pneumonia

PNEUMONIA
INTRODUCTION
INTRODUCTION :-
It is an inflammation of the lung parenchyma including terminal airways, alveolar
and interstitial spaces & is localized or patchy in distribution caused by various
organism.
The alveoli are filled with a fluid or pus making it difficult to breath.
• Consolidation :-
It is inflammatory induration of normal lung due to presence of cellular exudate in
alveoli.
ETIOLOGY
1)Age –All ages but 50% cases are below 50 yrs of age.
2) Season- common in winter & rainy season.
3) Devitalising conditions eg, overwork, exposure to extreme chill & cold.
4) Disorders like DM, chronic malnutrition and chronic avitaminosis.
5) Addiction to Alcohol or smoking.
6) Overcrowding & poor sanitary condition.
7) Acute & chronic respiratory diseases such as influenza, chronic bronchitis, bronchiectasis,
cystic fibrosis.
8) Immunological disorders such as in Leukemias, Multiple myeloma, Granulomatosis.
9) Inhalation of foreign materials as in coma, anaesthesia, achalasia cardia & oesophageal
carcinoma.
10) Drugs – steroids, cytotoxins & immunosuppressive drugs.
PATHOGENESIS
Entry of bacteria in the lung occurs by one of the following
rute
1. Inhalation of microbes from the air
2. aspiration of organisms from oropharynx /
nasopharynx
3. Hematogenous spread from distant focus the infection
4. Direct spread from adjoining site of infection
 After entry the organism passes to alveoli And alveolar
inflammation proceeds. The organism and exudates Pass to
surrounded alveoli Through the intralveolar pores (Pores of
cuhn). Thus infection quickly spreads Throughout the entire
lobe.
 The essential feature is And outpouring of inflammatory
exudates In the Alveoli. The alveoli are then fill up with
exudates And the air is displaced And the whole lobe is
converted into airless swollen solid mass.This process is
known as consolidation.
PATHOLOGICAL
CHANGES
 Lobar pneumonia is divided into 4 pathological changes

1. Stage of congestion
2. Stage of red hepatisation / early consolidation
3. Stage of grey hepatisation / late consolidation
4. Stage of resolution
• Stage of congestion
It shows early inflammatory response to bacterial infection in form of extreme
congestion and serofibrinous exudates
• Red hepatisation = early consolidation
The affected lobe is red, firm And consolidated. Cut surface is airless, red
pink, dry granular And has liver like consistency. Serofibrinous pleurisy occurs with
this stage.
• Gray hepatisation
The affected lobe is firm and heavy. The cut surface is dry and granular,
gray and liver like in consistency
Fibrinous pleurisy is seen.
• Resolution
The solid fibrinous exudates Liquified by enzymes Which restores normal
aeration in the affected lobe (Softening and fibrinous exudates being centrally
spread to the Periphery)
cut surface is gray red or direct brown and frothy, yellow creamy fluid Can
be expressed on pressing.
CLASSIFICATION
According to causative
agent
Bacterial = Streptococcus Parasite = Entamoeba hystolytica
pneumoniae Pneumocystic carinii
Staph aureus Fungal = Candida albincans
klebsialla pnuemonae Actinomycosis
Chlamydia Hystoplasma capsulatum
Viral = adenovirus Aspergellus niger
Measles Ricketsial
Picorna virus
Myxovirus
According to Site of involvement
Lobar pnuemonia
large segment of pulmonary lobe is involved
There may be only one lobe or a part of lobe is involved
It occurs in 20% of cases
Bronchopnemonia / lobular pneumonia
It begins in terminal bronchioles And scattered in air sacs
throughout the lungs
It can infect the whole lung
Interstitial pnuemonia
It affects alveolar wall (Interstitium)
It is seen in 10% of cases
According to clinical classification
Community acquired pneumonia
It is type of pneumonia which is acquired In community settings In subject with no recent or regular exposure to The healthcare
system
Hospital acquired pneumonia

Pnuemonia acquires within 48 hrs after admission to hospital which has not incubating at time of hospitalization
It is further classified as = ICU HAP
NON ICU HAP
Ventilator associated pnuemonia
Pneumonia that occurs more than 48-72 hrs After the endotracheal intubation
Infection of airways rather than Pulmonary parenchyma
Aspiration pneumonia
This results from Aspiration of gastric or Oesophageal contents as in cases of pyloric obstruction, achalsia or Oesophageal
carcinoma
Health care associated pneumonia

