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    Pneumonia: Anjitha Joseph

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    Pneumonia is an inflammation of the lungs that can have several causes. It affects millions worldwide and is a leading cause of death. There are different classifications of pneumonia including by site of lung involvement, causative agent, and method of acquisition. Common symptoms include fever, cough, and chest pain. Treatment involves antibiotics, oxygen therapy, and addressing complications. Prevention strategies focus on hand hygiene and infection control practices.

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    Pneumonia: Anjitha Joseph

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    38 views43 pages
    Pneumonia is an inflammation of the lungs that can have several causes. It affects millions worldwide and is a leading cause of death. There are different classifications of pneumonia including by site of lung involvement, causative agent, and method of acquisition. Common symptoms include fever, cough, and chest pain. Treatment involves antibiotics, oxygen therapy, and addressing complications. Prevention strategies focus on hand hygiene and infection control practices.

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    Pneumonia

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    Pneumonia

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    Pneumonia is an inflammation of the lungs that can have several causes. It affects millions worldwide and is a leading cause of death. There are different classifications of pneumonia including by site of lung involvement, causative agent, and method of acquisition. Common symptoms include fever, cough, and chest pain. Treatment involves antibiotics, oxygen therapy, and addressing complications. Prevention strategies focus on hand hygiene and infection control practices.

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    Download as pptx, pdf, or txt
    38 views43 pages

    Pneumonia: Anjitha Joseph

    Uploaded by

    anjitha
    Pneumonia is an inflammation of the lungs that can have several causes. It affects millions worldwide and is a leading cause of death. There are different classifications of pneumonia including by site of lung involvement, causative agent, and method of acquisition. Common symptoms include fever, cough, and chest pain. Treatment involves antibiotics, oxygen therapy, and addressing complications. Prevention strategies focus on hand hygiene and infection control practices.

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    of 43

    PNEUMONIA

    Anjitha Maria Joseph


    Definition:
    Pneumonia is defined as
    inflammation with
    exudative solidification of
    the lung parenchyma,
    generally acute.
    Epidemiology
    ●Each year, 5 million people
    die from pneumonia worldwide.
    ●Pneumonia is the ninth
    leading cause of death in the
    United States and the leading
    cause of infection related
    mortality
    ●Rates are greatest in
    children less than five and
    adults older than 75 years of
    age.
    ●It occurs about five times
    more frequently in the
    developing countries versus
    developed countries.
    CLASSIFICATION
    Classification by SITE
    Classification by AETIOLOGY
    Classification by MODE OF
    ACQUIRING PNEUMONIA
    1)Classification by Site
    ALVEOLARor LOBAR
    PNEUMONIA
    Lobar pneumonia is a form of
    pneumonia characterized by
    inflammatory exudate within the intra-
    alveolar space resulting in
    consolidation that affects a large and
    continuous area of the lobe of a lung.
    BRONCHOPNEUMONIA
    Inflammation is restricted to the
    conducting airways,especially
    terminal and respiratory
    bronchioles.
    INTERSTITIAL PNEUMONIA
    The inflammation is confined to
    interalveolar septa.
    There is infiltration of
    lymohocytes, macrophages,and
    plasma cells into the alveolar
    septa.
    Radiographically it gives a
    reticular pattern
    2)Classification by AETIOLOGY
    PRIMARY PNEUMONIA
    ●Caused by a specific
    pathogenic organism
    ●There is no pre-existing
    abnormality of the
    respiratory system.
    COMMON AETIOLOGICAL AGENTS LESS COMMON ATEIOLOGICAL AGENTS

