Transcript pneumonias - howMed Lectures

SECONDARY LOBULE
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Normal lung histology
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Inflammatory Cells
lsPneumonia
WHAT IS PNEUMONIA ?
Pneumonia: Definition
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Syndrome
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caused by acute infection, usually bacterial (may be non
bacterial)
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Involving lung parenchyma distal to terminal bronchioles
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Characterized by clinical and/or radiographic signs
of consolidation of a part or parts of one or both lungs.
What are symptoms of Pneumonia ?
Symptoms in Pneumonia
Cough
 Fever
 Shortness of Breath
 Rapid Breathing
 Confusion
 Restlessness
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What are signs of Pneumonia
General Inspection
 Respiratory Inspection
 Palpation
 Percussion
 Auscultation
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Clinical Signs in Pneumonia
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Fever
Tachycardia
Rapid Respiratory
Cyanosis in Severe cases
Signs of consolidation
Reduced movement
 Dull Percussion sound
 Bronchial Breathing and Crackles
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My be signs of Pleurisy/ Pleural Effusion
Radiological Signs of
Pneumonia
What is the Hall Mark ?
Radiological Signs of
Pneumonia
What is the Hall Mark ?
CONSOLIDATION
AIRBRONCHOGRAM
What is this ?
Pneumonia of RUL
Classification of
Pneumonias
??????
Classification of Pneumonia
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According to Etiology
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According to anatomical site
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According to Clinical Settings
Classification of Pneumonia
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According to Etiological agent
Classification of Pneumonia
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According to Aetiological agent
Bacterial Pneumonia
 Viral Pneumonia
 Bacteria like & Ricketsial Pneumonia
 Fungal Pneumonias
 Parasitic Pneumonia
 Chemical Pneumonia (lipoid pneumonia)
 Physical Pneumonia (ionizing radiation)
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Classification of Pneumonia
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According to anatomical site
Lobar
 Segmental
 Sub-segmental
 Lobular/ Bronchopneumonia/ Diffuse Pneumonia
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Lobar Pneumonia of RUL
Segmental Pneumonia Right Upper lobe
Bronchopneumonia/ Diffuse Pneumonia
Classification of Pneumonia
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According to Clinical Setting
Community acquired Pneumonia ( CAP)
 Hospital acquired/Health care associated Pneumonia
 Ventilator Associated Pneumonia (VAP)
 Aspiration Pneumonia
 Hypostatic Pneumonia
 Pneumonia in immunocompromised host
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“Community Acquired
Pneumonia”
Can U define ?
Community Acquired Pneumonia
(CAP)
Pneumonia
that begins outside hospital or is diagnosed
within 48 hours of admission in hospital
in a patient who has not been hospitalized
or residing in a long- term care facility
for 14 days or more before the onset of
symptoms
AETIOLOGY
No cause found in 40-60% of cases
 In more than 20% cases, more than one
organism
 Bacteria are more commonly identified than
viruses
 Commonest Organisms
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Strept pneumonaie
Mycoplasma
H influenza
Chlamydophilla pneumonaie
MRSA
Respiratory Viruses
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Which lobe is involved
What is the organism
60 years old woman is brought to hospital
in confusional state. She is febrile and
short of breath. On auscultation there are
few crackles in the mid zone bilaterally.
She is anaemic. WBC count is 6X109.
 Her chest x-ray is :
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What is the diagnosis ?
Mycoplasma Pneumonia)
Legionella Pneumonia
RISK FACTORS FOR PNEUMONIA
RISK FACTORS FOR PNEUMONIA
COPD
 Pulmonary Oedema
 Altered consciousness
 Recent Viral respiratory tract
infection
 Cigarette smoking
 Alcohol
 Bronchiectasis
 Bronchial obstruction
 Immunosupression
 Intravenous drug abuse
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How the organism reaches Lung ?
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Inhalation of micro-organism
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Aspiration of gastric content
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Spread from contagious site
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Hematological spread from distant site
Aspiration
What investigations will
you carry out ?
INVESTIGATIONS
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Blood Complete picture
Chest X Ray
Sputum Gram stain ?
Sputum Culture
Blood cultures
Urea, creatinine, electrolytes
Serological studies
Arterial blood gases (ABGs) in severe cases
Thoracocentesis if effusion is present
Serological tests
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Pneumococcal antigen
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Mycoplasma antibodies (IgM & IgG)
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Latex test on urine, sputum & serum
Cold agglutinin in 50% cases
Legionella antibodies
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Immunoflorescence test
MANAGEMENT OF
PNEUMONIA
Doctor should assess severity of the
Pneumonia and should decide whether
patient can be treated at home or in
hospital
When to admit ?
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Age > 65 y
Comorbid condition
Abnormal vital signs
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RR >30
BP < 90/60
Temp > 101
Altered mental status
Sepsis/ multiorgan dysfunction
Abnormal Lab findings
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TLC < 4000 or > 30000
Po2 ,60 PCO2 > 50
Multi-lobe involvement or pleural effusion
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Confusion
Urea level (>19 mmol/L)
Respiratory rate (>30 b/m)
Blood Pressure SBP<90 mmHg
or DBP <60 mmHg
Age >65 yrs
Excellent indicator for mortality
General Measures
Care of mouth and skin
 Fluids
 Cough Suppressants
 Analgesics for pain
 Antipyretics for fever
 Oxygen
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DURATION OF TREATMENT
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Influnced by severity of illness, the agent,
responsible, and other medical problems
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For Strept Pneumonia: treat for 72 hours after
the patient is afebrile
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For S aureus and Psudomonas, klebsiella,
anaerobes, mycoplasma, legionella: two weeks
at least
Lung Abcess
Empyema
COMPLICATIONS OF PNEUMONIA
Parapneumonic effusion
 Empyema
 Sepsis
 ARDS
 Lung abcess
 Focal Bronchiectasis
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PREVENTION OF PNEUMONIA
Polyvalent pneumococcal vaccine
 Influenza vaccine
 Smoking Cessation
 Alcohol cassation
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Thanks
AETIOLOGY
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BACTERIAL
 Streptococcus Pneumoniae
 2/3rd of case > 30%
 Haemophilus influenzae
 Klebsiella Pneumoniae
 Staphylococcus aureus
 Moraxella catarrhalis
Atypical Bacterial
 Mycoplasma pneumoniae
(9%)
 Chlamydia pneumoniae
(10%)
 Legionella Pneumoniae
 Coxeilla burneti
AETIOLOGY
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BACTERIAL
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Streptococcus Pneumoniae
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2/3rd of case
Haemophilus influenzae
Klebsiella Pneumoniae
Staphylococcus aureus
Moraxella catarhalis
Atypical Bacterial
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Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella Pneumoniae
Coxeilla burneti
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Viral
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Influenza A & B
Adenovirus
Varicella
Respiratry syncytial virus
Measles
Parainfluenza Virus
CMV
Corona Virus
Coxsackie virus
Rhino virus
Hospital Acquired Pneumonia
Two days after hospital admission
 Etiology
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Gram negative bacteria
Staphylococcal aureus
Anaerobic organisms
Lobar pneumonia causing organisms
Staphylococcal
Pneumonia in immunocompromised host
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Aetiological agents
• Pneumocystis carinii
• Pseudomonas aeroginosa
• Aspergillus fumigatus
• Cytomegalovirus
• Herpesviruses
• Mycobacterium
tuberculosis