Peumonia part2

PNEUMONIA

Dr. Manu Mohan KAssociate ProfessorPulmonary Medicine

Community Acquired Pneumonia

Most common Streptococcus pneumonia

Common Staphylococcus aureus, Legionella

pneumophila, Mycoplasma pneumoniae Uncommon

Haemophilus influenzae, Klebsiella pneumoniae, Streptococcus pyogenes, Pseudomonas aeruginosa

Rare Coxiella burnetti, Chlamydia psittacci,

Actinomyces israeli, viruses

Pneumococcal pneumonia

Predisposing conditions Splenectomized state, functional

asplenia, chronic lung, heart, renal, liver diseases, Diabetes mellitus

Clinical features Physical signs

Radiological examination

Supportive treatment

Respiratory support Fluid and electrolyte replacement Other consideration

Pleuritic pain Physiotherapy Corticosteroids Inotropic agents

Prevention

Vaccination Influenza Pneumococcal

Hospital acquired pneumonia

HAP is defined as pneumonia that occurs 48 hours or more after admission, which was not incubating at the time of admission

Hospital acquired pneumonia

VAP refers to pneumonia that arises more than 48–72 hours after endotracheal intubation

Hospital acquired pneumonia

HCAP includes any patient who was hospitalized in an acute care hospital for

two or more days within 90 days of the infection;

resided in a nursing home or long-term care facility;

received recent intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection; or

attended a hospital or hemodialysis clinic

Hospital acquired pneumonia

Common pathogens include aerobic gram-negative bacilli,

such as P. aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter species.

Infections due to gram-positive cocci, such as Staphylococcus aureus, particularly methicillin resistant S. aureus (MRSA)

Predisposing factors for HAP Reduced host defense Aspiration of nasopharyngeal or

gastric secretions Bacteria introduced into lower

respiratory tract Bacteremia

Hospital acquired pneumonia

Clinical features Investigations Management Prevention

Good hygiene Minimize aspiration limit stress ulcer prophylaxis

Aspiration Pneumonia

Mainly oropharyngeal flora Nosocomial case – polymicrobial

Suppurative pneumonia – clinical features Symptoms

Cough with expectoration Pleural pain Sudden expectoration

Clinical signs Fever Systemic upset Clubbing Signs of consolidation, rub

Investigations Management

Pneumonia - immunocompromised

Etiology Defective phagocytosis Defective cell-mediated

immunity Defective antibody production

Clinical features Investigation Treatment

Pneumonitis

Radiation pneumonitis Chemical pneumonitis

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