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"
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
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"
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
pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Bronchiectasis
A condition characterized by chronic permanent dilation & destruction of bronchi due to destructive changes in the elastic and muscular layers of bronchial walls.
The common thread in the pathogenesis of bronchiectasis consists of difficulty clearing secretions & recurrent infections with a “vicious circle” of infection and inflammation resulting in airway injury and remodelling.
PLEASE REFER TO REFERENCE TEXTBOOKS FOR CLARITY.
pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Bronchiectasis
A condition characterized by chronic permanent dilation & destruction of bronchi due to destructive changes in the elastic and muscular layers of bronchial walls.
The common thread in the pathogenesis of bronchiectasis consists of difficulty clearing secretions & recurrent infections with a “vicious circle” of infection and inflammation resulting in airway injury and remodelling.
PLEASE REFER TO REFERENCE TEXTBOOKS FOR CLARITY.
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Acute respiratory infections (ARIs) are classified as upper respiratory tract infections (URIs) or lower respiratory tract infections (LRIs). The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear.
An inflammatory process in lung parenchyma usually associated with a marked increase in interstitial and alveolar fluid
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
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1. Cebu Normal University GRADUATE SCHOOL Osmeňa Blvd., Cebu City PNEUMONIA John Louis S. Ricamora, AHSE, BSN, RN MSN 4006 – Advanced Psychopathology
2. Pneumonia - is an infection of the pulmonary tissue - can be community acquired or hospital acquired - caused by a virus, mycoplasmal agents, bacteria, or the aspiration of foreign substances.
4. Viral pneumonia Assessment: a. Mild fever, slight cough and malaise, to high fever, severe cough, and prostration b. Nonproductive or productive cough of small amounts of whitish sputum c. Wheezes or fine crackles
5. Interventions: a. Administer oxygen with cool mist as prescribed. b. Increase fluid intake. c. Administer antipyretics for fever as prescribed. d. Administer CPT as prescribed. e. Antimicrobial therapy is reserved for children in whom the presence of infection is demonstrated by cultures.
6. Primary atypical pneumonia ( Mycoplasma pneumoniae ) - most common cause of pneumonia in children between the ages of 5 and 12 years - more prevalent in crowded living conditions
7. Assessment: a. Fever, chills, anorexia, headache, malaise and muscle pain b. Rhinitis, sore throat, and dry, hacking cough c. Nonproductive cough initially; then production of seromucoid sputum that becomes mucopurulent or blood streaked Interventions: symptomatic
8. Bacterial pneumonia - hospitalization is indicated when pleural effusion or empyema accompanies the disease and is mandatory for children with staphylococcal pneumonia
9. Assessment: a. Acute onset, fever, toxic appearance b. Infant: irritability, lethargy, poor feeding, abrupt fever (may be accompanied by seizures); respiratory distress (air hunger, tachypnea, and circumoral cyanosis) c. Older child: headache, chills, abdominal pain, chest pain, meningeal symptoms (meningism)
10. d. Hacking, nonproductive cough e. Diminished breath sounds or scattered crackles f. As the infection resolves, coarse crackles and wheezing are heard and the cough becomes productive with purulent sputum.
11. Interventions: a. Antimicrobial therapy is initiated as soon as the diagnosis is suspected. b. Administer oxygen (via hood, mist tent, or nasal cannula) for respiratory distress as prescribed. c. Place the child in a mist tent as prescribed; cool humidification moistens the airways and assists in temperature reduction.
12. d. Suction mucus from the infant to maintain a patent airway if the infant is unable to handle secretions. e. Administer CPT q 4 hours as prescribed. f. Encourage the child to lie on the affected side (if pneumonia is unilateral) to splint the chest and reduce the discomfort caused by pleural rubbing.
13. g. Provide liberal fluid intake (administer cautiously to prevent aspiration); IV administered fluids may be necessary. h. Administer antipyretics for fever as prescribed; monitor temperature frequently because of the risk for febrile seizures. i. Institute isolation precautions with pneumococcal or staphylococcal pneumonia (according to agency policy).
14. j. Administer antitussives as prescribed. k. Continuous closed chest drainage may be instituted if purulent fluid is present. l. Promote bed rest to conserve energy. m. Fluid accumulation in the pleural cavity may be removed by thoracentesis; thoracentesis also provides a means of obtaining fluid for culture and for instilling antibiotics directly into the pleural cavity.
16. Streptococcus Pneumoniae - most common cause of a bacterial pneumonia there is usually an abrupt onset of the illness with shaking chills, fever, and production of a rust-colored sputum.
