This document provides definitions and classifications of pneumonia. It defines pneumonia clinically as symptoms of productive cough, sputum, dyspnea, or tachypnea with a new chest x-ray opacity. Radiologically, it is a non-homogenous opacity involving the lung with heart or diaphragm silhouette changes. Pneumonia can be classified etiologically, by location (community-acquired, hospital-acquired, ventilator-associated, or healthcare-associated), clinically, or pathologically. The document describes bronchopneumonia, lobar pneumonia, and interstitial pneumonia pathologically. It also discusses common pneumonia types like CAP.
Pneumocystis pneumonia (PCP) is caused by Pneumocystis jiroveci and is an opportunistic infection affecting those with weakened immune systems. It is diagnosed through microscopic visualization of the organism in samples obtained noninvasively through induced sputum or bronchoalveolar lavage, or invasively through lung biopsy. Common symptoms include dyspnea, fever, and cough. Chest imaging often shows bilateral infiltrates and laboratory tests like lactate dehydrogenase are elevated. Treatment involves anti-fungal medications.
Pneumonia is an infection of the lungs caused by bacteria, viruses or other pathogens. It is commonly transmitted when germs are inhaled into the lungs. Risk factors include impaired immunity, smoking, neurological conditions that impact swallowing, and chronic lung diseases. Diagnosis involves chest x-ray, sputum culture, blood tests and assessment of severity using CURB65 score. Treatment focuses on antibiotics, oxygen supplementation, hydration and symptom relief. Complications can include respiratory failure and sepsis.
Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by repeated inhalation and sensitization to various antigens. It affects the lung interstitium and has variable clinical presentations. Common causative agents include avian and microbial antigens. The immunopathogenesis involves both humoral and cellular immune responses. HP is classified as acute, subacute, or chronic based on clinical manifestations. Diagnosis relies on a history of antigen exposure, precipitating antibodies, clinical features, imaging, and pathology. Chest radiography and HRCT are important diagnostic tools, with HRCT showing findings like nodules, ground glass opacity, and fibrosis that vary depending on the disease stage.
Pneumonia is an infection of the lungs that can be caused by bacteria, viruses, or fungi. It occurs when the alveoli in the lungs become filled with fluid or pus, making breathing painful and limiting oxygen intake. There are different classifications and types of pneumonia depending on the causative agent and where it was acquired. Diagnosis involves physical exams, imaging tests like chest x-rays, and lab tests of sputum, blood, or fluid samples. Complications can include respiratory failure or sepsis. Treatment involves antibiotics for bacterial pneumonia, antivirals for viral pneumonia, and managing symptoms at home with rest, fluids, and fever control.
This document discusses bronchial hyperresponsiveness and bronchial provocation tests. It begins by defining asthma as a chronic inflammatory airway disease characterized by variable airflow obstruction and hyperresponsiveness to triggers. Bronchial hyperresponsiveness is an abnormal increase in airflow limitation following exposure to a stimulus and can be quantified using bronchial provocation tests. Several types of direct and indirect stimuli are described for use in bronchial provocation tests, with methacholine challenge being the most commonly used direct stimulus test due to its safety and sensitivity. The document outlines the procedures, interpretations, and indications for various bronchial provocation tests.
This document discusses the medications pirfenidone and nintedanib for treating pulmonary fibrosis. It provides details on their mechanisms of action, dosing protocols, adverse effects, monitoring recommendations, and dosage adjustments. Pirfenidone is thought to inhibit TGF-beta and TNF-alpha to reduce inflammation. Its most common side effects include nausea, rash, and diarrhea. Nintedanib targets tyrosine kinases involved in fibrosis, and its frequent adverse effects are diarrhea, nausea, and liver enzyme elevations. Both drugs require careful titration and monitoring of liver function due to potential for toxicity.
This document provides information about pneumonia, including:
- Pneumonia is an infection of the lungs that can be caused by bacteria or viruses. It is characterized by inflammation and consolidation of the lungs.
- The pathology of pneumonia involves an inflammatory response that leads to fluid build up in the lungs, visible on scans as infiltrates. This progresses from edema to red and gray hepatization as immune cells fight the infection.
- Community-acquired pneumonia has many potential causes and symptoms may include fever, cough, chest pain, and difficulty breathing. Treatment focuses on oxygen, intravenous fluids, and identifying the cause. Prevention involves vaccination, smoking cessation, and improving nutrition.
The ILLUMINATE and SPARK trials evaluated the efficacy and safety of QVA149 compared to other COPD medications. ILLUMINATE found that in moderate to severe COPD, QVA149 provided significant lung function improvements over 26 weeks compared to salmeterol-fluticasone. SPARK found in severe and very severe COPD, QVA149 reduced exacerbations more than glycopyrronium or tiotropium over 64 weeks and improved lung function and health status. Both trials showed QVA149 to be well tolerated.
Pneumocystis pneumonia (PCP) is caused by Pneumocystis jiroveci and is an opportunistic infection affecting those with weakened immune systems. It is diagnosed through microscopic visualization of the organism in samples obtained noninvasively through induced sputum or bronchoalveolar lavage, or invasively through lung biopsy. Common symptoms include dyspnea, fever, and cough. Chest imaging often shows bilateral infiltrates and laboratory tests like lactate dehydrogenase are elevated. Treatment involves anti-fungal medications.
Pneumonia is an infection of the lungs caused by bacteria, viruses or other pathogens. It is commonly transmitted when germs are inhaled into the lungs. Risk factors include impaired immunity, smoking, neurological conditions that impact swallowing, and chronic lung diseases. Diagnosis involves chest x-ray, sputum culture, blood tests and assessment of severity using CURB65 score. Treatment focuses on antibiotics, oxygen supplementation, hydration and symptom relief. Complications can include respiratory failure and sepsis.
Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by repeated inhalation and sensitization to various antigens. It affects the lung interstitium and has variable clinical presentations. Common causative agents include avian and microbial antigens. The immunopathogenesis involves both humoral and cellular immune responses. HP is classified as acute, subacute, or chronic based on clinical manifestations. Diagnosis relies on a history of antigen exposure, precipitating antibodies, clinical features, imaging, and pathology. Chest radiography and HRCT are important diagnostic tools, with HRCT showing findings like nodules, ground glass opacity, and fibrosis that vary depending on the disease stage.
Pneumonia is an infection of the lungs that can be caused by bacteria, viruses, or fungi. It occurs when the alveoli in the lungs become filled with fluid or pus, making breathing painful and limiting oxygen intake. There are different classifications and types of pneumonia depending on the causative agent and where it was acquired. Diagnosis involves physical exams, imaging tests like chest x-rays, and lab tests of sputum, blood, or fluid samples. Complications can include respiratory failure or sepsis. Treatment involves antibiotics for bacterial pneumonia, antivirals for viral pneumonia, and managing symptoms at home with rest, fluids, and fever control.
