidities or treat ABX
✓ FQ
* Levofloxacin
* Gemifloxacine
* Ciprofloxacin
✓ Macrolides + Amoxicillin
or Augmentin
or 2th or 3th Gen of cef

20. Conti...
Inpatient
Ward :
✓ Ceftriaxone or Cefotaxium + Macrolides or FQ
If pencilin allergy :
* Aztereonam

21. ICU
Cephalosporin + Macrolides or quinolones
If MRSA :
Vancomycin or Linezolid

22. Treatment of HAP
1_NO MDR:
 Penicillin's
 3th gen of cephalosporin
 FQ
2_ MDR:
 Penicillin's ( Imipenem or Meropenem )
 Cefepem
 Ceftazedime

23. Prevention
Vaccination :
PPSV23
PCV13

24. Complications
 Septic shock
 Pleural effusion
 Meningitis
 Abscess
 Hypoxia