Pneumonia is an infection of the lungs that can be classified as community-acquired, hospital-acquired, ventilator-associated, or healthcare-associated based on where infection was contracted. It progresses through stages including congestion, red and gray hepatization, and resolution. Diagnosis involves chest x-rays, sputum culture, urine antigen tests, and biomarkers. Risk factors are addressed through primary prevention like immunization, secondary prevention like screening high risk groups, and tertiary prevention like case management of recurrent cases. Treatment is based on CURB-65 severity score and may include outpatient therapy or ICU care.

1. PNEUMONIA

2. DEFINITION
Pneumonia is an infection of the pulmonary
parenchyma.
It is classified as
1.Community-acquired (CAP)
2.Hospital-acquired (HAP)
3.Ventilator-associated (VAP).
4.Health care-associated pneumonia (HCAP).

3. STAGES OF PNEUMONIA
 1) Congestion :- there is presence of a proteinaceous exudate and bacteria in
the alveoli.
 2) Red hepatization:- there is presence of erythrocytes in the cellular intra
alveolar exudate, neutrophil influx, Bacteria are occasionally seen
 3) Gray hepatization:- no new erythrocytes are extravasating, and those
already present have been lysed and degraded. The neutrophil is the
predominant cell, fibrin deposition is abundant, and bacteria have
disappeared. This phase corresponds with successful containment of the
infection and improvement in gas exchange.
 4) Resolution - the macrophage reappears as the dominant cell type in the
alveolar space, and the debris of neutrophils, bacteria, and fibrin has been
cleared, as has the inflammatory response.

4. DIAGNOSIS
 CHEST X-RAY
 CT THORAX
 SPUTUM GRAM STAIN AND CULTURE- To be adequate for culture, a sputum sample must
have >25 neutrophils and <10 squamous epithelial cells per low-power field.
For patients admitted to the ICU and intubated, a deep-suction aspirate or
bronchoalveolar lavage sample can be examined.
 BLOOD CULTURE- low yield•
 Urinary Antigen Tests:- detect pneumococcal and Legionella antigen in urine.•
 Polymerase Chain Reaction:- PCR of nasopharyngeal swabs has become the standard for
diagnosis of respiratory viral infection. In addition, PCR can detect the nucleic acid of
Legionella species, M. pneumoniae, C. pneumoniae, and mycobacteria.
 Biomarker:- C-reactive protein (CRP) and procalcitonin (PCT) serves as markers of severe
inflammation.

5. EPIDEMIOLOGY OF
PNEUMONIA IN
INDIA

6. PERSON

7. PERSON

8. PLACE

9. TIME

10. PRIMARY PREVENTION
 Education about pneumonia, good nutrition, regular exercise,
dangers of tobacco.
Regular exams & screening tests to monitor risk factors for illness.
Immunization against pneumonia.
Controlling potential hazards at home (i.e. reduce mold, clean
house).
Control work hazards (i.e. wash hands, avoid inhaling harmful
substances, good ventilation).
Prevention of low birth weight & breastfeeding education.

11. SECONDARY PREVENTION
Counsel people to take daily vitamins & minerals, and answer
any other dietary questions.
Recommend regular exams and screening tests in people with
known risk factors for pneumonia (i.e. elderly, children under 5,
smokers, people with COPD or HIV).
Encourage post-op and physically challenged patients to stay
active and cough/deep breathe to prevent pneumonia.
Provide modified diet, such as thickened liquids to people with
risk of aspiration.

12. TERTIARY PREVENTION
COPD or HIV management programs, with a
portion focusing on preventing infections such
as pneumonia.
Case management for patients who
repeatedly get pneumonia.
Patient support groups for high risk patients.

13. TREATMENT
 CURB-65 criteria :- severity-of-illness score
 C- Confusion
 U- Urea > 7 mmol/L or 40 g/dL
 R- Respiratory Rate > 30/min
 B- Blood Pressure; Systolic ≤ 90 mm Hg, Diastolic ≤ 60 mm Hg.
 65- Age 265 Years•
 Score-0- 30 days mortality rate is 1.5 % - can be treated as OPD
 Score-2- 30 days mortality rate is 9.2% - patient should be admitted
 Score ≥ 3- 30 days mortality rate is 22% - requires ICU care.

14. Risk Factors for Early Deterioration in CAP
 Multilobar infiltrates
 Severe hypoxemia (arterial saturation <90%)
 Severe acidosis (pH <7.30)
 Mental confusion
 Severe tachypnea (>30breaths/min)
 Hypoalbuminemia
 Neutropenia
 Thrombocytopenia
 Hyponatremia
 Hypoglycemia

15. Complications
Respiratory failure
Shock
Multiorgan failure
Coagulopathy
Metastatic infection- brain abscess, endocarditis.
Lung abscess
Complicated pleural effusion

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