This document discusses bronchial hyperresponsiveness and bronchial provocation tests. It begins by defining asthma as a chronic inflammatory airway disease characterized by variable airflow obstruction and hyperresponsiveness to triggers. Bronchial hyperresponsiveness is an abnormal increase in airflow limitation following exposure to a stimulus and can be quantified using bronchial provocation tests. Several types of direct and indirect stimuli are described for use in bronchial provocation tests, with methacholine challenge being the most commonly used direct stimulus test due to its safety and sensitivity. The document outlines the procedures, interpretations, and indications for various bronchial provocation tests.
This document discusses the medications pirfenidone and nintedanib for treating pulmonary fibrosis. It provides details on their mechanisms of action, dosing protocols, adverse effects, monitoring recommendations, and dosage adjustments. Pirfenidone is thought to inhibit TGF-beta and TNF-alpha to reduce inflammation. Its most common side effects include nausea, rash, and diarrhea. Nintedanib targets tyrosine kinases involved in fibrosis, and its frequent adverse effects are diarrhea, nausea, and liver enzyme elevations. Both drugs require careful titration and monitoring of liver function due to potential for toxicity.
This document provides information about pneumonia, including:
- Pneumonia is an infection of the lungs that can be caused by bacteria or viruses. It is characterized by inflammation and consolidation of the lungs.
- The pathology of pneumonia involves an inflammatory response that leads to fluid build up in the lungs, visible on scans as infiltrates. This progresses from edema to red and gray hepatization as immune cells fight the infection.
- Community-acquired pneumonia has many potential causes and symptoms may include fever, cough, chest pain, and difficulty breathing. Treatment focuses on oxygen, intravenous fluids, and identifying the cause. Prevention involves vaccination, smoking cessation, and improving nutrition.
The ILLUMINATE and SPARK trials evaluated the efficacy and safety of QVA149 compared to other COPD medications. ILLUMINATE found that in moderate to severe COPD, QVA149 provided significant lung function improvements over 26 weeks compared to salmeterol-fluticasone. SPARK found in severe and very severe COPD, QVA149 reduced exacerbations more than glycopyrronium or tiotropium over 64 weeks and improved lung function and health status. Both trials showed QVA149 to be well tolerated.
Bronchiectasis is defined as abnormal irreversibly dilated and thick-walled bronchi resulting from destruction of the bronchial wall. Its pathogenesis involves defects in mucociliary clearance, cellular immunity, or associated conditions. High-resolution CT is helpful for diagnosis by showing features like tram lines or honeycombing. Additional tests may be needed to identify underlying causes. Microbiology of infected airways guides antimicrobial therapy for managing the vicious cycle of infection and inflammation that can progress the disease.
The Walgreen Timetable predicts that pulmonary tuberculosis can manifest within months of primary infection, while miliary and meningeal tuberculosis typically occur 2-6 months later. TB adenitis usually develops 3-9 months after infection, while bones and joints tuberculosis can take several years, and renal and genital tuberculosis may take over a decade to manifest. Pulmonary lesions from reactivation of dormant foci take years after primary infection.
A pulmonary embolism occurs when a blood clot or other material occludes the pulmonary artery or its branches. This most commonly results from a deep vein thrombosis in the lower leg that embolizes to the lung. When a PE occurs, it causes ventilation-perfusion mismatching in the lungs. Diagnosis is difficult due to nonspecific symptoms but evaluation involves a Wells criteria assessment, D-dimer testing, echocardiogram, and CT pulmonary angiogram. Treatment consists of anticoagulation with low molecular weight heparin or novel oral anticoagulants. Fibrinolytic therapy may be used in massive PEs. Prevention focuses on prophylaxis in high risk hospitalized patients.
Pulmonary Complications of Sickle Cell Disease. pptxSarfraz Saleemi
This document summarizes pulmonary complications of sickle cell disease (SCD), including acute chest syndrome (ACS) and pulmonary hypertension (PH). It notes that ACS and PH are the most serious complications, with high morbidity and mortality. The document reviews the definition, risk factors, pathophysiology, diagnosis, and management of ACS. It also discusses the prevalence of PH in SCD populations worldwide and in Saudi Arabia, ranging from 20-38%. The pathophysiology of SCD-related PH involves chronic hypoxemia, endothelial dysfunction, and elevated pulmonary pressures from infarcts and vaso-occlusion. Independent risk factors for PH development in SCD include low hemoglobin, cardiovascular or renal disease, and elevated
Allergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku JosephDr.Tinku Joseph
HRCT is more sensitive than CXR in detecting bronchiectasis and other pulmonary changes in ABPA. It helps establish the diagnosis and assess disease severity and response to treatment.
This document defines pneumonia and its types, and describes the pathophysiology and stages of pneumonia. It discusses community-acquired pneumonia in terms of etiology, clinical manifestations, diagnosis, treatment, complications, follow up, prognosis, and prevention. Pneumonia results from a host response to microbial pathogens in the lungs. Symptoms include fever, cough, and difficulty breathing. Treatment depends on severity and involves antibiotics. Prevention involves vaccines against pneumococcus and influenza.
I evaluated and presented the IMPACT trial which compared the effects of once-daily triple therapy versus once-daily dual therapy on COPD exacerbations in afflicted patients. While this trial displayed strong evidence favoring triple therapy over dual therapies, certain methodologies may have inflated the difference.
Community Acquired Pneumonia is an inflammatory lung condition caused by infection. It is defined as pneumonia occurring outside of a hospital setting. Respiratory infections are the leading cause of doctor visits. Streptococcus pneumoniae is the most common pathogen identified, causing around 46% of cases. Risk factors include older age, smoking, lung disease, and conditions that impair immunity or clearance of secretions. Diagnosis involves assessing severity, likely pathogens, and testing sputum, blood, or urine depending on the suspected germ. Most cases are treated initially with antibiotics at home or in the hospital depending on severity. Vaccines can help prevent many types of community acquired pneumonia.
Practical approach to Idiopathic Pulmonary Fibrosis.Hiba Ashibany
This document provides information on idiopathic pulmonary fibrosis (IPF), including its causes, diagnosis, clinical features, prognosis, and treatment approaches. It summarizes that IPF is a progressive lung disease of unknown cause where scarring develops in the lungs. Diagnosis involves ruling out other conditions, imaging, and sometimes biopsies. Prognosis is generally poor with median survival of 3 years. Treatment includes drugs like pirfenidone and nintedanib that can slow disease progression in mild to moderate IPF.
This document discusses bronchiectasis, including its definition, causes, symptoms, diagnosis, and treatment. It notes that bronchiectasis involves the permanent and abnormal dilation of the medium-sized bronchi. There are three main theories for its causes: atelectasis, mucus plugging, and traction from lung fibrosis. Symptoms include cough, sputum production, breathlessness, and fever. Diagnosis involves tests like sputum culture, chest X-ray, and HRCT scan. Treatment consists of antibiotics, bronchodilators, chest physiotherapy, and addressing underlying causes. Chest physiotherapy helps clear secretions through techniques like postural drainage and directed coughing.
