Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.

1. PNEUMONIA
SUMI SINGH
NEPAL MEDICAL COLLEGE AND TEACHING HOSPITAL

2. What is pneumonia?
◦Pneumonia is an inflammation of lung parenchyma
and is associated with consolidation of alveolar
spaces.
◦The term “Lower respiratory Tract Infection(LRTI) may
include pneumonia, bronchiolitis and/or bronchitis

3. CLASSIFICATION
◦ ACCORDING TO ANATOMICAL CLASSIFICATION :
◦ LOBAR PNEUMONIA :
Homogenous consolidation of one or more lung lobes .
◦ BRONCHO-PNEUMONIA :
Patchy alveolar consolidation asso. with bronchial or bronchiolar
inflammation.
o INTERSTITIAL PNEUMONITIS:
inflammation of the interstitium , composed of walls of alveoli , alveolar sacs and
ducts and bronchioles

5. CLASSIFICATION
◦ ACCORDING TO ETIOLOGICAL DISTRIBUTION
VIRAL (40%)
BACTERIAL (>2/3)
ATYPICAL (chlamydia , mycoplasma)
o ACCORDING TO ACQUISITION :
- community acquired pneumonia
- hospital acquired pneumonia
- ventilation associated pneumonia
o Aspiration pneumonia

6. EPIDEMIOLOGY
◦ Pneumonia kills more children under the age of 5 than any other illness
in every region of the world .
◦ The incidence of pneumonia is more than 10-fold higher and the
number of childhood-related deaths d/t pneumonia = 2000-fold
higher in developing countries

7. Pneumonia : the leading killer of
children

8. RISK FACTORS
 LOW BIRTH WEIGHT
VITAMIN A DEFICIENCY
LACK OF BREASTFEEDING
PASSIVE SMOKING
POOR SOCIO-ECONOMIC STATUS
OVER-CROWDING
FAMILY H/O BRONCHITIS
HOSPITALIZATION , ESPECIALLY IN AN ICU OR REQUIRING INAVSIVE
PROCEDURES.

9. ETIOLOGY
ALTHOUGH MOST CASES OF PNEUMONIA ARE CAUSED BY MICRO-ORGANISMS
(INFECTIOUS)
NON-INFECTIOUS CAUSES INCLUDE :
◦ Aspiration of food or gastric acid
◦ Foreign bodies
◦ Hypersensitivity reactions
◦ Drug or radiation induced pneumonitis.

11. CLINICAL MANIFESTATION
◦ Onset of pneumonia may be insidious starting with URTI typically rhinitis and cough.
◦ Symptoms and signs include :
Fever
Cough
Dyspnoea , Tachypnea
Malaise
Pleuritic chest pain
Retractions of supraclavicular , intercostal and subcostal areas
On S/E : diminished air entry, bronchial breathing , wheeze and crepitations maybe present .

12. Recognition of signs of pneumonia
Tachypnoea is the most sensitive and specific sign of pneumonia.

13. Other signs of pneumonia
chest indrawing

14. Other signs of pneumonia
nasal flaring

15. CLASSIFICATION ACCORDING TO WHO

16. COMPLICATIONS
A. PULMONARY
 Parapneumonic effusion
 Empyema tx
 Retention of sputum causing collapse
 Lung abscess
 ARDS
B. EXTRAPULMONARY
 Pericarditis , myocarditis
 Renal failure
 Multiorgan failure