Pneumonia is an acute infectious respiratory disease characterized by pulmonary shadowing, with types including lobar and bronchopneumonia. It can be categorized as community-acquired or hospital-acquired pneumonia, identified by clinical features, risk factors, and specific pathogens. Diagnosis involves a variety of investigations, and management typically includes antibiotics and supportive care, with prognosis varying significantly based on severity.

2. PNEUMONIA

3. DEFINITION
It is an acute infectious respiratory illness associated with
radiological pulmonary shadowing that may be segmental,
lobar or multi-lobular.

4. TYPES:
1. Lobar Pneumonia
2. Bronchopneumonia

5. Lobar Pneumonia

6. Bronchopneumonia

7. CLASSIFICATION
 Community acquired pneumonia
 Hospital acquired pneumonia

8. COMMUNITY ACQUIRED PNEUMONIA
It occurs out of Hospital or within first 72 hours of hospitalization
TYPES
Typical CAP
Atypical CAP

9. Typical CAP
It presents with fever, shaking chills, cough, pleuritic
chest pain and dyspnea (typical features)
EXAMINATION
Tachycardia / Tachypnea
Late Inspiratory Crackles
Bronchial Breath Sounds
Dullness on Percussion
Pleural Friction Rub
Increase tactile and vocal fremitus

10. ORGANISMS
 BACTERIAL
 Streptococcus Pneumonia (60%)
 Hemophilus Influenza (15%)
 Klebsiella (6 - 10%)
 S. Aureus (2 – 10%)
 ON CXR:
 Lobar / Multi-lobular consolidation

11. PREDISPOSING FACTORS
 Old Age
 Smoking
 Alcohol
 Glucocorticoid Therapy
 HIV
 URI
 Pre-existing Lungs Disease

12. Atypical CAP
 It refers to organisms not culturable on standard blood agar
 AGENTS
BACTERIAL VIRAL
• Mycoplasma Pneumonia
• Chlamydia Psittaci
• Coxiella Burnettii (Q Feverr)
• Legionella Pneumophila
• Influenza, parainfluenza
• Measles
• Herpes Simplex
• Cytomegalovirus
• Coranaviruses (SARS-CoV and
MERS-CoV)

13. C / F
 Relative bradycardia (Pulse temperature dissociation)
 It presents with headache, sore throat, fatigue and malaise
 Sometimes associated with dry cough and chest pain
 Fever is uncommon

14. LEGIONELLA PNEUMONIA
RISKS
 Organ transplant Recipients
 Renal Failure
 CLD
 Smokers
 GI Symptoms
 Hyponatremia

15. INVESTIGATIONS
BLOOD
CBC (TLC Count > 20 / < 4 * 10-e9)
S / E (Hyponatremia)
Serum Albumin (low)
RFTs (Urea > 7 mmol / Liter)
ESR, CRP (Elevated)
Blood Culture ( Bacteremia)
ABGs (PH  Low / SaO2 < 92%)
Cold Agglutinins (Increase 50%)

16.  SPUTUM
 Staining and Culture (Acid Fast / Silver Stain)
 OROPHARANGEAL SWAB (PCR)
 URINE
 Legionella Antigen Test
 PLEURAL FLUID
 Culture
 CHEST X-RAY
 PA View
 Lateral View

17. DIFFERENTIALS
Pulmonary Infarction
Pulmonary TB
Pulmonary Edema
Pulmonary Eosinophilia
Malignancy

18. SEVERITY MARKERS
CURB – 65 (Score 4 – 5)
PaO2 < 8 Kpa (60 mmHg)
Progressive Hypercapnia
Severe Acidosis
Circulatory Shock
Consciousness Level Reduced

19. CURB – 65 SCORE
 C – Confusion
 U – Urea > 7 mmol / L
 R – Respiratory Rate > 30 /m
 B – Blood Pressure < 90 / 60
 Age > 65
 Score
 0 – 1  Home
 2  Hospital Admission
 3 or more  ICU Admission

20. HOSPITAL ACQUIRED PNEUMONIA
 Occurs after 72 hours of hospital admission (at least 2 days)
 TYPES
Early onset HAP (4 – 5 Days)
Late onset HAP

