PNEUMONIA

Definition
Pneumonia is defined as acute inflammation of the lung parenchyma distal to the terminal bronchioles which consist of respiratory bronchiole, alveolar ducts, alveolar sacs and alveoli-Harsh Mohan

Incidence
Leading cause of mortality & morbidity in children below 5 years of age In developing countries pneumonia kills 3 million children every year

Etiologic classification
A. Bacterial: Streptococcus pneumonia, Staphylococcus, Streptococcus, H influenzae, Klebsiella, M tuberculosis, E coli B. Viral: Influenza, Measles, RSV, Chickenpox C. Mycoplasma: Mycoplasma pnemoniae D. Fungal: Coccidomycosis, Histoplasmosis, Blastomycosis E. Protozoal: Pneumocystis carinii, Toxoplasma gondii, Entameoba histolytica F. Rickettsial: Typhus G. Miscellaneous: Aspiration pneumonia( vomitus, amniotic fluid in newborn, drowning, foreign body, chemicals like kerosine oil), Loeffler puemonia, hypostatic pneumonia

Anatomic classification
A. Bronchopeumonia: patchy involvement of lungs B. Lobar: one or more lobes are involved C. Pneumonitis: alveoli or interstitial tissue between them is affected

Based on acquisition
a) Congenital b) Community acquired c) Hospital acquired

Based on chronicity
a) Acute b) Chronic

Predisposing factors
Immunodeficiency-PEM, HIV Congenital respiratory malformations-TEF, gastro esophageal reflux Congenital heart disease-VSD Defective clearance of airway secretion-cystic fibrosis Chronic pulmonary diseases-TB, bronchiectasis, asthma

Pathogenesis
1. 2. 3. 4. Inhalation Aspiration Hematogenous spread Direct spread

Pathophysiology
a) b) c) d) Congestion Red hepatization Gray hepatization Resolution

Clinical features
Sudden onset High fever, chills, cough, respiratory distress Active movements of the alae nasi, gruntimg expiration, lower coastal recession with some cyanosis Pleuritic chest pain Cough with rust coloured sputum(Pneumococcal pneumonia

Contd..
Nausea, vomiting, anorexia Diarrhoea Abdominal pain especially when lower lobes are chest signs of consolidation-diminished movements of affected side, involved