Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
place the patient at risk for microbial invasion.
Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
place the patient at risk for microbial invasion.
Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus. It can also cause shortness of breath, wheezing, a low fever, and chest tightness. There are two main types of bronchitis: acute and chronic
Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection.
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus. It can also cause shortness of breath, wheezing, a low fever, and chest tightness. There are two main types of bronchitis: acute and chronic
Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection.
Pneumonia Symposia presented at Hôpital Sacré Coeur in Milot, Haiti, 2011.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
11. STREPTOCOCCUS
• The classic LOBAR pneumonia
• Normal flora in 20% of adults
• Only 20% of victims have + blood cultures
• “Penicillins” are often 100% curative
• Vaccines are often 100% preventive
12.
13. HAEMOPHILUS PNEUMONIA
• Commonest in CHILDREN <2, with otitis, URI,
meningitis, cellulitis, osteomyelitis, conjunctivitis
(pink eyes)
• PNEUMONIAS in CHILDREN <2 are often thought
of as being H Flu until proven otherwise.
• Most common pneumonia from COPD in adults
• BACTRIM (Trimethoprim-Sulfa) most common
treatment
• Vaccine available against capsulated form.
14.
15. MORAXELLA CATARRHALIS
• 2nd most common COPD pneumonia, after
haemophilus
• Gram NEGATIVE coccobacillus, like H. Flu
16. STAPH aureus
• Most common pneumonia following viral
pneumonias
• M.R.S.A., of course, is usually NOT
“community” acquired
• IV Drug abusers
• Increased risk of complications … lung
abscess, empyema.
17. KLEBSIELLA PNEUMONIAE
• DEBILITATED MALNOURISHED PEOPLE
• ALCOHOLICS with pneumonia are often
thought of as having Klebsiella until proven
otherwise
• Thick, gelatinous, blood tinged sputum
18. PSEUDOMONAS Aeruginosa
• Usually NOT community acquired but
nosocomial
• Burns & Neutropenia
• CYSTIC FIBROSIS patients with pneumonia
are presumed to have PSEUDOMONAS until
proven otherwise
• Dangerous … invasive organism
19. LEGIONELLA (pneumophila)
• Often in OUTBREAKS
• Often LOBAR
• Spread by water “droplets”
• Often immunosuppressed patients …
TRANSPLANT
21. COMMUNITY ACQUIRED, Viral
• CULTURES NOT HELPFUL
• Usually
– Confined to alveolar septum and
pulmonary interstitium
– Moderate amount of sputum
– No consolidation
25. INFLUENZA VIRUS
• RNA virus … types A,B,C
• PAN-demics, type A
• Virulence factors:
– Hemagglutinin (H1-H3) … Attachment
– Neuroaminidase (N1, N2) … Release of newly formed
virions
• Antigenic drift … Has MUTATED throughout
history, many STRAINS … Avian (H5N1)
• B and C in children
• Exact strains can be ID’s by PCR
26. METAPNEUMO VIRUS
• Most commonly seen in extremes of ages and
immunocompromised
• 20% of paediatric outpatient URTIs
27. SARS
(Severe Acute Respiratry Syndrome)
• A new CORONA-VIRUS
• 2002 China outbreak
• Spread CHIEFLY in Asia
• Last infection … 2004 in lab.
• Like most viral pneumonias, interstitium
infiltrated, some giant cells often present
29. MORPHOLOGY
• Mucosal hyperemia and swelling,
lymphomonocytic and plasmacytic infiltration of
the submucosa
• Overproduction of mucus secretions.
• Plugging … suppurative secondary bacterial
infection.
• Tonsillitis … frequent in children
• Severe bronchiolar involvement …, organization
and fibrosis, resulting in obliterative bronchiolitis
and permanent lung damage.
30. HOSPITAL CARE-ASSOCIATED
• Recently described clinical entity
• Risk factors
– Hospitalization of at least 2 days within the recent
past
– Presentation from a nursing home or long-term care
facility
– Attending a hospital or hemodialysis clinic
– Recent intravenous antibiotic therapy, chemotherapy
or wound care. The most common
• Common organisms
– Methicillin-resistant Staphylococcus aureus
– P. aeruginosa.
• Higher mortality than those with community-
acquired pneumonia.
31. NOSOCOMIAL
• “Pulmonary infections acquired in the course of a
hospital stay.”
