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Pneumonia 2
0 It is the most common infectious cause of death.
Pneumonia 3
EPIDEMIOLOGY
Pneumonia 5
Etiology
Potential etiologic agents in CAP - Bacteria
Viruses
Fungi
Protozoa
Pneumonia 7
Atypical bacterial pathogens
0 Mycoplasma pneumoniae
0 Chlamydophila pneumoniae
0 Legionella pneumophillia
0 These organisms are intrinsically resistant to all - B
lactam agents macrolide, a fluoroquinolone, or a
tetracycline.
0 Poor dental hygiene-anaerobes
0 HIV- p.carnii
0 Birds- Chlamydia psittaci
0 Cattle or parturient cat-Coxiella burnetti
Pneumonia 8
CLASSIFICATION
Classified based on two types
Base on Location Type
0 Lobar pneumonia
0 Bronchopneumonia
Environmental Type
0 Community- acquired pneumonia (CAP)
0 Hospital-acquired pneumonia (HAP)
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Lobar pneumonia
0 Lobar pneumonia is acute bacterial infection of a
part of lobe the entire lobe, or even two lobes of
one or both the lungs.
Pneumonia 10
Bronchopneumonia
0 Bronchopneumonia is infection of the terminal
bronchioles that extends into the surrounding
alveoli resulting in patchy consolidation of the
lung.
Pneumonia 11
Community Acquired
Pneumonia (CAP)
Pneumonia which develops in an otherwise
healthy person outside of hospital or have
been in hospital for less than 48hrs
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Nosocomial pneumonia
(HAP)
Pneumonia that was not incubating upon
admission developing in a patient
hospitalized for greater than 48 hrs.
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PATHOPHYSIOLOGY
Microbial invasion of the normally sterile lower
respiratory tract
Three routes-
0 Inhaled as aerosolized particles
0 Haematogenous spread from an extrapulmonary
site of infection
0 Aspiration of oropharyngeal contents
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Defence mechanisms that
protects lung from infection
0 Anatomic barriers –epiglottis, larynx
0 Cough reflexes
0 Tracheobronchial secretions
0 Mucocilliary lining
0 Cell & humoral mediated immunity
0 Dual phagocytic system-alveolar macrophages &
neutrophils
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Invasion occurs as a result of
0 Defect in host defence mechanism
0 Overwhelming inocculum
0 Lung infection with viruses suppress the
antibacterial activity of the lung by
impairing alveolar macrophage function &
mucocilliary clearance thus setting the
stage for secondary bacterial pneumonia.
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Clinical Manifestations
0 Indolent to fulminant in presentation
0 Mild to fatal in severity
0 Typical symptoms –
Fever
Chills
Cough
Rust coloured sputum
Mucopurulent sputum
Dyspnea ( shortness of breath)
Pleuritic chest pain
0 Elevated WBC
0 Bacteraemic Pneumonia 17
Chest X-ray
For Lobar Pneumonia
Consolidation
confined to
one or more
lobes (or
segments of
lobes) of
lungs.
Lobarpneumonia
Pneumonia 18
Chest X-ray
For Bronchopneumonia
•Patchy
consolidation
usually in the
bases of both
lungs.
Bronchopneumonia
Pneumonia 19
Diagnosis
Clinical diagnosis
0 History
0 Signs & symptoms
0 Chest x-ray
0 CT-Scan
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Diagnosis
Etiological diagnosis
0 Gram's Stain and Culture of Sputum
0 Blood Cultures
0 Antigen Tests
0 Polymerase Chain Reaction
0 Serology
0 Bronchoalveolar lavage
0 Bronchoscopy
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Complications
Pneumonia 22
COMMUNITY ACQUIRED
PNEUMONIA
Pneumonia is most common in winter because of
seasonal increase in viral infections
Mortality
1%- Non hospitalized patients
13.7%-Hospiatalized patients
19.6%-Bacteremic patients
<36.5%- Intensive care unit
Pneumonia 23
HOSPITAL ACQUIRED
PNEUMONIA
0 Pneumonia that was not incubating upon admission
developing in a patient hospitalized for greater than 48
hrs
Pneumonia 24
Predisposing features
Reduced host defence against bacteria
0 Reduced immune defences (Corticosteroid treatment,
diabetes, malignancy)
0 Reduced cough reflux (Post operative)
0 Disordered mucocilliary clearance (Anaesthetic agents)
Aspiration of nasopharyngeal or gastric secretions
0 Immobility or reduced conscious level
0 Vomiting, Dysphagia,
0 Nasogastric intubation
Pneumonia 25
0 Most bacterial nosocomial infection occur by
microaspiration of bacteria colonizing the
patients oropharynx or upper GI tract
0 Most common pathogen – Aerobic gram
negative bacilli
0 Most commonly exposed to multiresistant
hospital pathogen
0 86% nosocomial infection-mechanical
ventilation
0 Mortality-0 to 50%
Pneumonia 26
Bacterial introduction into LRT
Endotracheal intubation
Infected ventillatiors / nebuliser /bronchoscopy
Dental or sinus infection
Bacteraemia
Abdominal sepsis
Intravenous canula
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Causative organisms
Common organisms
Gram negative bacteria-
0 Escherichia coli
0 Klebsiella sp.
0 Pseudomonas aeruginosa
Gram positive bacteria-
0 Streptococcus pneumoniae
0 Staphylococcus aureus
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Treatment
Goals of therapy-
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General approach to treatment
0 Adequacy of respiratory function
0 Humidified oxygen for hypoxemia
0 Bronchodilators (albuterol)
0 Chest physiotherapy with postural drainage
0 Adequate hydration if necessary
0 Expectorants such as guaifenesin
0 Chest pain- analgesics
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Selection of an antimicrobial
agent
0 Empirical use of relatively broad spectrum antibiotic
0 Narrow spectrum antibiotics to cover specific
pathogen
0 Potential pathogens involved
0 Age
0 Previous ¤t medication history
0 Underlying disease
0 Present clinical status
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Antibiotic doses for treating pneumonia
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Treatment for special cases
1. Patient less than 60 years & without comorbidities:-
Azithromycine ( 500mg OD) *1day
( 250mg OD) *4days
Norfloxacin/Levofloxacin (400mg OD) *7days
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5. Patient hospitalised & severely ill:-
Combination of 3rd gen cefalosporins + Macrolides
Ceftriaxone + Azithromycin
and newer fluroquinolones (Gatifloxacin)
We can add Vancomycin.
6. Patient with icu admission:-
3rd gen cefalosporins + Fluroquinolones
(Gatifloxacin)
+
Nutritional supplements + Saline
Vancomycin/Meropenam
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7. For HAP:-
Cephalosporins + Aminoglycocides
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Drugs with usual doses
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