Hypersensitivity Pneumonitis is a syndrome characterized by diffuse lung inflammation and airway response caused by inhalation of antigens that the patient is sensitized to. It has an incidence rate of about 0.9 per 100,000 people annually. Common findings include ground glass opacities, nodules, air trapping, and reticulation or fibrosis in chronic cases. Diagnosis involves known antigen exposure, compatible symptoms, lung function tests showing restriction or reduced diffusion capacity, BAL lymphocytosis, and histopathology findings. Treatment involves antigen avoidance, corticosteroids, and prevention through environmental controls and protective equipment.
This document provides guidelines for the diagnosis and management of community-acquired pneumonia (CAP). It defines CAP and discusses its epidemiology and common causes. Streptococcus pneumoniae is often the leading cause worldwide, though causes can vary regionally in India. Chest radiography is important for diagnosis but has limitations. Computed tomography is not routinely needed. The role of microbiological testing of blood and sputum in hospitalized patients is outlined.
This document discusses community-acquired pneumonia (CAP), including etiology, pathogenesis, clinical presentation, diagnosis, treatment recommendations, and management based on risk stratification. Key points include:
- CAP is usually caused by Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae. Atypical pathogens and respiratory viruses are also common.
- Clinical features may include cough, fever, tachypnea, and findings on chest exam. Chest x-ray is needed to confirm pneumonia.
- Treatment depends on patient risk factors and severity, ranging from outpatient oral antibiotics for low risk to intravenous antibiotics plus macrolide for high risk or
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
Hemoptysis is defined as the spitting of blood from the lungs or bronchial tubes. It can be classified based on severity from mild to massive. Common causes include infections like tuberculosis, cancers, vascular abnormalities and vasculitis. Initial management focuses on airway protection, oxygenation and circulation. Bronchoscopy helps identify the bleeding site and allows local measures like lavage, vasoconstrictors and tamponade. For persistent or massive bleeding, bronchial artery embolization or surgery may be needed. Precise localization through CT and arteriography guides definitive treatment.
Bronchiectasis is a chronic lung condition characterized by abnormal dilatation of the bronchi. It occurs due to destruction of the elastic and muscular components of the bronchial wall from repeated pulmonary infections. Common causes include cystic fibrosis, pneumonia, tuberculosis, and allergic bronchopulmonary aspergillosis. Symptoms include chronic cough with purulent sputum, pneumonia, hemoptysis, and poor health. Diagnosis involves sputum culture, chest x-ray, and high-resolution CT scan of the chest. Management includes chest physiotherapy, antibiotics, and sometimes surgery for uncontrolled infections or hemorrhage. Complications can include recurrent lung infections, abscesses, and respiratory failure.
Diffuse alveolar hemorrhage (DAH) is a life-threatening condition characterized by widespread bleeding from the pulmonary microcirculation. It can be caused by capillaritis due to conditions like Wegener's granulomatosis or idiopathic. Diagnosis involves clinical evaluation, chest imaging, hematological and urine tests, and bronchoscopy with BAL. Treatment focuses on controlling bleeding with corticosteroids, immunosuppressants, and supportive care. DAH requires prompt diagnosis and treatment to reduce high morbidity and mortality risks.
A 30-year-old man from Yemen presented with fever and dyspnea for three weeks. He had a history of occasional smoking and unclear sexual history. On examination, he had rapid breathing and oxygen saturation of 91% on room air. Initial tests showed leukopenia and elevated LDH. Chest X-ray showed diffuse bilateral infiltrates. Given his symptoms and test results, Pneumocystis pneumonia was suspected as the cause of his dyspnea. Treatment with trimethoprim-sulfamethoxazole was recommended, with alternatives available for patients with sulfamethoxazole allergy.
This document summarizes guidelines for diagnosing and treating chronic obstructive pulmonary disease (COPD). It outlines how spirometry is used to diagnose COPD and confirms airway limitation. It lists common drug treatments for stable COPD including beta agonists, muscarinic antagonists, corticosteroids, and antibiotics. It also discusses supplemental oxygen therapy guidelines based on blood gas levels. Three assessment cases are included related to exacerbation management and non-invasive ventilation.
This document discusses community acquired pneumonia (CAP). It defines pneumonia and describes its typical signs and symptoms. It classifies pneumonia and lists factors that can predispose people to developing it. The document discusses the pathology and typical presentations of lobar pneumonia, bronchopneumonia, interstitial pneumonia, and miliary pneumonia on chest x-rays. It also covers the etiology, risk factors, physical exam findings, investigations, differential diagnosis and management of CAP.
This document provides information on various respiratory conditions including definitions, signs and symptoms, investigations, and management. It covers topics such as asthma, COPD, tuberculosis, pulmonary embolism, pleural effusion, pneumonia, and others. For asthma, it defines it as a chronic inflammatory airway disease, lists common symptoms and signs, and outlines acute and chronic management according to BTS guidelines. For COPD, it defines the condition and describes the differences between emphysema and bronchitis. It also provides details on assessing severity and treatment approaches.
Bronchiectasis is defined as abnormal irreversibly dilated and thick-walled bronchi resulting from destruction of the bronchial wall. Its pathogenesis involves defects in mucociliary clearance, cellular immunity, or associated conditions. High-resolution CT is helpful for diagnosis by showing features like tram lines or honeycombing. Additional tests may be needed to identify underlying causes. Microbiology of infected airways guides antimicrobial therapy for managing the vicious cycle of infection and inflammation that can progress the disease.
The Walgreen Timetable predicts that pulmonary tuberculosis can manifest within months of primary infection, while miliary and meningeal tuberculosis typically occur 2-6 months later. TB adenitis usually develops 3-9 months after infection, while bones and joints tuberculosis can take several years, and renal and genital tuberculosis may take over a decade to manifest. Pulmonary lesions from reactivation of dormant foci take years after primary infection.
A pulmonary embolism occurs when a blood clot or other material occludes the pulmonary artery or its branches. This most commonly results from a deep vein thrombosis in the lower leg that embolizes to the lung. When a PE occurs, it causes ventilation-perfusion mismatching in the lungs. Diagnosis is difficult due to nonspecific symptoms but evaluation involves a Wells criteria assessment, D-dimer testing, echocardiogram, and CT pulmonary angiogram. Treatment consists of anticoagulation with low molecular weight heparin or novel oral anticoagulants. Fibrinolytic therapy may be used in massive PEs. Prevention focuses on prophylaxis in high risk hospitalized patients.
Pulmonary Complications of Sickle Cell Disease. pptxSarfraz Saleemi
This document summarizes pulmonary complications of sickle cell disease (SCD), including acute chest syndrome (ACS) and pulmonary hypertension (PH). It notes that ACS and PH are the most serious complications, with high morbidity and mortality. The document reviews the definition, risk factors, pathophysiology, diagnosis, and management of ACS. It also discusses the prevalence of PH in SCD populations worldwide and in Saudi Arabia, ranging from 20-38%. The pathophysiology of SCD-related PH involves chronic hypoxemia, endothelial dysfunction, and elevated pulmonary pressures from infarcts and vaso-occlusion. Independent risk factors for PH development in SCD include low hemoglobin, cardiovascular or renal disease, and elevated
Allergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku JosephDr.Tinku Joseph
HRCT is more sensitive than CXR in detecting bronchiectasis and other pulmonary changes in ABPA. It helps establish the diagnosis and assess disease severity and response to treatment.