17. Pneumococcal Conjugate Vaccine (PCV7; Prevnar) - is part of the routine infant immunization schedule in the U.S. and is recommended for all children < 2 years of age and children 2-4 years of age who have certain medical conditions.
18. Pneumococcal Polysaccharide Vaccine (PPV23; Pneumovax) - is recommended for adults at increased risk for developing pneumococcal pneumonia including the elderly, people who have diabetes , chronic heart, lung, or kidney disease, those with alcoholism, cigarette smokers , and in those people who have had their spleen removed.
19. - Antibiotics often used in the treatment of this type of pneumonia include penicillin , amoxicillin and clavulanic acid (Augmentin, Augmentin XR), and macrolide antibiotics including erythromycin , azithromycin (Zithromax, Zmax), and clarithromycin (Biaxin).
20. Klebsiella pneumoniae and Hemophilus influenzae - are bacteria that often cause pneumonia in people suffering from chronic obstructive pulmonary disease (COPD) or alcoholism. - Useful antibiotics in this case are the second- and third-generation cephalosporins, amoxicillin and clavulanic acid, fluoroquinolones ( levofloxacin [Levaquin], moxifloxacin-oral [Avelox], gatifloxacin-oral [Tequin], and sulfamethoxazole and trimethoprim [Bactrim, Septra]).
21. Mycoplasma pneumoniae - is a type of bacteria that often causes a slowly developing infection. Symptoms include fever, chills, muscle aches, diarrhea , and rash . This bacterium is the principal cause of many pneumonias in the summer and fall months, and the condition often referred to as "atypical pneumonia." - Macrolides (erythromycin, clarithromycin, azithromycin, and fluoroquinolones) are antibiotics commonly prescribed to treat Mycoplasma pneumonia .
22. Legionella pneumoniae - most often found in contaminated water supplies and air conditioners. It is a potentially fatal infection if not accurately diagnosed. Pneumonia is part of the overall infection, and symptoms include high fever, a relatively slow heart rate, diarrhea, nausea, vomiting, and chest pain. Older men, smokers, and people whose immune systems are suppressed are at higher risk of developing Legionnaire's disease. - Fluoroquinolones are the treatment of choice in this infection. This infection is often diagnosed by a special urine test looking for specific antibodies to the specific organism.
23. Chlamydia pneumoniae - all cause a syndrome known as "atypical pneumonia." In this syndrome, the chest x-ray shows diffuse abnormalities, yet the patient does not appear severely ill. These infections are very difficult to distinguish clinically and often require laboratory evidence for confirmation.
24. Pneumocystis carinii - pneumonia is another form of pneumonia that usually involves both lungs. It is seen in patients with a compromised immune system, either from chemotherapy for cancer, HIV/AIDS, and those treated with TNF (tumor necrosis factor), such as for rheumatoid arthritis. - Once diagnosed, it usually responds well to sulfa-containing antibiotics. Steroids are often additionally used in more severe cases.
25. Viral pneumonias - do not typically respond to antibiotic treatment. These infections can be caused by adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus (that also causes croup). These pneumonias usually resolve over time with the body's immune system fighting off the infection. It is important to make sure that a bacterial pneumonia does not secondarily develop. If it does, then the bacterial pneumonia is treated with appropriate antibiotics. In some situations, antiviral therapy is helpful in treating these conditions.
26. Fungal infections - that can lead to pneumonia include histoplasmosis, coccidiomycosis, blastomycosis, aspergillosis, and cryptococcosis. These are responsible for a relatively small percentage of pneumonias in the United States. - Each fungus has specific antibiotic treatments, among which are amphotericin B, fluconazole (Diflucan), penicillin, and sulfonamides.
28. Guidelines on Pneumonia Empiric Therapy: (Usual Recommended Dosages of Antibiotics in Adults, 50-60 Kg Body Weight, with Normal Liver and Renal Function)
29. 1. Low Risk CAP (Out-Patient) Common Organisms: 1. Strep. Pneumoniae, 2. H. influenzae, 3. M. pneumoniae, 4. C. pneumoniae, 5. M. catarrhalis; Mortality rate at 1-5% a. For previously healthy, choice of: Amoxicillin 500 mg cap TID PO (standard regimen) or Co-trimoxazole forte (Globaxol forte) tab BID PO or Macrolides like: - Roxithromycin (Macrol, Rulid) 150 mg tab BID PO x 7 days - Clarithromycin (Klaricid) 500 mg tab BID PO x 7 days - Azithromycin 500 mg tab OD x 3 days or 2 grams single dose
30. b. For those with stable co-morbid illness, choice of: Co-Amoxiclav (Amoclav, Augmentin) 375-625 mg tab TID PO or Cefuroxime (Zegen) 250-500 mg tab BID PO or Macrolides as above.
