Pneumonia

Pneumonia is defined as an inflammatory disease of the terminal airways and pulmonary interstitium. It is
important to recognize that pneumonia has many etiologies. Too often, the term “pneumonia” is used
inappropriately as a synonym for bacterial pneumonia, and clinical findings indicative of pneumonia are
erroneously ascribed to bacterial infection. Infectious agents that may cause pneumonia include bacteria
(including rickettsial agents), viruses (canine distemper virus, canine influenza virus, CAV-2, canine PIV,
feline herpesvirus, feline calicivirus), protozoa (Toxoplasma, Neospora), respiratory parasites
(Paragonimus, Aelurostrongylus, Filaroides), and fungi (Blastomyces, Histoplasma, Coccidioides,
Aspergillus, Cryptococcus, and Pneumocystis).
Some viral agents predispose to secondary bacterial pneumonia (canine distemper virus, canine PIV,
FeLV, and FIV). Noninfectious forms of pneumonia include aspiration pneumonia, pneumonia secondary
to smoke inhalation, and lipid pneumonia (exogenous lipid pneumonia from aspiration of fatty substances
or endogenous lipid pneumonia related to lipid release from breakdown of pulmonary tissues).
Appropriate treatment of pneumonia requires identification of the specific etiology, including identification
of specific organisms and their antimicrobial sensitivities in bacterial disease.
Bacterial pneumonia is considered a secondary condition that is established following some other
pathological insult that impairs the natural defense mechanisms of the lung. Infection is usually
associated with resident respiratory flora, although hematogenous spread is another potential source of
bacteria (Enterococcus), and most cases of pneumonia involve more than one bacterial agent
(polymicrobial). Common agents include Streptococcus, Staphylococcus, E. coli, Pasteurella, Klebsiella
Pseudomonas, Bordetella, and Mycoplasma. Samples for bacterial culture and sensitivity can be
collected by TTW, BAL, or lung aspirate. Empiric antibacterial therapy using broad-spectrum drugs with
good respiratory distribution should be initiated pending culture results. A combination of (1) an
aminopenicillin or a first-generation cephalosporin and (2) a fluoroquinolone or an aminoglycoside
provides a rational empiric choice. Parenteral administration of drugs is advised for patients with severe
hypoxemia that may secondarily impair gut function and absorption of orally administered drugs. Aerosol
administration of antibiotics is not recommended. Response to treatment is monitored by sequential
thoracic radiographs ± ABG determination and antibacterial drugs are continued until 1–2 weeks past
resolution of clinical and radiographic evidence of disease.
Other forms of infectious pneumonia are also treated as indicated for the specific causative agent (i.e.,
long-term [months] administration of oral antifungal drugs with or without a course of injectable antifungal
drug for fungal pneumonia; clindamycin or trimethoprim–sulfa with or without pyrimethamine for protozoal
pneumonia). Patients with infectious or noninfectious pneumonia will often require general treatment
measures such as oxygen supplementation, fluid therapy, nebulization, and coupage. Use of
bronchodilators and mucolytics in the treatment of pneumonia is controversial.

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