    Streptococcus pneumonia Klebsiella pneumonia


    (most common)
    Haemophilus influenzae Streptococcus pyogenes
    Staphylococcus aureus Pseudomonas aerugnosa
    Legionella pneumophila Clamidophila pneumoniae
    Moraxella catarrhalis VIRUSES:H1N1 Influenza
    vIrus,corona virus producing
    SARS,Respiratory syncytial virus
    Fungi:Histoplasma
    capsulatum,Cryptococus
    SECONDARY PNEUMONIA
     Characterised by absence of any
    specific pathogenic organism in
    sputum and presence of some pre-
    existing abnormality of respiratory
    system.
     ASPIRATION of pus from infected nasal
    sinuses.
     Ineffective coughing
     Partial bronchial obstruction(eg:by
    tumour)
    SUPPURATIVE PNEUMONIA (NECROTISING
    PNEUMONIA)
     Main causative organisms are
    Staphylococcus aureus ,Klebsiella
    pneumonia, and occasionally
    H.influenza.
     Prominent features are destruction
    of lung tissue by inflammation
    ,abscess formation and subsequent
    development of fibrosis.
    3)Classification by mode of
    acquiring pneumonia
    ●Community-Acquired
    Pneumonia(CAP)
    ●Health care-associated
    Pneumonia(HCAP)
    ●Pneumonia in
    immunocompromised host
    ●Hospital Acquired Pneumonia(HAP)
    ●Ventilated Associated
    Pneumonia(VAP)
    Community-Acquired
    Pneumonia(CAP)
    It is defined as acute
    pulmonary infection in a
    patient who is not hospitalised
    or living in a long-term care
    facility 14 or more days before
    presentation and does not meet
    the criteria for HCAP.
    Types of CAP:
    ACUTE
    Acute pneumonia presents with
    sudden onset over a few hours to
    several days.
    The clinical presentation may be
    typical or atypical, depending on
    the pathogen.
    TYPICAL ATYPICAL
    Streptococcus Legionella pneumophila
    pneumoniae
    Haemophilus influenzae Chlamydophila
    pneumoniae
    Moraxella catarrhalis Mycoplasma
    pneumoniae