• Risk factors
– Severe underlying disease
– Immunosuppression
– Prolonged antibiotic therapy, or invasive access devices
such as intravascular catheters.
– Patients on mechanical ventilation
• Often life-threatening complications.
• Gram-positive cocci (mainly S. aureus and S.
pneumonia) and gram-negative rods
(Enterobacteriaceae and Pseudomonas species).
32. Classifications of PNEUMONIAS
• COMMUNITY ACQUIRED ACUTE
• HEALTH CARE-ASSOCIATED
• HOSPITAL ACQUIRED
• ASPIRATION
• CHRONIC
• NECROTIZING/ABSCESS FORMATION
• PNEUMONIAS in IMMUNOCOMPROMISED HOSTS
33. ASPIRATION PNEUMONIAS
• UNCONSCIOUS PATIENTS
• PATIENTS IN PROLONGED BEDREST
• LACK OF ABILITY TO SWALLOW OR GAG
• USUALLY CAUSED BY ASPIRATION OF GASTRIC
CONTENTS
• POSTERIOR LOBES (gravity dependent) MOST
COMMONLY INVOLVED, ESPECIALLY THE SUPERIOR
SEGMENTS OF THE LOWER LOBES
• TYPICALLY MORE THAN ONE ORGANISM IS FOUND ON
CULTURES.
• OFTEN LEAD TO ABSCESSES
34. • MICROASPIRATION
– GERD patients
– Leads to small, poorly formed non-necrotizing
granulomas with multinucleated foreign body
giant cell reaction.
– Usually inconsequential
35. LUNG ABSCESSES• ASPIRATION
• SEPTIC EMBOLIZATION
• NEOPLASIA
• FROM NEIGHBORING STRUCTURES:
– ESOPHAGUS
– SPINE
– PLEURA
– DIAPHRAGM
• ANY PNEUMONIA WHICH IS SEVERE AND
DESTRUCTIVE, AND UN-TREATED … Kleb., S. aureus
• IF NO CAUSE DETERMINED … PRIMARY CRYPTOGENIC
LUNG ABSCESSES.
36. • Vary in diameter from a few millimeters to large cavities
of 5 to 6 cm
• ASPIRATION … more common on the right, most often
single.
• PNEUMONIA OR BRONCHIECTASIS … usually
multiple, basal, and diffusely scattered.
• SEPTIC EMBOLI & PYEMIC ABSCESSES …multiple
and may affect any region of the lungs.
• Suppurative destruction of the lung parenchyma
within the central area of cavitation.
37.
38.
39. • Manifestations
– cough, fever, and copious amounts of foul-smelling purulent or
sanguineous sputum.
– Fever, chest pain, and weight loss
– Clubbing of the fingers and toes may appear within a few weeks
• Must be confirmed radiologically.
• In older individuals … rule out an underlying carcinoma,
(10% to 15%)
• Complications: Extension into the pleural cavity,
hemorrhage, the development of brain abscesses or
meningitis from septic emboli, and (rarely) secondary
amyloidosis (type AA).
40. CHRONIC Pneumonias
• USUALLY NOT persistences of the community or nosocomial
bacterial infections, but CAN BE, at least histologically
• Often SYNONYMOUS with the 4 classic systemic fungal or
granulomatous pulmonary infections infections, i.e.,
TB, Histo-, Blasto-, Coccidio-
• If you see pulmonary granulomas, think of a CHRONIC
process, often years
42. HISTOPLASMOSIS
• Spores in bird or bat droppings
• Mimics TB
• Histoplasma CAPSULATUM (intracellular)
• Pulmonary granulomas, often large and calcified
• Tiny organisms live in macrophages
• Ohio, Mississippi valley
• MANY other organs can be affected
• In fulminant cases … no granulomas, only
macrophages aggregates
43.
44.
45. BLASTOMYCOSIS• Spores in soil
• Mimics TB, like ALL the granulomatous lung diseases
do.
• Blastomyces DERMATIDIS
• Pulmonary granulomas, often large and calcified
• Large distinct SPHERULES (larger than coccidio)
• Ohio, Mississippi valley, Great Lakes, WORLDWIDE
• MANY other organs can be affected, especially SKIN
• In the normal host, the lung lesions of blastomycosis
are suppurative granulomas.
46.
47.
48. COCCIDIOMYCOSIS
• Spores in soil
• Mimics TB
• Coccidioides IMMITIS
• Pulmonary granulomas, often large and calcified
• Smaller spherules than blasto.
