Pneumonia

Nikola Blažević

Mentor: A. Žmegač Horvat

- inflammation of the lungs caused by infection

- many different causes: bacteria, viruses, fungi, idiopathic

- damages ALVEOLI > exudate (fluid) > consolidates > lack of oxygen

NORMAL ALVEOLI

PNEUMONIA

1. Symptoms (dyspnea, cough)

2. Physical examination

3. X-ray (not always reliable)

4. Blood test (high white cell count >

inflammation)

5. Sputum cultures

6. CT (most reliable)

DIAGNOSIS

Prediction rule for the frequency of inflammation:

Temperature > 100 degrees F (37.8 degrees C)

Pulse > 100 beats/min

Crepitations

Decreased breath sounds

Absence of asthma

Probability of inflammation based on the number of findings:

5 findings - 84% to 91% probability

4 findings - 58% to 85%

3 findings - 35% to 51%

2 findings - 14% to 24%

1 finding - 5% to 9%

0 findings - 2% to 3%

COMBINED FINDINGS

Early classification schemes:

• Anatomical: 1. lobar pneumonia(streptoccocus or klebsiella pneumoniae)

2. multilobar pneumonia

3. interstitial pneumonia(viruses or atypical bacteria)

• Radiological

• Microbiological

Combined clinical classification:

1. ACUTE(less than three weeks duration)

- classic bacterial bronchopneumonia

- atypical(interstitial pneumonitis)

- aspiration pneumonia syndromes

2. CHRONIC

- non-infectious

- mycobacterial Streptococcus pneumoniae

- fungal

- bacterial infections caused by airway obstruction

Classification

Community-acquired pneumonia (CAP)

- in a person who has not recently been hospitalized!

- most common type of pneumonia

- home care, oral antibiotics

Most common cause of CAP H. influenzae

Streptococcus pneumoniae most common cause of CAP worldwide

viruses

atypical bacteria

Fourth most common cause of death in UK and sixth in US

Hospital-acquired pneumonia (nosocomial)

- acquired during or after hospitalization for another illness or

procedure, 72h latency time after admission

- 5% patients develop HAP

- more deadly

Microorganisms (more resistant):

• MRSA (methicillin-resistant Staphylococcus aureus)

• Pseudomonas

• Enterobacter

• Serratia

Risk factors :

• mechanical ventilation

• decreased amounts of stomach acid

• immune disturbances

• heart and lung diseases

• Severe acute respiratory syndrome (SARS)

• Bronchiolitis obliterans organizing pneumonia (BOOP)

• Eosinophilic pneumonia

• Aspiration pneumonia

• Dust pneumonia

SARS

- oral antibiotics, rest, lots of fluid!

- home care no hospitalization needed

- people with other medical problems and elderly hospitalization if pneumonia persists

Bacterial pneumonia treated with antibiotics:

- amoxicillin

- fluoroquinolones

- cephalosporins

- aminoglycosides

Viral pneumonia influenza A rimantadine , amantadine

Bacterial pn. resolves within 2 to 4 weeks

- 1/20 people with pneumococcal pneumonia die

- half of the people who develop MRSA on ventilator die

Viral pn. lasts longer than bacterial

Mycoplasmal pn. 4 to 6 weeks to resolve

- low mortality

• Vaccination H. influenzae and S. pneumoniae in the 1st year

- repeat after 5-10 years

• Abtibiotics Group B Streptococcus and Chlamydia trachomatis positive pregnant women

• Treating underlying illnesses (e.g. AIDS) can decrease the risk of pneumonia

• Smoking cigarette smoke interferes with many of the body's natural defenses against pneumonia

Thank You