    Staphylococcus aureus
    CHRONIC
    The onset of chronic pneumonia
    is more insidious, often with
    gradually escalating symptoms
    over days, weeks, or months.
    Causetive organisms:
    Mycobacterium tuberculosis
    Histoplasma capsulatum
    Blastomycosis dermatitidis
    Health care-associated
    Pneumonia(HCAP)
     Defined as infections occurring within 90
    days of a 2 day or longer hospitalisation,
    stay in a nursing home or long term care
    residence in last 30 days; within 30 days of
    receiving intravenous antibacterial therapy,
    chemotherapy or wound care or after a
    hospital or haemodialysis clinic visit;or in
    any patient in contact with any multidrug
    resistant pathogen
    Hospital Acquired
    Pneumonia(HAP)
    HAP is defined as an LRTI that
    develops in hospitalized patients
    more than 48 hours after
    admission and excludes
    community-acquired infections
    that are incubating at the time of
    admission.
     HAP is a common clinical problem and
    represents the second most common
    nosocomial infection in the United States,
    accounting for 15% to 22% of all such
    infections.
     Current estimates suggest that more than
    150,000 individuals develop HAP each year.
    HAP increases hospital length of stay 7 to 9
    days at an average incremental per-patient
    cost of $40,000.
    Ventilated Associated
    Pneumonia(VAP)
    VAP is defined as an LRTI
    that develops more than
    48 to 72 hours after
    endotracheal intubation
    Pneumonia in
    immunocompromised host
    ●Neutropenic patients
    ●HIV patients
    ●Malignancies
    ●Patients on
    mimmunouppressives
    PATHOGENESIS
    Six pathogenetic mechanisms may contribute to
    the developmentof pneumonia.
    Mechanism of Disease:
    1)Inhalation of aerosolized
    infectious particles
    Examples of Specific Infections:
    Tuberculosis
    Histoplasmosis
    Cryptococcosis
    Blastomycosis
    2) Aspiration of organisms
    colonizing the oropharynx
    Examples of Specific Infections:
     Community-acquired bacterial pneumonia
     Aspiration pneumonia
     Hospital-acquired pneumonia
     Ventilator-associated pneumonia
    3)Direct inoculation of organisms
    into the lower airway
     Hospital-acquired pneumonia
     Ventilator-associated pneumonia
    4)Spread of infection to the
    lungs from adjacent
    structures
     Amebicpneumonia from rupture of
    amebic liver abscess into the lung.
    5)Spread of infection to the lung
    through the blood
     Staphylococcus aureus pneumonia
    arising from right-sided bacterial
    endocarditis
    6) Reactivation of latent infection,
    usually resulting from
    immunosuppression
    ●Reactivation tuberculosis
    ●Cytomegalovirus
    Pathological Stages in development of
    Pneumonia
     1)STAGE OF CONGESTION
    Just congestion of vessels without alveolar
    exudation
     2)STAGE OF RED HEPATISATION
    Intra alveolar exudation especially with RBCs
     3)STAGE OF GREY HEPATISATION
    The exudation is of mainly WBCs with minimal
    RBCs
     4)STAGE OF RESOLUTION
    The exudate is removed or absorbed by
    macrophages and proteolytic enzymes
    CLINICAL FEATURES
    SUDDEN ONSET OF RIGORS
    FEVER
    PLEURITICCHEST PAIN
    COUGH PRODUCTIVE OF
    PURULENT SPUTUM
    HAEMOPTYSIS
    Extrapulmonary features:
    MYALGIA
    ARTHRALGIA
    HEADACHE
    MENTAL CONFUSION
    ABDOMINAL PAIN
    DIARRHOEA
    EXAMINATION:
     TACHYPNEA
     TACHYCARDIA
     INCREASED TACTILE AND VOCAL
    FERMITUS
     DULL PERCUSSION NOTE OVER THE
    AREA OF INFECTION
     CREPITATIONS
    INVESTIGATIONS
    ●Total and differential leucocyte count
    ●Blood culture
    ●Sputum stain and culture
    ●Serological and antigen detection tests
    ●ABG analysis
    ●Radiological studies
    ●PCR
    Lobar pneumonia caused by Streptococcus
    pneumoniae.
    A 36-year-old previously healthy woman presents
    with abrupt onset of fevers and shaking chills, cough
    productive of yellow sputum, and right-sided
    pleuritic chest pain. Chest
    radiograph reveals lobar consolidation. Sputum
    culture yields S. pneumoniae.
    DIFFERENTIAL DIAGNOSIS
     Pulmonary edema
    • Pulmonary infarction
    • Acute respiratory distress syndrome
    • Pulmonary hemorrhage
    • Lung cancer or metastatic cancer
    • Atelectasis
    • Drug reactions involving the lung
    • Pulmonary eosinophilia
    MANAGEMENT AND
    TREATMENT
    Criteria for risk stratification (CURB‐65)
     • Confusion
     • Urea >40mg/dl
     • Respiratory rate ≥30/min
     • Low blood pressure (diastolic blood pressure
    ≤60 mm Hg or systolic blood pressure <90
    mmHg)
     • Age ≥65 years
    MANAGEMENT
    ● General Measures:
    Check the AIRWAY BREATHING ana CIRCULATION
    ● OXYGEN THERAPY
    Correct Hypoxia
    ●maintain FLUID BALANCE
    Give IV fluids
    ●Treatment of Pleuritic chest pain
    using mild analgesics
    ●ANTIBIOTIC TREATMENT
    Major Classes of Antibiotics Used in
    the Treatment of Pneumonia
    Antibiotic Class REPRESENTATIVE DRUG

    PENCILLINS PENCILLIN G, AMPICILLIN

    UREIDOPENCILLINS PIPERACILLIN

    2nd generation cephalosporins CEFUROXIME

    3rd generation cephalosporins CEFTRIAXONE ,CEFOTAXIME

    QUNILONES LEVOFLOXACIN ,MOXIFLOXACIN

    MACROLIDES AZITHROMYCIN, ERYTHROMYCIN

    TETRACYCLINES DOXYCYCLINE

    Beta-lactam/beta-lactamase piperacillin/
    inhibitor combinations tazobactum
    COMPLICATIONS OF PNEUMONIA
     PLEURAL EFFUSION
     LUNG ABSCESS
     ARDS
     SEPSIS
     PNEUMOTHORAX
     EMPYEMA
    PREVENTION STRATEGIES OF
    NOSOCOMIAL PNEUMONIA
     Handwashing
     Isolation of patients with resistant organisms
     Infection control and surveillance
     Subglottic secretion aspiration
     Selective digestive decontamination
     Topical tracheobronchial antibiotics
    VAP BUNDLE
    The Ventilator Bundle contains four
    components:
     elevation of the head of the bed to 30-45
    degrees
     daily 'sedation vacation’ and daily
    assessment of readiness to extubate
     peptic ulcer disease prophylaxis
     and deep venous thrombosis prophylaxis

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