This document defines pneumonia and its types, and describes the pathophysiology and stages of pneumonia. It discusses community-acquired pneumonia in terms of etiology, clinical manifestations, diagnosis, treatment, complications, follow up, prognosis, and prevention. Pneumonia results from a host response to microbial pathogens in the lungs. Symptoms include fever, cough, and difficulty breathing. Treatment depends on severity and involves antibiotics. Prevention involves vaccines against pneumococcus and influenza.
I evaluated and presented the IMPACT trial which compared the effects of once-daily triple therapy versus once-daily dual therapy on COPD exacerbations in afflicted patients. While this trial displayed strong evidence favoring triple therapy over dual therapies, certain methodologies may have inflated the difference.
Community Acquired Pneumonia is an inflammatory lung condition caused by infection. It is defined as pneumonia occurring outside of a hospital setting. Respiratory infections are the leading cause of doctor visits. Streptococcus pneumoniae is the most common pathogen identified, causing around 46% of cases. Risk factors include older age, smoking, lung disease, and conditions that impair immunity or clearance of secretions. Diagnosis involves assessing severity, likely pathogens, and testing sputum, blood, or urine depending on the suspected germ. Most cases are treated initially with antibiotics at home or in the hospital depending on severity. Vaccines can help prevent many types of community acquired pneumonia.
Practical approach to Idiopathic Pulmonary Fibrosis.Hiba Ashibany
This document provides information on idiopathic pulmonary fibrosis (IPF), including its causes, diagnosis, clinical features, prognosis, and treatment approaches. It summarizes that IPF is a progressive lung disease of unknown cause where scarring develops in the lungs. Diagnosis involves ruling out other conditions, imaging, and sometimes biopsies. Prognosis is generally poor with median survival of 3 years. Treatment includes drugs like pirfenidone and nintedanib that can slow disease progression in mild to moderate IPF.
This document discusses bronchiectasis, including its definition, causes, symptoms, diagnosis, and treatment. It notes that bronchiectasis involves the permanent and abnormal dilation of the medium-sized bronchi. There are three main theories for its causes: atelectasis, mucus plugging, and traction from lung fibrosis. Symptoms include cough, sputum production, breathlessness, and fever. Diagnosis involves tests like sputum culture, chest X-ray, and HRCT scan. Treatment consists of antibiotics, bronchodilators, chest physiotherapy, and addressing underlying causes. Chest physiotherapy helps clear secretions through techniques like postural drainage and directed coughing.
Hypersensitivity Pneumonitis is a syndrome characterized by diffuse lung inflammation and airway response caused by inhalation of antigens that the patient is sensitized to. It has an incidence rate of about 0.9 per 100,000 people annually. Common findings include ground glass opacities, nodules, air trapping, and reticulation or fibrosis in chronic cases. Diagnosis involves known antigen exposure, compatible symptoms, lung function tests showing restriction or reduced diffusion capacity, BAL lymphocytosis, and histopathology findings. Treatment involves antigen avoidance, corticosteroids, and prevention through environmental controls and protective equipment.
This document provides guidelines for the diagnosis and management of community-acquired pneumonia (CAP). It defines CAP and discusses its epidemiology and common causes. Streptococcus pneumoniae is often the leading cause worldwide, though causes can vary regionally in India. Chest radiography is important for diagnosis but has limitations. Computed tomography is not routinely needed. The role of microbiological testing of blood and sputum in hospitalized patients is outlined.
This document discusses community-acquired pneumonia (CAP), including etiology, pathogenesis, clinical presentation, diagnosis, treatment recommendations, and management based on risk stratification. Key points include:
- CAP is usually caused by Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae. Atypical pathogens and respiratory viruses are also common.
- Clinical features may include cough, fever, tachypnea, and findings on chest exam. Chest x-ray is needed to confirm pneumonia.
- Treatment depends on patient risk factors and severity, ranging from outpatient oral antibiotics for low risk to intravenous antibiotics plus macrolide for high risk or
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
Hemoptysis is defined as the spitting of blood from the lungs or bronchial tubes. It can be classified based on severity from mild to massive. Common causes include infections like tuberculosis, cancers, vascular abnormalities and vasculitis. Initial management focuses on airway protection, oxygenation and circulation. Bronchoscopy helps identify the bleeding site and allows local measures like lavage, vasoconstrictors and tamponade. For persistent or massive bleeding, bronchial artery embolization or surgery may be needed. Precise localization through CT and arteriography guides definitive treatment.
Bronchiectasis is a chronic lung condition characterized by abnormal dilatation of the bronchi. It occurs due to destruction of the elastic and muscular components of the bronchial wall from repeated pulmonary infections. Common causes include cystic fibrosis, pneumonia, tuberculosis, and allergic bronchopulmonary aspergillosis. Symptoms include chronic cough with purulent sputum, pneumonia, hemoptysis, and poor health. Diagnosis involves sputum culture, chest x-ray, and high-resolution CT scan of the chest. Management includes chest physiotherapy, antibiotics, and sometimes surgery for uncontrolled infections or hemorrhage. Complications can include recurrent lung infections, abscesses, and respiratory failure.
Diffuse alveolar hemorrhage (DAH) is a life-threatening condition characterized by widespread bleeding from the pulmonary microcirculation. It can be caused by capillaritis due to conditions like Wegener's granulomatosis or idiopathic. Diagnosis involves clinical evaluation, chest imaging, hematological and urine tests, and bronchoscopy with BAL. Treatment focuses on controlling bleeding with corticosteroids, immunosuppressants, and supportive care. DAH requires prompt diagnosis and treatment to reduce high morbidity and mortality risks.
A 30-year-old man from Yemen presented with fever and dyspnea for three weeks. He had a history of occasional smoking and unclear sexual history. On examination, he had rapid breathing and oxygen saturation of 91% on room air. Initial tests showed leukopenia and elevated LDH. Chest X-ray showed diffuse bilateral infiltrates. Given his symptoms and test results, Pneumocystis pneumonia was suspected as the cause of his dyspnea. Treatment with trimethoprim-sulfamethoxazole was recommended, with alternatives available for patients with sulfamethoxazole allergy.
This document summarizes guidelines for diagnosing and treating chronic obstructive pulmonary disease (COPD). It outlines how spirometry is used to diagnose COPD and confirms airway limitation. It lists common drug treatments for stable COPD including beta agonists, muscarinic antagonists, corticosteroids, and antibiotics. It also discusses supplemental oxygen therapy guidelines based on blood gas levels. Three assessment cases are included related to exacerbation management and non-invasive ventilation.