• Tiny organisms live in macrophages
• American SOUTHWEST
• MANY other organs can be affected
51. COMPROMISED HOSTS
• Defenses are suppressed by
– Disease
– Immunosuppressive therapy for organ or
hematopoietic stem cell transplants
– Chemotherapy for tumors
– Irradiation.
• Infectious agents
– Bacteria (P. aeruginosa, Mycobacterium species, L.
pneumophila, and Listeria monocytogenes),
– Viruses (cytomegalovirus [CMV] and herpesvirus)
– Fungi (P. jiroveci, Candida species, Aspergillus
species, the Phycomycetes, and Cryptococcus
neoformans).
52.
53. HIV Patient
• 30% to 40% of hospitalizations in HIV-infected
individuals.
• Bacterial pneumonias in HIV-infected persons are
more common, more severe, and more often
associated with bacteremia than in those without HIV
infection.
• The CD4+ T-cell count determines the risk of infection
with specific organisms.
– Bacterial and tubercular infections … more than 200
cells/mm3
– Pneumocystis pneumonia … less than 200 cells/mm3
– Cytomegalovirus, fungal, and Mycobacterium avium complex
infections … less than 50 cells/mm3
Of course these are NOT mutually exclusive classifications, e.g., ANY pneumonia may result in an abscess.
* Go back to the previous slide!
This is the reason why after you feel so good about curing your patients pneumonia with antibiotics, you wonder if he will be back again, due to the underlying REAL reason he got the pneumonia!
Would a classical pneumonia produce more of a restrictive pattern or obstructive? Answer: Unfair question! (could be both). Functionally it might behave like a restrictive in the pulmonary blood gas lab, but it may be a complication of an obstructive.
Know the gram staining properties of the common community acquired pneumonia organisms.
Do the upper two images demonstrate the “lobar-ness” of the pneumonia? Ans: Yes; GRAM POSITIVE DIPLOCOCCI
H. Flu graphics; GRAM NEGATIVE BACILLUS
GRAM NEGATIVE
* Go to slides 61 or 74
* Go to slides 61 or 74
Viral pneumonias, generally interstitial, bacterial pneumonias generally alveolar!!!
Can you see the RLL “subtle” infiltrate? Or do you want to call the radiologist?
Normal involves URT, new one infects lower RT.
Corona viruses are RNA, “enveloped”, i.e., “crowned” viruses
As soon as you step into a hospital, expect to be greeted by MRSA
Of course these are NOT mutually exclusive classifications, e.g., ANY pneumonia may result in an abscess.
* Go back to the previous slide!
STREP, STAPH, H.FLU, PSEUDOMONAS are the most frequent secondary complicators.
This is not a TYPE of pneumonia, but a complication of ANY pneumonia!
An abscess can be thought of as a pneumonia in which all of the normal lung outline can no longer be seen, and there is 100% pus. Notice the increasing destruction of the alveolar framework as you progress closer to the center of the abscess.
In this case CHRONIC means CLINICALLY CHRONIC, not PATHOLOGICALLY CHRONIC.
“Chronic” by classification, but “granulomatous” by histology.
Histologic differentiation from tuberculosis, sarcoidosis, and coccidioidomycosis requires identification of the 3- to 5-μm thin-walled yeast forms,
A, Laminated Histoplasma granuloma of the lung. B, Histoplasma capsulatum yeast forms fill phagocytes in the lung of a patient with disseminated histoplasmosis, inset shows high power of pear-shaped thin-based budding yeasts (silver stain).
Three clinical forms: pulmonary blastomycosis, disseminated blastomycosis, and a rare primary cutaneous form
round, 5- to 15-μm yeast cell that divides by broad-based budding. It has a thick, double-contoured cell wall, and visible nuclei
Blastomycosis. A, Rounded budding yeasts, larger than neutrophils, are present. Note the characteristic thick wall and nuclei (not seen in other fungi). B, Silver stain.
Thick-walled, nonbudding spherules 20 to 60 μm in diameter, often filled with small endospores.
Granulomatous reactions are commonly seen with mycobacteria, fungi, sarcoid, foreign bodies, and rarely with almost anything.
* Really jiroveci, not carinii any more.
PCP is the most common pneumonia in AIDS patients. It is so prevalent, many rationales consist in giving treatment for it prophylactically.
An interesting tidbit is that “cotton wool” or “wooly” exudates are described BOTH radiologically as well as histologically