It includes any patient who received recent antibiotic therapy, chemotherapy or wound care within past 30 days of current
infection, attended a hospital hemodialysis clinic and pt. who has extensive health care contacts.
CLINICAL FEATURES
SYMPTOMS
- Continuous temperature of 103-104°F Associated with chills
- Pain in rt chest In about 70% of cases due to associated pleurisy
- If diaphragmatic pleura affected There may be shoulder pain
- Difficulty in breathing, cough with tenacious sputum, gradually rusty or pinkish due
to presence of RBC
- Headache due to hypoxia
- Malaise, weakness, bodyache, loss of appetite, fatigue, Wt loss, in severe cases
delirium, And confusion may develop due to toxemia
- Excessive sweating in elderly patients
SIGNS
- Pt is toxic with flushed face
- Central cyanosis may be present
- Tachycardia, Tachypnea
- Skin is Hot and Moist
- Pallor may present sometimes Due to peripheral
vasoconstriction
INVESTIGATIONS
Chest X-ray
1.
Shows areas of consolidation, infiltration, or cavitation in the lungs.

2. Complete Blood Count (CBC)
May show elevated white blood cell count, indicating infection.
3. Blood Cultures
May be positive for bacteria, such as Streptococcus pneumoniae or Haemophilus influenzae.
4. Sputum Gram Stain
May show presence of bacteria, such as Streptococcus pneumoniae or Klebsiela pneumoniae.
5. Pulse Oximetry
May show decreased oxygen saturation.
6. CT Scan
May show more detailed images of the lungs, including areas of consolidation or cavitation.
DIFFERENTIAL DIAGNOSIS
1. Bronchitis
Inflammation of the bronchial tubes, which may present with similar symptoms to pneumonia.
2. Asthma
A chronic respiratory disease characterized by inflammation, airway obstruction, and spasm of the bronchial tubes.
3. Chronic Obstructive Pulmonary Disease (COPD)
A progressive lung disease characterized by chronic inflammation and airflow limitation.
4. Pulmonary Embolism
A blockage of an artery in the lungs, which may present with similar symptoms to pneumonia.
5. Tuberculosis
A bacterial infection that primarily affects the lungs, which may present with similar symptoms to pneumonia.
6. Pneumonitis
Inflammation of the lung tissue, which may be caused by infection, radiation, or chemicals.
7. Lung Cancer
A malignant tumor that originates in the lungs, which may present with similar symptoms to pneumonia.
8. Cystic Fibrosis
A genetic disorder that affects the respiratory, digestive, and reproductive systems, which may present with similar symptoms to
pneumonia.
COMPLICATIONS
 Complications
may develop in the complicated cases And in patients with Impaired
immunologic defenses
1) organisation
- In about 3% of cases Resolution of the exudate does not occur but instead it undergoes
organization
- There is ingrowth of fibroblast from alveolar septa resulting in fibrous, tough leathery
lung tissue.
- This type of post pneumonic fibrosis is called calcification.
2) pleural effusion
- About 5% of treated cases of pnuemonia develop inflammation of pleura with effusion.
- The pleural effusion usually resolves but sometimes may undergo organisation with
fibrous adhesions between visceral and parietal pleura.
3) Empyema
- Less than 1% of treated cases of pneumonia develop encysted pus in the
pleural cavity termed empyema
4) Lung abscess
- A rare complication of pnuemonia is formation of lung abscess especially when
there is secondary infection by other organisms
5) Metastatic infection
- Infection in the lungs and pleural cavity in pneumonia extended into the
pericardium and heart causing purulent pericarditis, bacterial endocarditis and
myocarditis
TREATMENT
 GENERAL MEASURES
1. IV fluids
2. Oxygen
3. Addition of bronchodilators and Mucolytics may enhance Sputum
clearance
4. Physiotherapy to teach effective Coughing technique
5. Mechanical ventilation may be required in patients with
Respiratory failure
HOMOEOPATHIC
THERAPEUTICS
1)Antimonium Tart:
This is useful for chest congestion and persistent cough with mucus. It helps clear
the airways and supports easier breathing.
2)Phosphorus:
Effective for dry cough and difficulty breathing, especially when there is blood in
phlegm. Phosphorus helps strengthen lung tissue.
3)Bryonia Alba:
Recommended for chest pain that worsens with movement or deep breathing.
Bryonia alleviates inflammation and supports lung health.
4)Arsenicum Album:
Known for treating respiratory infections with fever, restlessness, and
breath discomfort.
5)Kali Carb:
Useful for severe chest congestion and sharp chest pain, particularly when
breathing is shallow and labored.
6)Hepar Sulphur:
Ideal for infections with purulent phlegm, Hepar Sulphur reduces mucus
and ea lung irritation.
PREVENTION
1) Get vaccinated
2) Practice good hygiene
3) avoid people who are sick
4) cover your mouth and nose
5) Quiet smoking
6) Eat healthy diet and get regular physical activity

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PNEUMONIA

 Lobar pneumonia is divided into 4 pathological changes

Hospital acquired pneumonia

Health care associated pneumonia

Shows areas of consolidation, infiltration, or cavitation in the lungs.

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