This document discusses community acquired pneumonia (CAP). It defines pneumonia and describes its typical signs and symptoms. It classifies pneumonia and lists factors that can predispose people to developing it. The document discusses the pathology and typical presentations of lobar pneumonia, bronchopneumonia, interstitial pneumonia, and miliary pneumonia on chest x-rays. It also covers the etiology, risk factors, physical exam findings, investigations, differential diagnosis and management of CAP.
This document provides information on various respiratory conditions including definitions, signs and symptoms, investigations, and management. It covers topics such as asthma, COPD, tuberculosis, pulmonary embolism, pleural effusion, pneumonia, and others. For asthma, it defines it as a chronic inflammatory airway disease, lists common symptoms and signs, and outlines acute and chronic management according to BTS guidelines. For COPD, it defines the condition and describes the differences between emphysema and bronchitis. It also provides details on assessing severity and treatment approaches.
This document provides an outline and overview of pneumonia. It begins by defining pneumonia and describing its signs and symptoms. It then discusses risk factors, pathogenesis, classifications, and clinical features. The remainder of the document covers investigations into pneumonia, including medical history, physical exams, imaging tests, laboratory tests, and diagnostic criteria. It concludes by addressing treatment for community-acquired pneumonia and inpatient management.
Bronchopneumonia is a type of pneumonia characterized by patchy lung inflammation and infection. It is often caused by aspiration of oropharyngeal bacteria. Community-acquired pneumonia is commonly seen in children and the elderly. Hospital-acquired pneumonia is a major complication for hospitalized patients, especially those on ventilators. Diagnosis involves clinical features, imaging, and microbiological testing of sputum or bronchial samples. Treatment focuses on oxygenation, fluid balance, and antibiotics tailored to likely causative organisms. Immunocompromised patients are at higher risk for opportunistic pathogens.
Three key points about pneumonia:
1. Pneumonia is an acute respiratory illness caused by infection in the lungs, commonly due to bacteria like Streptococcus pneumoniae. It presents with symptoms like cough, fever, and chest pain.
2. Diagnosis involves chest x-ray and investigations to identify the causative organism. Treatment depends on severity and involves oxygen, fluids, and antibiotics. Complications can include parapneumonic effusion or empyema if not treated promptly.
3. Prevention strategies include vaccination, smoking cessation, and reducing indoor air pollution. Pneumonia remains a major global cause of death despite modern treatments.
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"
Common suppurative diseases of lung- Bronchiectasis...!Sharmin Susiwala
Bronchiectasis is a condition characterized by irreversible dilation of part of the bronchial tree due to damage to elastic and muscular components, usually from acute or chronic infection. It requires both an infectious insult and impaired drainage or airway obstruction. Symptoms include daily cough and sputum production. Diagnosis involves chest imaging showing abnormal lung signs and high-resolution CT scanning. Treatment focuses on controlling infections with antibiotics and clearing secretions. Complications can include lung damage and recurrent pneumonia.
Community-acquired pneumonia is usually caused by Streptococcus pneumoniae and presents with fever, cough, and dyspnea. Diagnosis involves chest x-ray and culture. Treatment depends on severity and includes macrolides or fluoroquinolones for outpatients and fluoroquinolones plus azithromycin for inpatients. Hospital-acquired pneumonia has a higher risk of Gram-negative bacteria. Ventilator-associated pneumonia requires combination therapy including antipseudomonal drugs. Pneumocystis pneumonia affects those with AIDS and presents as hypoxia; treatment is TMP/SMX with steroids for severe cases.
BRONCHIECTASIS approach and treatment by Dr.Amira TabidiAmira30013
Pulmonolgy ,it's a common respiratory air way disease with many radiogical features that's vital to learn about it so you can reach the diagnosis easily along with a solid clinical approach
Dr. Md. Khairul Hassan Jessy
Associate Professor, Respiratory Medicine
National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka.
Acknowledment:
Davidson’s Principles and Practice of Medicine
This document discusses chronic obstructive pulmonary disease (COPD). It defines COPD as a preventable disease characterized by airflow limitation caused by significant exposure to noxious particles. COPD includes chronic bronchitis and emphysema. Chronic bronchitis is defined as cough and sputum for at least 3 months per year for two years. Emphysema involves abnormal enlargement of airspaces. Causative factors include tobacco smoke, indoor air pollution, and occupational exposures. Symptoms include cough, sputum production and breathlessness. Signs may include wheezing and prolonged expiration. Spirometry is important for diagnosis and classification of severity. Treatment involves smoking cessation, vaccinations, bronchodilators, inh
This document provides information on pneumonia, including its definition, classification, infectious agents, host defenses in the lungs, routes of infection, community-acquired pneumonia, symptoms, diagnosis, treatment, and complications. It defines pneumonia as an infection of the lungs that causes consolidation and filling of alveoli. Community-acquired pneumonia is most often caused by Streptococcus pneumoniae, Haemophilus influenzae, or Mycoplasma pneumoniae. Diagnosis involves assessment of severity, consideration of possible causes, chest imaging, and microbiological testing of sputum or blood. Empiric antibiotic therapy depends on location of treatment and severity of illness. Duration of treatment typically ranges from 7 to 14 days depending on the causative
This document provides information on pneumonia and lung abscess from a seminar presentation. It begins with an introduction to pneumonia, defining it as an infection of the lungs. It then discusses the incidence of pneumonia globally and in various countries. Etiology, risk factors, pathophysiology, classification, signs and symptoms, complications, diagnosis, and management of pneumonia are explained. It also provides detail on lung abscess including definition, risk factors, pathophysiology, signs and symptoms, complications, diagnosis, and management. Surgical interventions for complications like empyema are also mentioned.
COPD is characterized by airflow limitation caused by airway disease and lung destruction. It includes chronic bronchitis and emphysema. Symptoms include dyspnea, cough, and sputum production. Diagnosis is confirmed by spirometry showing reduced FEV1/FVC ratio. Treatment focuses on smoking cessation, vaccinations, pulmonary rehabilitation, bronchodilators, and corticosteroids to improve symptoms and quality of life. Acute exacerbations are managed with bronchodilators, steroids, and antibiotics. Differential diagnoses include asthma, bronchiectasis, pulmonary embolism, and cystic fibrosis.
Lung abscess is a localized infection and necrosis of lung tissue that forms a cavity containing pus. It is usually caused by aspiration or infection traveling via the bloodstream. Common symptoms include fever, cough, sputum production, and weight loss. Diagnosis involves chest x-ray or CT scan to identify lung cavities. Treatment consists of antibiotics chosen based on suspected bacteria and may require hospitalization. Complications can include spread of infection to the pleural space or amyloidosis.
Pneumonia is an inflammation of the lung parenchyma caused by infection, most commonly by bacteria such as Streptococcus pneumoniae. It is characterized by consolidation of the lungs due to inflammatory exudate filling the alveoli. Pneumonia is classified based on location as either lobar pneumonia, affecting an entire lung lobe, or bronchopneumonia, which occurs in the terminal bronchioles and spreads to surrounding alveoli. Symptoms include fever, chills, shortness of breath, cough, and chest pain. Chest x-rays are used for diagnosis and to distinguish between lobar and bronchopneumonia based on the pattern of lung consolidation.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
3. CLINICAL DEFINITION
Two or more of the following symptoms/physical findings: productive
cough, purulent sputum, dyspnoea or tachypnea (respiratory rate >20
breaths per minute), rigors or chills, pleuritic chest pain in conjunction with
a new opacity on chest radiograph.
