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  1. 1. Presented By; Afshan Shamim B.S 3 rd year 6 th Semester
  2. 2. Definition <ul><li>Lower respiratory tract infection in a non-hospitalized person that is associated with symptoms of acute infection with or without new infiltrate on chest radiographs </li></ul>
  3. 3. E pidemiology <ul><li>CAP is a common illness in all parts of the worldm,major cause of death among all age groups </li></ul><ul><li>CAP occurs more commonly in males than females </li></ul><ul><li>Individuals with underlying illnesses such as emphysema, tobacco smoking, alcoholism, or immune system problems are at increased risk for pneumonia </li></ul>
  4. 4. Symptoms <ul><li>problems breathing </li></ul><ul><li>coughing that produces greenish or yellow sputum </li></ul><ul><li>a high fever that may be accompanied with sweating, chills, and uncontrollable shaking </li></ul><ul><li>sharp or stabbing chest pain </li></ul><ul><li>rapid, shallow breathing that is often painful </li></ul>
  5. 5. Less common symptoms include <ul><li>the coughing up of blood </li></ul><ul><li>headaches </li></ul><ul><li>loss of appetite </li></ul><ul><li>excessive fatigue </li></ul><ul><li>blueness of the skin </li></ul><ul><li>nausea </li></ul><ul><li>vomiting </li></ul><ul><li>joint pain </li></ul><ul><li>muscle aches </li></ul>
  6. 6. Additional symptoms for infants <ul><li>being overly sleepy </li></ul><ul><li>yellowing of the skin </li></ul><ul><li>difficulties feeding </li></ul>
  7. 7. Pathophysiology <ul><li>The symptoms of CAP are the result of both the invasion of the lungs by microorganisms and the immune system's response to the infection </li></ul>
  8. 8. The mechanisms of infection ; VIRUSES <ul><li>Inhalation of droplets reach to lungs invasion of cells cell death </li></ul><ul><li>Immune mechanism </li></ul><ul><li>WBCs (lymphocytes) cytokines causes leaking of fluid into alveoli results in interruption of transport of oxygen </li></ul>
  9. 9. Bacteria and fungi <ul><li>Inhalation or through blood stream invasion immune response neutrophils engulf & kill m.o also release cytokines fluid leaked from surrounding blood vessels result in impaired oxygen transportation </li></ul>
  10. 10. Parasites <ul><li>Parasites enter the body through the skin or by being swallowed. Once inside the body, these parasites travel to the lungs, most often through the blood. There, a similar combination of cellular destruction and immune response causes disruption of oxygen transportation. </li></ul>
  11. 11. Microorganisms causing CAP Streptococcus pneumoniae Escherichia coli Klebsiella pneumoniae Moraxella catarrhalis Staphylococcus aureu Chlamydia trachomatis Streptococcus agalactiae Listeria monocytogenes Tuberculosis Viruses herpes simplex viru s adenovirus Older infants Newborn infants
  12. 12. Adults Mycoplasma pneumoniae Chlamydophila pneumoniae Legionella pneumophila Influenza Para influenza Respiratory syncytial virus Adenovirus Atypical organisms Viruses cause 20% of CAP
  13. 13. Bacterial causes <ul><li>Streptococcus pneumoniae ; common bacterial cause of CAP </li></ul><ul><li>Hemophilus influenzae </li></ul><ul><li>Enteric Gram negative bacteria </li></ul><ul><ul><li>Escherichia coli and Klebsiella pneumoniae </li></ul></ul><ul><li>Pseudomonas aeruginosa </li></ul>
  14. 14. Risk factors <ul><li>Age older than 65 years </li></ul><ul><li>Human immunodeficiency virus or immuno-compromised </li></ul><ul><li>Recent antibiotic therapy or resistance to antibiotics </li></ul><ul><li>Asthma </li></ul><ul><li>Chronic obstructive pulmonary disease </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Diabetes </li></ul><ul><li>Liver disease </li></ul><ul><li>Neoplastic disease </li></ul>
  15. 15. Complications of CAP <ul><li>Sepsis </li></ul><ul><li>Respiratory failure </li></ul><ul><li>Pleural effusion </li></ul><ul><li>Abscess </li></ul>
  16. 16. S pecial circumstances leading to CAP <ul><li>Obstructio n </li></ul><ul><ul><li>When part of the airway leading to the alveoli is obstructed, the lung is not able to clear fluid when it accumulates. This can lead to infection of the fluid resulting in CAP. </li></ul></ul>
  17. 17. Cont….. <ul><li>Lung disease </li></ul><ul><ul><li>People with underlying lung disease are more likely to develop CAP. Diseases such as emphysema or habits such as smoking result in more frequent and more severe bouts of CAP. </li></ul></ul>
  18. 18. Cont….. <ul><li>Immune problems </li></ul><ul><ul><li>People who have immune system problems are more likely to get CAP. </li></ul></ul>
  19. 19. Prevention <ul><li>Treating underlying illness </li></ul><ul><li>Smoking cessation </li></ul><ul><li>Vaccination against Haemophilus influenzae and Streptococcus pneumoniae in the first year of life have greatly reduced their role in CAP in children </li></ul>
  20. 20. ANTIBIOTIC TREATMENT Newborn infants <ul><li>Most newborn infants with CAP are hospitalized and given intravenous ampicillin and gentamicin for at least ten days. </li></ul><ul><li>This treats the common bacteria </li></ul><ul><ul><li>Streptococcus agalactiae </li></ul></ul><ul><ul><li>Listeria monocytogenes </li></ul></ul><ul><ul><li>Escherichia coli </li></ul></ul>
  21. 21. ANTIBIOTIC TREATMENT Children <ul><li>Treatment depends on both the age and the severity of illness </li></ul><ul><li>According to a recent analysis a 3 days course of antibiotics seems to be sufficient for most cases of mild to moderate CAP in children </li></ul>
  22. 22. ANTIBIOTIC TREATMENT :Adults <ul><li>Divided based upon common organisms encountered into four categories </li></ul><ul><ul><li>Healthy patients without risk factors </li></ul></ul><ul><ul><li>Patients with underlying illness and/or risk factors </li></ul></ul><ul><ul><li>Hospitalized individuals not at risk for Pseudomonas </li></ul></ul><ul><ul><li>Individuals requiring intensive care at risk for Pseudomonas </li></ul></ul>
  23. 23. Healthy patients without risk factors <ul><li>The primary microoganisms in this group are; </li></ul><ul><ul><li>Viruses </li></ul></ul><ul><ul><li>atypical bacteria </li></ul></ul><ul><ul><li>penicillin sensitive Streptococcus pneumoniae </li></ul></ul><ul><ul><li>Hemophilus influenzae </li></ul></ul><ul><li>Recommended management is with a macrolide antibiotic such as azithromycin or clarithromycin for seven to ten days . </li></ul>
  24. 24. Patients with underlying illness and/or risk factors <ul><li>Treatment is with a fluoroquinolone active against Streptococcus pneumoniae or a beta-lactam antibiotic such as cefuroxime, amoxicillin, plus a macrolide antibiotic for seven to ten days </li></ul>
  25. 25. Individuals requiring intensive care at risk for Pseudomonas <ul><li>Individuals being treated in an intensive care unit with risk factors for infection with Pseudomonas aeruginosa require specific such as; </li></ul><ul><ul><li>Cefepime </li></ul></ul><ul><ul><li>Imipenem </li></ul></ul><ul><ul><li>Meropenem </li></ul></ul><ul><ul><li>piperacillin/tazobactam </li></ul></ul>
  26. 26. Summary
  27. 27. Summary ThankYou