PNEUMONIA

1 WASSIM MEHBOOBALI NOORANY

 INTRODUCTION

 inflammation of the substance of the lungs. An infection of the

lower respiratory tract that involves the airways and
parenchyma with consolidation of the alveolar spaces

 It is usually caused by bacteria

 Pneumonitis- lung inflammation +/- consolidation

 Defects in host defenses increase the risk of pneumonia.

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 CLASSIFICATION
2 ways: -by anatomic location
-by etiology
 By anatomic location
 Lobar/ typical pneumonia- localized to one or more lobes of the lung which are
completely consolidated.
 Atypical pneumonia describes patterns other than lobar pneumonia. Usually by
Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia pneumoniae and
Coxiella burnetii
 Bronchopneumonia- inflammation of the lung that is centered in the bronchioles and leads
to the production of a mucopurulent exudate that obstructs some of these small airways and
causes patchy consolidation of the adjacent lobules.
 Interstitial pneumonitis- inflammation of the interstitium (walls of the alveoli, the alveolar

sacs and ducts, and the bronchioles). Its characteristic of acute viral infections, but also may
be a chronic process.
 By aetiology
 Infections-bacterial, viral & fungal
 chemical causes- aspiration of vomit 3
 radiotherapy
 allergic mechanisms
 INFECTIOUS CAUSES
 Streptococcus pneumoniae
 Mycoplasma pneumoniae

 Chlamydia pneumoniae

 Chlamydia psittaci

 Staphylococcus aureus

 Legionella pneumophila

 Coxiella burnetii

 Influenza A virus (usually with a bacterial component)

 Haemophilus influenzae

 Cytomegalovirus

 Aspergillus fumigatus

 Pseudomonas aeruginosa

 Pneumocystis carinii

 Actinomyces israelii
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 Nocardia asteroides

 Anaerobic organisms
 PRECIPITATING FACTORS
 Strep pneumoniae -follows viral infxn with influenza/ parainfluenza.
 Hospitalized 'ill' patients -Gram-negative organisms.

 Cigarette smoking- invasive pneumococcal disease

 Alcohol excess.

 Bronchiectasis (e.g. in cystic fibrosis).

 Bronchial obstruction (e.g. carcinoma)

 Immunosuppression -Pneumocystis carinii, Mycobacterium avium-

intracellulare, cytomegalovirus.
 IV drug abuse - Staph. aureus infection.

 Inhalation from oesophageal obstruction -infection with anaerobes.

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 CLINICAL
 Fever- less in viral infection
 Tachypnea- rapid and shallow

 Dyspnea

 Chills

 Cough

 Malaise

 pleuritic chest pain

 rusty-coloured sputum

 Reduced chest movement on affected site

 retractions, and apprehension-difficulty breathing or shortness of breath,

 Wheezing/ stridor

 localized crackles and decreased breath sounds; a pleural effusion also has dullness
to percussion.
 In bacterial-WBC count is elevated (>20,000/mm3) with a predominance of 6
neutrophils; in viral- normal or elevated WBC with lymphocytosis
 Bacterial- ESR greater than 100 mm/h
 KENYAN PROTOCOL
Hx of cough or difficulty
breathing; ageyes
>60 days

yes
O2 satn < 90%
Cyanosis
Inability to drink/ b.feed for any wheeze
Very severe pneumonia
AVPU- <A consider asthma Oxygen
Grunting
Xpen/ genta
no
Head nodding
no
Lower chest wall indrawing Severe pneumonia
AVPU=noA
Benzyl penicillin
no
RR Pmeumonia
>/= 50- 2-11 MTHS CTX or if given
>/= 40- >/= 12 MTHS previously- high dose
no ampicillin 7

NO pneumonia
Probably UTI
 ASPIRATION PNEUMONIA/
MENDELSON'S SYNDROME
 Involves acute aspiration of gastric contents into the lungs.
 Caused by intense destructiveness of gastric acid

 Due to: -Tracheo-oesophageal fistula,

-periods of impaired consciousness

-in reflux oesophagitis with an oesophageal stricture
-in bulbar palsy.
 The most usual sites for spillage are the apical and posterior segments
of the right lower lobe.
 The persistent pneumonia is often due to anaerobes and it may
progress to lung abscess or even bronchiectasis.
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INVESTIGATIONS
 Chest X-ray-
 Bacterial-lobar consolidation and pleural effusion
 Viral- diffuse, streaky infiltrates of bronchopneumonia

 WBC-
 bacterial elevated (>20,000/mm3) with a predominance of
neutrophils;
 viral- normal or elevated WBC with lymphocytosis

 ESR- >100mm/ h in bacterial pneumonia

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 COMPLICATIONS

 Parapneumonic effusion- inflammatory fluid collect in adjacent

pleural space
 Empyema- purulent fluid in pleural space

 Pneumatocele- air dissection within lung tissue

 Bronchiectasis- dilated bronchi due to scarring of airway and lung

tissue
 Abscess- necrosis of lung tissue. Due to aspiration or infection
behind obstructed bronchus. A cavitary lesion with surrounding
parenchymal inflammation

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THE END

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