This document discusses pneumonia, including its causes, types, symptoms, diagnostic tests, treatment, and complications. Pneumonia is an infection of the lungs that can be caused by viruses, bacteria, or other pathogens. It is classified based on location in the lungs and whether it is primary, secondary, or due to aspiration. Common symptoms include cough, fever, difficulty breathing. Diagnostic tests may include chest x-rays and sputum/fluid cultures. Treatment depends on severity but generally involves antibiotics, and complications can include respiratory failure or sepsis.

1. pneumonia

2. • Pneumonia is an acute infection of the lung
parenchyma that often impairs gas exchange.
• Many types of organisms can cause
pneumonia, including viral, bacterial, fungal,
protozoal, or other organisms.

3. • The infection may also be described by
location: bronchopneumonia, lobular
pneumonia, or lobar pneumonia.
• Pneumonia is also classified into three types—
primary, secondary, or aspiration pneumonia.
• Primary pneumonia results directly from
inhalation or aspiration of a pathogen, such as
bacteria or a virus; it includes pneumococcal
and viral pneumonia.

4. • Secondary pneumonia may follow initial lung
damage from a noxious chemical or other
insult (super-infection) or may result from
hematogenous spread of bacteria from a
distant area.
• Aspiration pneumonia results from inhalation
of foreign matter, such as vomitus or food
particles, into the bronchi.

5. • Aspiration pneumonia is more likely to occur
in elderly or debilitated patients, those
receiving nasogastric tube feedings, and those
with an impaired gag reflex, poor oral hygiene,
or a decreased level of consciousness.

6. • CAUSES
• Pneumonia is caused by a number of
infectious agents, including viruses, bacteria
and fungi. The most common are:
• Streptococcus pneumoniae – the most
common cause of bacterial pneumonia in
children.

7. • Haemophilus influenzae type b (Hib)
– the second most common cause of
bacterial pneumonia; Respiratory
syncytial virus (RSV) is the most
common viral cause of pneumonia.
.

8. • In bacterial pneumonia, an infection initially
triggers alveolar inflammation and edema
• Capillaries become engorged with blood,
causing stasis. As the alveolocapillary
membrane breaks down, alveoli fill with blood
and exudate

9. • Viral infection typically causes diffuse
pneumonia and first attacks bronchiolar
epithelial cells, causing interstitial
inflammation and desquamation.
• It then spreads to the alveoli, which fill with
blood and fluid.

10. • In aspiration pneumonia, aspiration of gastric
juices or hydrocarbons triggers similar
inflammatory changes and also inactivates
surfactant over a large area.
• Decreased surfactant leads to alveolar
collapse. Acidic gastric juices may directly
damage the airways and alveoli.

11. • Particles with the aspirated
gastric juices may obstruct the
airways and reduce airflow,
thereby leading to secondary
bacterial pneumonia.

12. • Certain predisposing factors increase the risk of
pneumonia. They include chronic illness and
debilitation, cancer (particularly lung cancer),
abdominal and thoracic surgery, atelectasis,
common colds or other viral respiratory
infections, chronic respiratory diseases, influenza,
smoking, malnutrition, alcoholism, sickle cell
disease, tracheostomy, exposure to noxious
gases, aspiration, and immunosuppressive
therapy.

13. • Symptoms and signs
• The symptoms of viral and bacterial
pneumonia are similar. However, the
symptoms of viral pneumonia may be more
numerous than the symptoms of bacterial
pneumonia.

14. • The symptoms of pneumonia include:
• Increased or rapid respiratory rate
• cough
• fever
• chills
• loss of appetite
• wheezing (more common in viral infections).

15. • When pneumonia becomes severe, children
may experience lower chest wall indrawing,
where their chests move in or retract during
inhalation (in a healthy person, the chest
expands during inhalation).

16. • Very severely ill infants may be unable to feed
or drink and may also experience
unconsciousness, hypothermia and
convulsions.

17. • Pneumonia in children under 5 year’s age
Pneumonia should be suspected in all children
who present with:
• cough
• difficulty breathing
• Fever
• fast respiratory rate (tachypnea).

18. • A child has tachypnea (increased RR) if:
• RR >60 breaths/minute in children under 2
months
• RR >50 breaths/minute in children from 2 to
11 months
• RR >40 breaths/minute in children 12 months
to 5 years

19. • COMPLICATIONS
• Complications from pneumonia may include
septic shock, hypoxemia, respiratory failure,
• empyema, lung abscess, bacteremia,
endocarditis, pericarditis, and meningitis.

20. • DIAGNOSTIC TESTS
• Chest radiography shows infiltrates with
characteristics specific to the type of
pneumonia present.
• Sputum stain demonstrates acute
inflammatory cells; Gram stain and sputum
culture may identify the organism.

21. • Tracheobronchial secretions or
brushings or washings obtained
via bronchoscopy may be used
for smear and culture.

22. • TREATMENT
• Severe pneumonia (inpatient treatment)
• ceftriaxone IM or slow IV (3 minutes)
• Children: 50 mg/kg once daily
• Adults: 1 g once daily
• The treatment is given by parenteral route for at least 3 days then, if the clinical
condition has
• improved 2(see page 0) and oral treatment can be tolerated, switch to amoxicillin
PO to complete 7 to 10
• days of treatment:
• Children: 30 mg/kg 3 times daily (max. 3 g daily)
• Adults: 1 g 3 times daily
• or
• ampicillin slow IV (3 minutes) or IM
• Children: 50 mg/kg every 6 hours
• Adults: 1 g every 6 to 8 hours

23. • Ampicillin is preferably administered in 4 divided
doses. If the context does not permit it, the daily
dose must be divided in at least 3 doses.
• The treatment is given by parenteral route for at
least 3 days then, if the clinical condition has
improved and oral treatment can be tolerated,
switch to the oral route with amoxicillin PO to
complete 7 to 10 days of treatment.

24. • If the clinical condition deteriorates or does
not improve after 48 hours of correct
administration, administer ceftriaxone as
above + cloxacillin IV infusion:
• Children: 25 to 50 mg/kg every 6 hours
• Adults: 2 g every 6 hours

25. • After clinical improvement and 3 days with no
fever, switch to amoxicillin/clavulanic acid
(coamoxiclav) PO to complete 10 to 14 days of
treatment.

26. • Pneumonia without signs of serious illness
(outpatient treatment)
• amoxicillin PO
• Children: 30 mg/kg 3 times daily (max. 3 g
daily) for 5 days
• Adults: 1 g 3 times daily for 5 days

27. • Follow-up in 48 to 72 hours or sooner if the
child’s condition deteriorates:
– If the condition is improving 2(see page 0) :
continue with the same antibiotic to complete
treatment.
– If there is no improvement after 3 days of
correct administration: add azithromycin