Based on the information provided: 1. The likely diagnosis is community-acquired pneumonia. 2. Possible infecting organisms include Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae. 3. Empirical antibiotics that would be appropriate include amoxicillin or doxycycline to cover typical and atypical organisms. Adding a macrolide such as clarithromycin or azithromycin would broaden coverage.

1. Pneumonia

2. *Group members
1. Amima Bint Irfan
2. Amroz Gilal
3. Noor-ul-Huda
4. Tanzila Maham
5. Yousra Yousuf
6. Yousra Ayoub
7. Roha Badar
8. Sabrina Sajid
9. Ramsha Tanveer
10.Nimra Zaheer

3. PNEUMONIA:
.Pneumonia is defined as inflammation of lung parenchyma that is the alveoli
rather than bronchioles or bronchi.
.Infective origin is characterized by consolidation.
CONSOLIDATION:
.It is a pathological process in which the alveoli are filled with inflammatory
exudate
.Bacteria and white blood cells that on chest x-ray appear as an opaque shadow
in the normally clear lungs.

4. CLASSIFICATION:
Clinically it is classified as:
. Atypical pneumonia
. Typical pneumonia
TYPICAL:
Typical pneumonia is usually caused by “STREPTOCOCUS”
pneumoniae.
ATYPICAL:
Atypical pneumonia is caused by influenza virus, adenovirus and other identified
microorganisms

5. *EPIDEMIOLOGY
*Affects 450 million people over the world over a year causing
4 million deaths yearly
*>50% mortality rate before the antibiotic era
*Most death causing infection in USA
*Common in elderly, young and critically ill.

6. Routes of access of pathogens to the lungs
*Inhaled as aerosolized particles
*Enter the blood stream from an extra pulmonary site if
infection
*Aspiration of oropharengial content
Disease occurs in case of impaired lung defense
Bacterial colonization in upper airway

8. *CLINICAL PRESENTATION OF
GRAM NEGATIVE PNEUMONIA
Gram negative bacteria that causes pneumonia
are:
a)Pseudomonas aeruginosa
b)E.coli
c)Klebsiella spp.
d)Haemophilus sp

9. *Pseudomonas aeruginosa
The source may be
endogenous (from respiratory
or GI tract colonization) or
exogenous from tap water in
hospital-acquired pneumonia.
It is an aerobic, motile
bacillus often characterized
by its distinct grape like odor

10. *Klebsiella Pneumonia
*Facultative anaerobic encapsulated
bacillus that leads to necrotizing lobar
pneumonia.
*Patients with chronic alcoholism diabetes
or COPD are at risk of infection this
organism

11. *CULTURE OF K. PNEUMONIA
The Klebsiella
pneumonia colonies are
non-hemolytic i.e. shows
Gamma Hemolysis (γ-
hemolysis).
In Macconkey Agar medium,
the colonies of Klebsiella
pneumonia are pink colored
due to the lactose
fermentation

12. *Haemophilus Pneumonia
It is aerobic bacillus either
available in capsulated or
encapsulated forms
Causes bronchopneumonia
H.influenza type B being
most prevalent in children .

13. CAUSATIVE ORGANISMS:
• Streptococcus pneumoniae: is a facultative anaerobe identified by its
chainlike staining pattern. Causes disease in 70% of cases. Also
responsible for Nosocomial pneumonia.
• Staphylococcus aureus causes disease in 2 to 5% cases.
* GRAM POSITIVE PNEUMONIA

14. LABORATORY FINDINGS:
• Peripheral leukocytosis with neutrophilia and increased percentage of immature
granulocytes.
• Elevated WBC count
• Arterial hypoxemia.
• Chest radiography: bilaterally patchy bronchopneumonia
• Thin walled air containing cysts or pneumatoceles shows staphylococcal pneumonia.

15. *COMMUNITY ACQUIRED
PNEUMONIA

16. *COMMUNITY ACQUIRED
PNEUMONIA
Community acquired pneumonia (CAP) refers to that
type of pneumonia that is acquired from outside of the
hospitals or extended care facilities.
*It is one of the most common infectious disease
diagnose by the clinicians

17. *Causative organisms:
Organism Comments
Streptococcus pneumonia Cause labor pneumonia
Staphylococcus aureus Severe pneumonia with
abscess formation
Mycoplasma pneumonia Cause acute pneumonia in
young people
Viruses Some viruses can also cause
pneumonia in adults

18. *CLINICAL FEATURES
Pneumococcal
lobar pneumonia
Initial dry cough, with period
of time become purulent or
blood stained sputum.
Dyspnoea, fever and pleuritic chest
pain,
High no. of WBCS,
X ray shows consolidation to one
or more lobes.
Bronchopneumonia
Productive cough
along with
breathlessness,
Patchy consolidation
on the chest X ray (on
basis of lungs)

19. *Bronchopneumonia vs lobar
pneumonia

20. Diagnosis

21. *Pneumonia caused by pneumococci and H influenzae so sputum culture
test, bronchoscopy and bronchoalveolar lavage is done
*For pneumococcal disease blood culture is done
*For pneumococcal antigen urine test or plasma test is done
*For legionella infection culture or urinary test is done
*Viruses may be detected by immunofluorescence or by viral culture
test