21. DIAGNOSTIC CRITERIA
Purulent Sputum Production
New Radiological Infiltrate
Unexplained Increase in Oxygen Requirement
Core Temperature > 38.3 C
TLC Count (Increase or Decrease)

22. SUPPURATIVE PNEUMONIA
 Destruction of Lung parenchyma by Inflammatory Process
 Mostly occurs in Apical Segments of Lower Lobs
 AGENTS
 Prevotella
 Fusobacterium
 Bacteroides
 Actinomycosis
 S. Pneumonia, S. Aureus, H. Influenza (Bacterial infection of pulmonary infarct or collapsed
lobe)

23. CA – MRSA
Produce cytotoxin pantone – valentine leucocidin
Causes suppurative skin infection
Rapidly progressive severe necrotizing pneumonia
CXR
Abscess with cavitation and air fluid level

24. LEMIERRE’S SYNDROME
Rare Cause of Pulmonary
Abscess
Causative Agent
Fusobacterium Necrophorum
C / F
Sore throat
Painful Swollen neck
Fever with Rigors
Foul Smelling Sputum
Dyspnea
hemoptysis

25. PNEUMONIA IN IMMUNO COMPROMISED
PATIENTS
It is caused by low virulence non pathogenic opportunistic
bacteria, viruses and fungi
Mostly present in HIV patients and drug users
AGENTS
Pneumocystis Jiroveci
Mycobacteria
HRCT and biopsy leads to diagnosis

26. MANAGEMENT
Goals of Management should be
Oxygen Maintenance
Fluid Balance
Nutrition
Anti-biotics (Main Stay)

27. COMMUNITY ACQUIRED PNEUMONIA
UNCOMPLICATED CAP COMPLICATED CAP
• Amoxicillin 500mg * TDS * PO
• If Allergic:
• Clarithromycin 500mg Bid
• Erythromycin 500mg QID
• Or Doxycycline
• Alternatives:
• Fluoroquinolones
• Respiratory Fluoroquinolones
• Levofloxacin 750mg per day
• Moxifloxacin 400mg per day
• Macrolides / Amoxicillin-
clavulanate
• In hospitalized patients
• Fluoroquinolones / 3rd Gen
Cephalosporins
• Plus
• Macrolides

28. SEVERE CAP
 Clarithromycin 500 mg BID * IV / Erythromycin 500 mg QID * IV
+
 Co-amoxiclav 1.2 g TDS * IV / Ceftriaxone 1 -2 g * IV / Cefuroxime
1.5 g * TDS * IV / Amoxicillin 1g QID * IV + Flucloxacillin 2 g QID * IV

29. HOSPITAL ACQUIRED PNEUMONIA
Any of these three
1. 1st Gen Cephalosporins ( ceftazidime / cefepime)
2. Carbapenems (Imipenem)
3. Piperacillin / Tazobactam

30. VENTILATOR ASSOCIATED PNEUMONIA
Cephalosporins ( ceftazidime / cefepime)
 Piperacillin / Tazobactam
Carbapenems (Imipenem)
Aminoglycosides / Fluoroquinolones
Vancomycin or Linezolid

31. SUPPURATIVE PNEUMONIA
Duration of therapy is 4 – 6 weeks with abscess
Amoxicillin 1g TDS
metronidazole
Co-amoxiclav  risk of C. difficile infection

32. IN HIV PATIENTS
3rd Gen Cephalosporins / Quinolones
Antipseudomonal Penicillin
Aminoglycosides

33. S. Aureus
Flucloxacillin (1 – 2 g) QID * IV
Clarithromycin 500 mg BID * IV
Mycoplasma / Legionella
Clarithromycin 500 mg BID * IV
Erythromycin 500 mg QID * IV
Plus
Rifampicin 600 mg BID * IV (Severe)

34. COMPLICATION
 Para-pneumonic effusion  common
 Empyema
 Lobar collapse
 DVT / PE
 Pneumothorax
 Lung Abscess
 ARDS
 Multi-organ failure
 Atrial Fibrillation
 Hepatitis / pericarditis / myocarditis

35. PROGNOSIS
Mortality Rate
< 1% (Non Severe)
5 – 10 % (Severe)

36. THE END