4. RADIOLOGICAL DEFINITION
Non homogenous opacity involving any part of the lung with silhouetting
of heart boarder or diaphragmatic boarder depending on the zones of
lung involved with the presence of air Bronchogram.
5. CLASSIFICATION
Based on etiology.
Based of place of occurrence
Clinical classification
Pathological classification
7. BASED ON THE PLACE OF OCCURENCE
CAP (community Acquired pneumonia)
HAP ( Hospital Acquired pneumonia)
VAP ( ventilator associated pneumonia )
HCAP ( Healthcare associated Pneumonia )
8. CAP (community acquired pneumonia)
Pneumonia that develops outside the hospital is considered community-
acquired pneumonia (CAP)
9. HAP ( Hospital acquired pneumonia)
Pneumonia diagnosed 48 hours or more after admission to hospital is
nosocomial, or hospital acquired.
10. VAP (ventilator associated pneumonia)
Pneumonia diagnosed 48 hours or more after endotracheal intubation.
11. HCAP (Healthcare associated
pneumonia)
Pneumonia diagnosed in any patient who was hospitalized in an acute care
hospital for 2 or more days within 90 d of the diagnosis; resided in a
nursing home or long-term care facility;
received recent intravenous antibiotic therapy, chemotherapy, or wound
care within the past 30 d of the current infection; or attended a hospital or
haemodialysis clinic
12. CLINICAL CLASSIFICATION
TYPICAL PNEUMONIA ATYPICAL PNEUMONIA
Fever + productive cough Fever + Dry cough or scanty sputum
Predominant Neutrophillic leukocytosis Mild leukocytosis
Sputum gram stain reveals organisms Doesn’t reveal organisms
CXR– Alveolar exudates are present CXR– No Alveolar exudates, Interstitial pattern
Most common organisms– Streptococcus
pneumonia
Staphylococcus aureus, Klebsiella, Pseudomonas
Most common organisms– Mycoplasma,
Legionella, Chlamydia, Viral pneumonia.
13. PATHOLOGICAL CLASSIFICATION
There are 3 types of pneumonia,
Bronchopneumonia – ( DIFFUSE )
Lobar pneumonia – ( CONFINED TO A LOBE )
Interstitial pneumonia – ( INTERSTITIAL INVOLVEMENT )
14.
15.
16.
17.
18.
19. BRONCHOPNEUMONIA
PATHOGENESIS
Bronchopneumonia is caused by variety of bacteria.
It may affect all ages but particularly frequent in following conditions.
1. As a terminal event in a chronic disease
2. Infancy
3. Old age
4. As a manifestation of secondary infection in viral conditions like influenza or
measles.
20. Bronchopneumonia is primarily a spreading inflamation of terminal
bronchioles and other related alveoli.
The lesions are initially focal involving one or more lobules.
Being a spreading inflammation, the foci are not at the same stage of
inflammatory process.
The disease starts as a bronchiolitis.
21. After the initial bronchiolitis , spread to alveoli quickly follows.
EARLY STAGES – alveolar wall is congested giving red color to the tissues.
22. LATER STAGES – exudate becomes fibrinous & neutrophils are extremely
numerous. Congestion is less marked and lesions become pale grey.
23. Inflammation spreads through pores of kohn to adjacent lobules.
When the inflammation subsides, resolution may take place. The fibrin
dissolved and the exudate is partly absorbed and partly removed by
coughing.
24. LOBAR PNEUMONIA PATHOGENESIS
This condition affects a complete lobe or even two lobes.
The most striking changes occur in alveolar tissue.
Although spread of the inflammatory process is via the ducts and not
through the walls through alveolar walls.
Changes in the bronchioles are of minor importance.
M > F
30-50 years
25. Four distinct phases are recognized.
1. Congestion ( 1-2 days )
2. Red hepatisation (2nd - 4th day)
3. Grey hepatisation (4th – 8th day)
4. Resolution (8th – 9th day )
These are the classic changes seen only in untreated cases. Antibiotic
therapy dramatically inhibits the changes described below.
26. congestion
The lobe of lung shows the usual early changes of acute inflammation.
It is dark Red & frothy , blood stained fluid can be squeezed from it.
Large number of causative bacteria are present in the fluid.
Microscopically, alveolar capillaries are engorged & contain increased
number of neutrophils.
The onset is sudden with fever & rigors.
27. Red hepatisation
The lobe Is DRY, solid & granular.
It contains no air. Some fibrin is present in the pleural surface.
In contrast to stage of congestion, there is now well marked fibrinous
exudates & neutrophils are present in the alveoli.
Clinically, there is pain on breathing due to the pleural exudate & a
productive cough with brown sputum.
Leucocytosis occurs early & a positive blood culture is obtained in most
cases.
28.
29. Grey hepatisation
The affected lobe is even more solid & the pleural surface is covered by a
confluent fibrinous exudate.
The cut surface is DRY & GRANULAR but greyish white in colour.
The alveolar exudate is increased in amount with dense fibrin strands and very
numerous neutrophils. In this exudate which gives the grey color to affected lobe.
The congestion of capillaries is now much reduced.
Antibodies to the bacteria appear in the blood at this stage, and the organisms
disappear quite rapidly.
Coughing is not so marked & less productive.
Chest pain & high fever persist.
30.
31. Resolution
With the elimination of bacteria, the inflammatory process subsides & since
there is no tissue destruction, the lung returns to normal apart from the
pleura where the fibrinous adhesions between the visceral & parietal pleural
layers tend to undergo organization with the formation of fibrous adhesions.
The fibrin is liquefied by proteolytic enzymes possibly produced in part by
the neutrophils.
The liquid products together with neutrophils are coughed up
Macrophages from lung tissue invade the alveoli.
The disease ends with sudden drop in temperature.
32.
