PNEUMONIA

PNEUMONIA

• Insults

• Tissue response

• Mode of spread

• Classification

• Causative agents

• Clinical features

• Complications

• Differential diagnosis

• Investigations

• Treatment

• Poor prognosis

• References

RISK FACTORS

• Viral>>>Staph.aureus, G-ve bacilli
• Cigarettes/C.O.P.D>>>Impair mucociliary

function & phagocytosis

• Alcohol
• Head trauma
• Anasthaesia
• C.N.S lesions>>>decreased conciousness,dec

gag reflex>>>>>>>>>>ASPIRATION

• Foreign body/ tumours>>>Impair bronchial

drainage>>>Infection

INSULTS

• Dec leucocytes/ dec Ig>>>Recurrent

Pneumonia

• Steroids/Immunosuppression>>>opportuni

stic infections

• Severely ill
   Ventillators
    I.C.U
    N.G tubes
   A/B
   Surgery>>>Nosocomial infections

TISSUE RESPONSE

. Strep. Pneumoniae/ H. Influenza:

lobar consolidation (NO tissue necrosis)

. Staph. Aureus/ G-ve bacilli:

Necrosis>>>cavitation (abcess), peribonchial

. Atypical: Viruses

Mycoplasma Pneumonia

Chlamydia Pneumonia/ Psittica

Legionella Pneumophila

Coxella Burnetti>>>>>>

Intrestitial, diff, bilateral

. Mycobacterium Tuberculosis/ Fungi:

Slow granulation.

CLASSIFICATION

• Community
• Nosocomial

• Radiological
• Microbiological

• Immunocompromized
• Aspiration
• Recurrent

COMMUNITY AQUIRED

PNEUMONIA

Increase in winter( viruses & close contact)

• Strep.pneumonia 60% (G + C)

• H.influenza 10% (G-CB) >C.O.P.D

• Moraxella Catarrhalis (G-C) >C.O.P.D

• ATYPICAL: Legionella pneumophila(G-B)
                          Mycoplasma pneumonia
                          Chlamydophila
                          Viruses

• Staph. Aureus & G-ve Bacilli>>> less common
Staph (influenza), Klebsiella & G-ve (alcohol)

HOSPITAL ACQUIRED

PNEUMONIA

• Second most common nosocomial

infection

• Very ill>>> Increased mortality
• Polymicrobial: G-B (pseudomonas,

Klebsiella, E.Coli)

                           Anaerobes
                           Staph. Aureus
   Pneumococci & others also

PNEUMONIA IN

IMMUNOCOMPROMIZED

Opportunistic organisms :
• Bact. : Nocardia/ Legionella
• Mycobacterium :M. Avium/

Intercellularae

• Viruses:CMV/ Herpes zoster
• Fungi: Candida/ Aspergillus
• Protozoa: Pneumocystis

carinii(Jeroveci)/ Toxoplasma gondii

CLINICAL FEATURES

• Symptoms: Fever, chills, cough,

haemoptysis, pleurisy, s.o.b, toxic.

• Examination: Consolidation.

VS. Atypical pneumonia.

COMPLICATIONS

• Hypoxia.
• Cardiopulmonary failure.
• Lung abcess.
• Empyema.
• Spread of infection.
• Lobar collapse
• Thromboembolism
• ARDS, renal failure, multiorgan failure

DIFFERENTIAL DIAGNOSIS

• Pulmonary infarction

• Tuberculosis

• Atelectasis

• Lung tumors

• Bronchiectasis

• Pulmonary oedema

• Hypersensitivity reactions: chemicals/ drugs

• Sarcoidosis

• Vasculitis

• Pulmonary hge

INVESTIGATIONS

• C.B.C: WBC/ differential
• C.X.R: consolidation/abcess/ effusion
• Sputum
• Pleural tap/ biopsy
• Bronchoscopy/ Lavage/ Biopsy
• ABG
• Bld. Culture
• Cold agglutinins
• Urinalysis