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SECONDARY LOBULE Normal lung histology Inflammatory Cells lsPneumonia WHAT IS PNEUMONIA ? Pneumonia: Definition Syndrome caused by acute infection, usually bacterial (may be non bacterial) Involving lung parenchyma distal to terminal bronchioles 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 What are signs of Pneumonia General Inspection Respiratory Inspection Palpation Percussion Auscultation Clinical Signs in Pneumonia Fever Tachycardia Rapid Respiratory Cyanosis in Severe cases Signs of consolidation Reduced movement Dull Percussion sound Bronchial Breathing and Crackles 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 According to Etiology According to anatomical site According to Clinical Settings Classification of Pneumonia According to Etiological agent Classification of Pneumonia According to Aetiological agent Bacterial Pneumonia Viral Pneumonia Bacteria like & Ricketsial Pneumonia Fungal Pneumonias Parasitic Pneumonia Chemical Pneumonia (lipoid pneumonia) Physical Pneumonia (ionizing radiation) Classification of Pneumonia According to anatomical site Lobar Segmental Sub-segmental Lobular/ Bronchopneumonia/ Diffuse Pneumonia Lobar Pneumonia of RUL Segmental Pneumonia Right Upper lobe Bronchopneumonia/ Diffuse Pneumonia Classification of Pneumonia 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 “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 Strept pneumonaie Mycoplasma H influenza Chlamydophilla pneumonaie MRSA Respiratory Viruses 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 : 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 How the organism reaches Lung ? Inhalation of micro-organism Aspiration of gastric content Spread from contagious site Hematological spread from distant site Aspiration What investigations will you carry out ? INVESTIGATIONS 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 Pneumococcal antigen Mycoplasma antibodies (IgM & IgG) Latex test on urine, sputum & serum Cold agglutinin in 50% cases Legionella antibodies 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 ? Age > 65 y Comorbid condition Abnormal vital signs RR >30 BP < 90/60 Temp > 101 Altered mental status Sepsis/ multiorgan dysfunction Abnormal Lab findings TLC < 4000 or > 30000 Po2 ,60 PCO2 > 50 Multi-lobe involvement or pleural effusion 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 DURATION OF TREATMENT Influnced by severity of illness, the agent, responsible, and other medical problems For Strept Pneumonia: treat for 72 hours after the patient is afebrile 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 PREVENTION OF PNEUMONIA Polyvalent pneumococcal vaccine Influenza vaccine Smoking Cessation Alcohol cassation Thanks AETIOLOGY 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 BACTERIAL Streptococcus Pneumoniae 2/3rd of case Haemophilus influenzae Klebsiella Pneumoniae Staphylococcus aureus Moraxella catarhalis Atypical Bacterial Mycoplasma pneumoniae Chlamydia pneumoniae Legionella Pneumoniae Coxeilla burneti Viral 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 Gram negative bacteria Staphylococcal aureus Anaerobic organisms Lobar pneumonia causing organisms Staphylococcal Pneumonia in immunocompromised host Aetiological agents • Pneumocystis carinii • Pseudomonas aeroginosa • Aspergillus fumigatus • Cytomegalovirus • Herpesviruses • Mycobacterium tuberculosis