31. 2. Moderate Risk CAP (In-Patient) Common Organisms: Above organisms plus: 1. Enteric gram-negative bacilli, 2. Anaerobic bacteria, 3. Legionella pneumophilia; Mortality rate 5-25% a. Choice of: Cefuroxime (Zegen, Zinacef) 750 mg q 8 hr IV Ampicillin-Sulbactam (Unasyn) 750 mg-1.5 gm q 8 hr IV Co-Amoxiclav (Amoclav, Augmentin) 600 mg-1.2 gm q 8 hr IV plus b. Azithromycin IV or c. New Fluoroquinolones Alone PO: (Cheaper option) Ex. Levofloxacin (Levox) 500 mg tab OD PO x 5-7 days
32. 3. High Risk CAP (Intensive Care) Common Organisms: Above organisms plus: 1. Staphylococcus aureus, 2. Pseudomonas aeruginosa; Mortality rate at 50% a. Choice of: Ceftazidime 1-2 gm q 8 hr IV or Piperacillin-Tazobactam (Tazocin) 2.25 gm q 6-8 hr IV or Meropenem 500 mg q 8 hr IV or Cefepime 1-2 gm q 12 hr IV plus b. Azithromycin IV or Levofloxacin (Levox) 500 mg IV OD x 3 days then 500 mg tab PO x 4 days +/- c. For those with risk for Pseudomonas: Ciprofloxacin 200 mg q 12 hr IV x 3 days then 500 mg tab PO x 4 days or Amikacin 500 mg IV q 12 hr or Gentamicin IV
33. 4. For Aspiration Pneumonia: a. Aspiration Pneumonia (community-acquired) Clindamycin 300-600 mg q 6-8 hr IV or Penicillin G 1-2 millions units q 4 hr IV b. Aspiration Pneumonia (nosocomial) Piperacillin-Tazobactam (Tazocin) 2.25 gm q 6-8 hr IV or Clindamycin 300-600 mg q 6-8 hr IV plus Tobramycin 80 mg q 8 hr IV
34. 5. Treatment Based on Typical and Atypical Clinical Presentation: a. Typical Presentation: Fever, acute onset, pleuritic chest pain, lobar consolidation by x-ray, yellow copious phlegm, pleural effusion. Treatment: Beta-lactams (e.g. Co-amoxiclav) or Cephalosporins (e.g. Cefuroxime) b. Atypical Presentation: No fever, chronic, intersitial infiltrates by x-ray, scanty white phlegm Treatment: Macrolides (e.g. Clarithromycin)
35. 6. Cheeper Antibiotic Options: a. For CAP Category I and Category II: Amoxicillin PO for Typical Pneumonia Roxithromycin PO for Atypical Pneumonia b. For CAP Category III: New Fluoroquinolones Alone PO Ex. Levofloxacin (Levox) 500 mg tab OD PO
37. Therapeutics: 1. Antibiotic regimen as listed above given for a maximumof 7-8 days only to minimize the emergence of resistance. 2. Berodual nebulization (10 gtts in 3 ml NSS) q 6 hours and prn
38. 3. Switch Therapy: Intravenous antibiotic treatment may be shifted to oral antibiotics after 48-72 hours if the following parameters are fulfilled: (a) there is less cough and resolution of respiratory distress (normalization of respiratory rate), (b) the temperature is normalizing, (c) the etiology is not a high risk (virulent/resistant) pathogen, (d) there is no unstable co-morbid conditions or life-threatening complications, and (e) oral antibiotics are tolerated.
39. 4. For abundant secretions, may give Acetylcysteine (Fluimucil) 100 mg or 200 mg sachet disolved in ½ glass H2O TID. Discontinue if patient has wheezing.
41. How is pneumonia prevented? - Vaccines are available for the prevention of specific types of pneumonia. This is usually given to persons not less than 65 years old and children. Ask your doctor about it. - Maintain a healthy, clean lifestyle, eat a balanced diet, get enough rest, and exercise regularly to enhance your immune system. - Stop smoking! Smoking destroys the natural defense of the lungs and may lead to other lung diseases. - Avoid crowded places especially when your immune system is low (after an illness).
