- inflammation of the lungs caused by infection
- many different causes: bacteria, viruses, fungi, idiopathic
- damages ALVEOLI > exudate (fluid) > consolidates > lack of oxygen
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