Pneumonia is an infection of the lungs that can be caused by bacteria, viruses, or other pathogens. Common symptoms include cough, fever, shortness of breath, and chest pain. Pneumonia is usually spread through airborne droplets from coughing or sneezing. Treatment involves antibiotics if bacterial or antivirals if viral. Prevention strategies include vaccination, reducing indoor smoke and pollution, and improving nutrition and primary healthcare access.

1. PNEUMONIAPNEUMONIA
Prepared by
ASWATHI C K
3rd YEAR BAMS

2. What is pneumonia?
 Pneumonia
 Infection of the lungs.
 Alveoli fill with fluid and pus, making
breathing more difficult.
 Pneumococcal pneumonia
 Caused by bacteria called pneumococcus
(Streptococcus pneumoniae).
 Can also be caused by other bacteria,
viruses, fungi, parasites.

3. EPIDEMOLOGICAL DETERMINANTS
• AGENT FACTOR
Bacteria : Most common
Streptococcus pneumoniae
Streptococcus pyogenes
Legionella pneumophila
Klebsiella pneumoniae
Virus : Respiratory syncycial virus
Influenza A,B
Parainfluenza 1-3
Adenoviruses
Other agents Clamydia type B
Coxiella burntti
Mycoplasma pneumoniae

4. AGENT......
• There are more than 100 strains of
infectious agents identified, only a few are
responsible for the majority of the cases
• Mixed infections with both viruses and
bacteria may occur in up to 45% of
infections in children
• agent may not be isolated in
approximately half of cases despite
careful testing

5. STREPTOCOCCUS PNEUMONIAE
• Gram-positive, alpha-hemolytic, facultative
anaerobic bacteria
• resides asymptomatically in the
nasopharynx of healthy carriers

6. Reservoir
• Exclusively a human pathogen; no animal or
environmental reservoir
Carrier
• Carried in the nasopharynx of 40-70% of
humans without symptoms.
Portal of entry
• Respiratory tract
Infecting body parts
• respiratory tract, sinuses, and nasal cavity

7. HOST FACTOR
• Case fatality rates are higher in young
infants & malnourished children
• Rate more in children <5yrs & adults older
than 75yrs
• In developing countries,rate is highest due
to malnutrition & low birth weight
• In developed countries RI are less fatal

8. RISK FACTORS
Developing countries : overcrowded dwellings, poor
nutrition
low birth weight, intense indoor smoke pollution
Developed countries : school going children to
- household
 People with some medical conditions are at higher
risk for pneumonia, including: heart disease, lung
disease, diabetes, etc.
 Smoking also increases risk of developing
pneumonia.

9. ENVIRONEMENT
• More common in winter & early spring
• Overcrowding
• Diminished host resistance

10. MODE OF TRANSMISSION
Direct transmission(person to person)
Normally by the airborne route(droplets)-
sneezing,coughing.....
INCUBATION PERIOD
1-4 Weeks

11.  Most cases of pneumonia are spread
person-to-person by coughing out of
tiny droplets.
 Some pathogens can live in nose and
throat without causing disease.
 But when inhaled into lungs, they can
cause pneumonia.
 While many people are exposed to
pneumococcus, usually only those with
underlying health issues develop
pneumonia.

12. PATHOGENESIS
• bacteria invade the spaces between cells
and between alveol
• macrophages and neutrophils attempt to
inactivate
• neutrophils cytokines activate immune
system fever, chills, and fatigue
• neutrophils, bacteria, and fluid from
surrounding blood vessels fill the alveoli,
resulting in the consolidation

13. TYPES OF PNEUMONIA
Pneumonia affects your lungs in two
Ways .
According to areas involved :
 Lobar pneumonia : affects a
section (lobe) of a lung.
 Bronchial pneumonia
(Bronchopneumonia) :
affects patches throughout both lungs.