22. Treatment

23. *For pneumococcal pneumonia, benzyl penicillin or
amoxicillin are used
*If patient is penicillin allergic so erythromycin
monotherapy is used
*For pneumococcal bacteraemia combination therapy
of ß lactam and macrolide reduced the mortality
rate
*For chlamydophila pneumonia tetracyclines and
quinolones are effective to use
*For staphylococcal pneumonia flucloxacillin with
rifampicin, fusidic or gentamicin are used

24. *For mild disease , It is treated with amoxicillin that provides activity against
pneumococci and H.infleunzae.
*Moderate/severe disease requires admission to the hospital.
*Amoxicillin + Macrolide = for less severe disease.
*Cefuroxime + Macrolide = for more severe disease.
*Treatment should cover both ‘typical’ and ‘atypical’ causes until the etiology
is known.
*Assessment tools such as CURB-65, the Serum urea, the respiratory rate,
blood pressure and age>65 years.

25. *HOSPITAL ACQUIRED
(nosocomial)PNEUMONIA
HAP

26. Infection occurring in a patient in a hospital or other health-care
facility in whom the infection was not present at the time of admission.
Lower respiratory infection.
Second most common and leading cause of death.
Occurs at least 2 days after hospital admission.
VAP and HCAP.
Time of onset and sources of pathogens.

27. Bacteria, such as Streptococcus
pneumoniae or Haemophilus influenzae,
are the most common causes of HAP.
Pseudomonas aeruginosa, Klebsiella spp.,
Enterobacteriaceae, E.coli etc. are the
common causes of HAP as length of
hospital stay increases. HAP is estimated
to increase hospital stays by seven to
nine days. In addition, as length of
hospital stay increases, it is more likely
for multi-drug resistant (MDR) organisms
to become the cause of the infection.

28. •Sepsis
•Respiratory failure
Predisposing factors are:
•Stroke
•Previous antibiotic exposure
•Chronic lung disease
•Mechanical ventilation
•Recent surgery.
*Clinical Features:

29. *Diagnosis:
*Sputum test
*Blood culture.
*Bronchoalveolar lavage.

30. *Treatment *Broad spectrum antibiotics are
indicated.
*The choice of antibiotics influenced by:
1. Preceding antibiotic therapy.
2. Duration of hospital admission
3. The most important is individual’s
experience with hospital bacteria

31. Single agent therapy
Broad spectrum therapy
Late onset (>5 days) or risk factors for
MDR’s
No Yes
HAP suspected

32. *Treatment regimen for HAP
Regimen Comments
Ureidopenicillin + aminoglycosides Good activity against Gram-negative bacilli such as P.aeruginosa
Cephalosporin + aminoglycosides Good activity against Gram-negative bacilli such as E.coli, Klebsiella and
Gram-positive but poor against P.aeruginosa and anaerobes.
Clindomycin + aminoglycosides Good activity against Gram-positive organisms and anaerobes but less
against Gram- negative.

33. Ciprofloxacin + glycopeptide Ciprofloxacin provides good activity against most Gram-negative
bacilli. Glycopeptide provides activity against Staph. aureus.
Ceftazidime (monotherapy) Convenient and avoid risk of aminoglycosides toxicity. Very active
against Gram-negative bacilli.
Meropenem (monotherapy) Broad-spectrum agent but expensive, not active against MRSA .
Linezolid combinations Necessary to cover MRSA in empiric or targeted treatment of HAP.

34. *if legionnaire’s disease suspected, erythromycin
would be added.
*If anaerobic infections are suspected,
metronidazole would be required.

35. *PREVENTION:
USING VACCINATION
ENVIROMENTAL MEASURES
GOOD LIFE STYLE

36. *VACCINATION:
ANTIBACTERIAL ANTIFUNGAL

37. *HAVING GOOD LIFE STYLE:
NO SMOKING
NO ABUSING
ALCOHOL
WASHING HANDS

38. *ASPIRATION PNEUMONIA:
Inhalation of
oropharyngeal or
gastric content into
lower airway, the act
of taking foreign
material into the lung.

39. *Type of aspiration pneumonia:

40. *SYMPTOMS OF ASPIRATION
PNEUMONIA
FATIGUE CHEST PAIN WHEEZING FEVER
SWEATING
DIFFICULTY
SWALLOWING

41. *TREATMENT:
*Use of antibiotic with combination of metronidazole + amoxicillin is usually
adequate or metronidazole + cefuroxime
*X-RAY or computed tomography or bronchoscope to check the airway and
blockages.
*A sputum culture test, complete blood count, arterial blood gas test, can help
how severe the infection and what type of treatment is required.

42. *CASE STUDY
*A 61-year old man is found collapsed at home and taken to hospital. His
family reports him complaining of a sore throat a few days before
admission. On examination, he is pyrexial, hypoxic and tachycardiac with
reduced air entry. Chest x-ray reveals right basal pneumonia.
1. What is the likely diagnosis?
2. What are the possible infecting organisms?
3. What empirical antibiotics would you choose?