33. Clinical features
SYMPTOMS
1. Cough
2. Sputum --- color of sputum
3. SOB
4. Wheeze
5. Chest pain
6. Fever
Rusty colored -- bronchopneumonia
Greenish sputum -- pseudomonas
Yellowish mucoid sputum -- bronchiectasis
Red currant jelly sputum -- klebsiella
39. Commonly used criteria for risk
stratification in CAP
CURB – 65
CRB – 65
SMART – COP
SMRT – CO
ATS – IDSA criteria
CPIS score
PSI scoring
40. CURB – 65
C CONFUSION
U UREA >= 7 mmol / L
R Respiratory rate >= 30 / min
B Low blood pressure ( diastolic blood
pressure <= 60 mm Hg
OR
Systolic blood pressure <= 90 mm Hg
65 65 YEARS
41. CRB – 65
C CONFUSION
R RESPIRATORY RATE >= 30 / min
B Low blood pressure ( Diastolic blood
pressure <= 60 mm Hg
OR
Systolic blood pressure <= 90 mm Hg
65 65 years
42. SMART – COP
S Low systolic blood pressure ( < 90 mm
Hg)
M Multi lobar CXR involvement
A Low albumin ( 3.5 g /dL )
R Respiratory Rate >= 25 / min
T Tachycardia >= 125 / min
C Confusion
O Poor oxygenation ( Pao2 < 70 mm Hg)
spo2 < 93 %
P Low pH < 7.35
43. SMRT – CO
S Low systolic blood pressure ( < 90 mm
Hg)
M Multi lobar CXR involvement
R Respiratory Rate >= 25 / min
T Tachycardia >= 125 / min
C Confusion
O Poor oxygenation ( Pao2 < 70 mm Hg)
spo2 < 93 %
44. ATS – IDSA criteria
MAJOR CRITERIA
1. Invasive mechanical ventilation
2. Septic shock with need of vasopressors
MINOR CRITERIA
1. RR >= 30 bpm
2. Pao2 / Fio2 = < 250
3. Multilobar infiltrates
4. Confusion / Deterioration
5. Uremia ( BUN >= 20 mg / dl )
6. Leukopenia ( < 4000 cells / mm3 )
7. Thrombocytopenia ( < 1 lakh cells / mm3 )
8. Hypothermia ( core body temp < 36 C )
45. CPIS
CPIS points 0 1 2
Tracheal secretions rare Abaundant Abaundant &
purulent
CXR infiltrates none diffuse localised
Temperature (◦c ) >= 36.5 to <=38.4 >= 38.5 to < 38.9 >= 39 or <= 36
Leukocytosis ( per
mm3)
>=4000 &
<=11000
< 4000 or >11000 < 4000 or >11000
& band forms
PaO2 / FiO2 ratio > 240 or ARDS <= 240 & no ARDS
microbiology NEGATIVE POSITIVE
52. CAP ( community acquired
pneumonia)
CAP can be defined both on clinical and radiographic findings. In the
absence of chest radiograph, CAP is defined as:
1. symptoms of an acute lower respiratory tract illness (cough with or without
expectoration, shortness of breath, pleuritic chest pain) for less than 1 week; and
2. at least one systemic feature (temperature >37.7°C, chills, and rigors, and/or severe
malaise
3. new focal chest signs on examination (bronchial breath sounds and/or crackles);
with
4. no other explanation for the illness
53. When a chest radiograph is available
with new radiographic shadowing for which there is no other explanation
(not due to pulmonary edema or infarction).
Radiographic shadowing may be seen in the form of a lobar or patchy
consolidation, loss of a normal diaphragmatic, cardiac or mediastinal
silhouette, interstitial infiltrates, or bilateral perihilar opacities,
with no other obvious cause.
54. What is the aetiology of CAP
worldwide?
A microbiological diagnosis could be made in only 40–71% of cases of
CAP. Streptococcus pneumoniae is the most common etiological agent.
Viruses are responsible for CAP in as much as 10–36% of the cases.
The widespread antibiotic (mis)use is probably responsible for decreasing
culture rates in CAP. In 2009.
Str. pneumoniae (35.3%) was the most common isolate, followed by
Staphylococcus aureus (23.5%), Klebsiella pneumoniae (20.5%), and
Haemophilus influenzae (8.8%).
55. A diagnosis of CAP can be suspected if at least one of the following
findings is present on the chest radiograph:
(i) an asymmetric increase in lung opacification with air bronchogram;
(ii) presence of silhouette sign;
(iii) an area of increased opacity bounded by a well-defined interface
against adjacent aerated lung (such as along a fissure);
(iv) if only an anterior–posterior view is obtained (such as a portable
examination), increased attenuation of the cardiac shadow; and
(v) for radiographs with widespread airspace disease, more
asymmetric or multifocal distribution of opacification.
56. NOTE :
resolution of chest radiograph findings may lag behind clinical cure during
follow-up, and up to 50% of patients may not show complete radiographic
resolution at 4 weeks.
Radiographic resolution may be delayed in the elderly.
Patients with radiologic deterioration would almost always have one or the
other clinical feature.
suggestive of clinical failure (persistent fever, abnormal auscultatory
findings, or persistent tachypnea).
57. Recommendations
CT THORAX – it shouldn’t be done routinely. It should be performed in
those with non resolving pneumonia.
BLOOD CULTURES – Should be done in all hospitalized patients & not
required in op basis patients.
BIOMARKERS – not required routinely
58. What general investigations are
required in patients with CAP?
For patients managed in an outpatient setting, no investigations are
routinely required apart from a chest radiograph
Pulse oximetry is desirable in outpatients
Pulse oximetry saturation, if available, should be obtained as early as
possible in admitted patients .Arterial blood gas analysis should be
performed in those with an oxygen saturation ≤90% and in those with
chronic lung disease
Blood glucose, urea, and electrolytes should be obtained in all
hospitalized patients with CAP .
Full blood count and liver function tests are also helpful in the
management of patients with CAP.
59. Which microbiological investigations need to be
performed in CAP?
Blood cultures have a low sensitivity but high specificity in identifying the
microbial aetiology. Despite the low yield of blood culture, the microbial
aetiology of CAP is identified in a significant proportion of patients with
this investigation.
Blood cultures should be obtained in all hospitalized patients with CAP.
Blood cultures are not required in routine outpatient management of CAP
60. Sputum Gram stain and cultures :
The yield of sputum cultures varies from 34 to 86%. Despite a low
sensitivity, Gram stain of sputum is useful as it provides rapid results and
can help narrow down the aetiology.
Twenty to 40 fields from sputum smear should be examined
microscopically under low power.
The number of epithelial cells in representative fields that contain cells
should be averaged. If epithelial cells are >10/ low power field, the sample
should be rejected for culture.
If the number of pus cells is 10 times the number of epithelial cells with
3+ to 4+ of a single morphotype of bacteria, the specimen should be
accepted for culture
61. Which are the antibiotics useful for empiric treatment
in various settings?
The initial empiric antibiotic treatment is based on a number of factors:
(a) the most likely pathogen(s)
(b) knowledge of local susceptibility patterns;
(c) pharmacokinetics and pharmacodynamics of antibiotics.
(d) compliance, safety, and cost of the drugs
(e) recently administered drugs
The empiric antibiotic treatment is primarily aimed at Streptococus.
pneumoniae as it is the most prevalent organism in CAP.
62. Is there a need to cover atypical organisms?
the need for empiric treatment of these organisms in mild CAP in the
outpatient setting has been challenged as evidence suggests no benefit of
covering these organisms with appropriate antibiotics in the outpatient
setting.
Combination therapy should be restricted to patients with severe
pneumonia.
63. What should be the optimum method of risk
stratification?
Initial assessment should be done with CRB-65. If the score is >1, patients
should be considered for admission.
Patients selected for admission can be triaged to the ward (non-ICU)/ICU
based upon the major/minor criteria of ATS-IDSA CRITERIA
If any major criterion or ≥3 minor criteria are fulfilled, patients should
generally be admitted to the ICU.