14. LOBAR PNEUMONIA

15. BRONCHOPNEUMONIA
(Bronchitis and Pneumonia occur together)

16. CLINICAL MANIFESTATIONS

17. SIGNS AND SYMPTOMS
 High fever, Shaking Chills
 Shortness of breath (Dyspnoea)
 Increased breathing rate
 Chest pain when you breathe deeply or
cough
 Dusky or purplish skin colour (cyanosis)
from poorly oxygenated blood
 Fatigue and muscle aches
 Nausea, vomiting or diarrhoea
 Cough, particularly cough productive of
sputum

18. SIGNS AND SYMPTOMS
 Streptococcus pneumoniae: Rust-colored sputum
Pseudomonas, Haemophilus, and pneumococcal species:
May produce green sputum
Klebsiella species pneumonia: Red currant-jelly sputum
Anaerobic infections: Often produce foul-smelling or bad-
tasting sputum
Newborns and infants may not show any sign of the
infection. Or they may vomit, have a fever and cough,
appear restless or tired and without energy, or have
difficulty breathing and eating.
Older people who have pneumonia sometimes have
sudden changes in mental awareness.

19. COMPLICATIONS
 Bacteria in the bloodstream (bacteremia)
 Lung abscess.
 Build up of fluid in the space between the lung and chest wall
(pleural effusion).
 Difficulty breathing.
 Shock and respiratory failure
 Septic arthritis
 Endocarditis

20. DIAGNOSIS
• History taking and clinical assessment
• Physical examination
• X-ray findings of lobar consolidation
• Leukocytosis
• Bacteriological confirmation
Sputam-gram staining & culture
Blood culture

21.  PHYSICAL EXAMINATION
• Count the breath in one minute
• Look for chest indrawing
• Look & listen for stridor
• Look for wheeze
• See if the child is abnormally sleepy or
difficult to wake
• Feel for fever
• check for severe malnutrition
• Look for cyanosis

22. CONTROL
• Improving the primary medical care
services
• Developing better methods for early
detection,treatment & where possible
prevention
• Education of mother

23. PREVENTION
• Better nutrition
• Reduction of smoke pollution
• Better MCH care
• Immunization
Measles vaccine
Hib vaccine
Pneumococcal pneumonia vaccine

24. • Measles:
Dose : 0.5 ml age : 9th month
• Hib vaccine:
Dose : combined with DPT & polio myelitis
Age : 6,10,14th week
Booster dose:12-18 months
• Pneumococcal pneumonia vaccine
a.PPV23
b.PCV

25. PPV23(Pneumococcal Polysaccharide
Vaccine)
• protects against 23 types of pneumococcus
• Children under 2 yrs of age and immuno
-compromised individuals does not respond
• Recommended for selected groups - who
have undergone splenectomy/sickle cell
disease,
chronic disease of heart,lung,liver,.....DM,
alcoholism,generalized malignancies,organ
transplant,....

26. • Dose : 0.5ml(25microgrms of purified capsular
polysaccharide from each 23 serotypes)
• Site : intra-muscular ,deltoid or as
subcutaneous dose
Protective capsular type specific antibodies
develope by the 3rd week following vaccination
minor adverse effects such as transient
redness & pain at the site of injection occur in
30-50% cases

27. PCV(Pneumococcal conjugate vaccine)
• 2conjugate vaccines : PCV10 & PCV13
• 2 schedules 3 primary doses(3p+0)
2primarydoses+1booster
(2p+1)
• (3p+0) : from 6 weeks of age
interval : 4-8 weeks
given at 6,10,14 weeks or 2,4,6 months
• (2p+1) : 2 primary doses;as early as 6 weeks of
age in infant-interval-8weeks

28. • 4-8 weeks or more b/w primary doses for
infants≥7 months
• 1 booster dose should be given between
9-15 months of age
• mild reactions like erythema and
tenderness in 50% of cases
• HIV +ve and preterm babies : 3p doses in
12 month of age + booster dose in 2nd
yr of life

29. TREATMENT
• COTRIMOXAZOLE
• IM injection of benzyl pencillin,ampicillin or
chloramphenicol
• very severe : provision of oxygen therapy
IM injection of chloramphenicol
IM of Cloxacillin & Gentamycin

30. X-RAYS
Viral pneumonia x-ray

31. X-RAYS
Lobar pneumonia x-ray (RUL)

32. X-RAYS
bronchopneumonia x-ray

33. X-RAYS
Staph pneumonia x-ray