64. What should be the antibiotic therapy in the
outpatient setting?
Therapy should be targeted toward coverage of the most common
organism, namely Streptococcus pneumonia.
Fluoroquinolones should not be used for empiric treatment.
65. What should be the antibiotic therapy in the
hospitalized non-ICU setting?
Route of administration (oral or parenteral) should be decided based upon
the clinical condition of the patient and the treating physician’s judgment
regarding tolerance and efficacy of the chosen antibiotics.
Switch to oral from intravenous therapy is safe after clinical improvement
in moderate to severe CAP.
66. What should be the antibiotic therapy in ICU
setting?
Antimicrobial therapy should be changed according to specific
pathogen(s) isolated.
Diagnostic/therapeutic interventions should be done for complications,
e.g. thoracentesis, chest tube drainage, etc. as required.
If a patient does not respond to treatment within 48–72 h, he/she should
be evaluated for the cause of non-response, including development of
complications, presence of atypical pathogens, drug resistance, etc.
Switch to oral from intravenous therapy is safe after clinical improvement
in moderate to severe CAP.
Outpatients should be treated for 5 days and inpatients for 7 days
67. What adjunctive therapies are useful for the
management of CAP?
There is no evidence to suggest the usefulness of treatments such as
1. activated protein C,
2. anticoagulants,
3. immunoglobulin,
4. granulocyte colony-stimulating factor,
5. statins,
6. probiotics,
7. chest physiotherapy,
8. antiplatelet drugs,
9. cough medications,
10. inhaled nitric oxide,
11. ACE inhibitors, and others in the routine management of CAP.
68. What should be the time to first antibiotic dose?
Intuitively, antibiotics should be started as soon as possible after the
diagnosis of CAP is established.
In severe CAP, antibiotics should be administered as soon as possible,
preferably within 1 hour.
In non-severe CAP, a diagnosis should be established before starting
antibiotics.
Therapy should be targeted toward coverage of the most common
organism, namely Str. pneumoniae
69. What is the optimum duration of treatment?
Most non-severe infections would settle within 3–5 days.
oral therapies may be given with a functional gastrointestinal tract,
although initially the intravenous route is preferable.
Patients may be switched to oral medications as soon as they improve
clinically and are able to ingest orally.
70.
71.
72. STEROIDS IN CAP
Steroids are not recommended for use in non-severe CAP.
Steroids should be used for septic shock or in ARDS secondary to CAP
according to the prevalent management protocols for these conditions
73. NIV in CAP
Noninvasive ventilation may be used in patients with CAP and acute
respiratory failure
Noninvasive ventilation appears to be beneficial, and has the potential to
reduce endotracheal intubation, shorten the ICU stay, and reduce the risk
of death in the ICU if applied early in the course of CAP
74. When should patients be
discharged?
Discharge may be contemplated when the patient starts taking oral
medications, is hemodynamically stable, and there are no acute comorbid
conditions requiring medical care
At least three recent meta-analyses have shown that short-term treatment
(5–7 days) is as effective as conventional treatment (10–14 days), with
decrease in the risk of adverse effects, duration of hospitalization, and no
increase in mortality
76. What is the micro-organism profile of HAP/VAP?
Gram-negative bacteria are the most common pathogens causing
HAP/VAP in the Indian setting , and should be routinely considered as the
most common etiological agents of HAP/VAP.
77. Hcap
HCAP is a heterogeneous entity which includes pneumonia that occurs in
the following patient populations:
1. hospitalization in an acute care hospital for two or more days within 90 days of the
infection
2. residence in a nursing home or long-term care facility,
3. recent intravenous antibiotic therapy, chemotherapy, or wound care within 30 days
of the current infection. and attendance at a hemodialysis clinic.
4. Whether HCAP is a separate entity or a subgroup of CAP or HAP is currently
unclear.
81. Are invasive techniques to collect lower respiratory
tract secretions better than blind endotracheal
aspirates?
it has been suggested that invasive methods, including bronchoscopy-
directed BAL or PSB, or protected BAL or PSB can improve the diagnostic
yield over blind ETA, and guide appropriate antibiotic selection
Each technique has its own diagnostic threshold and methodological
limitations. The choice depends on local expertise, availability, and cost.
83. What is the role of routine endotracheal aspirate
culture surveillance? (REAS)
Routine endotracheal aspirate culture surveillance (REAS) is performed by
obtaining serial endotracheal aspirate cultures at fixed intervals even in the
absence of infection
The results of the cultures obtained are then employed in guiding the
antibiotic regimen if the patient develops evidence of HAP
As this strategy is more expensive than the antibiogram strategy, it is not
feasible in developing countries
Routine endotracheal aspirate culture is not recommended. An
antibiogram approach should be followed wherever feasible
84. How do we decide on the empiric antibiotic regimen
to be started in a case of suspected HAP/VAP?
Every ICU/hospital should have its own antibiotic policy for initiating
empiric antibiotic therapy in HAP based on their local microbiological flora
and resistance profiles . This policy should be reviewed periodically.
85.
86.
87. What is the optimal duration of antibiotic therapy?
In patients with VAP due to Pseudomonas, Acinetobacter, and MRSA, a
longer duration (14 days) of antibiotic course is recommended.
Assessment of CPIS on day 7 may identify the patients in whom therapy
could be stopped early
In other patients with VAP who are clinically improving, a 7-day course of
antibiotics is recommended
90. STAPHYLOCOCUS AUREUS
Pneumonia due to this agent is usually of sudden onset.
Affects persons with comorbid illnesses (except during influenza outbreaks,
when healthy young adults may be infected).
Frequently complicated by cavitation (20%), pneumothorax (10%), jaundice
(8%), empyema (5%), acute renal failure (5%), and pericarditis (2%).
100. What is the approach to diagnosis of HAP/VAP?
101. What are the other good practices to be followed in
the ICU?
Stress ulcer prophylaxis: Sucralfate should be used in patients with HAP,
while H-2 receptor antagonists or proton pump inhibitors should be used in
patients with VAP.
Early enteral feeding: Enteral feeding is superior to parenteral nutrition and
should be used whenever tolerated and in those without any contraindications
to enteral feeding.
DVT prophylaxis: DVT prophylaxis with unfractionated heparin (5000 U thrice
a day) or a low-molecular-weight heparin should be routinely used in all ICU
patients with no contraindications to prophylactic anticoagulation.
Glucose control: A plasma glucose target of 140–180 mg/dL is recommended
in most patients with HAP/VAP, rather than a more stringent target (80–110
mg/dL) or a more liberal target (180–200 mg/dL).
102. Blood products: Red cells should be transfused at a hemoglobin threshold
of <7 g/dL except in those with myocardial ischemia and pregnancy.
Platelet transfusion is indicated in patients with platelet count <10,000/μL,
or <20,000/μL if there is active bleeding. Fresh frozen plasma is indicated
only if there is a documented abnormality in the coagulation tests and
there is active bleeding or if a procedure is planned.