PNEUMONIA
Name
01 What is Pneumonia?
02 Types of Pneumonia
03 Risk Factors
Contents
04 Diagnosis
05 Treatment
06 Prevention
What is Pneumonia?
Definition
Inflammation of the lungs
Pneumonia is a common respiratory infection characterised by the
inflammation of the air sacs in one or both lungs.
These sacs may fill with pus or fluid, making it difficult to breathe.
The alveoli rather than the bronchioles or bronchi of infective
origin characterized by consolidation.
Consolidation is a pathological process in which the alveoli are
filled with a mixture of inflammatory exudate, bacteria and white
blood cells(pleural effusion) that on chest X-ray appear as an
opaque shadow in the normally clear lungs.
Pneumonia is one of the leading causes of death, affecting approximately 450
million people a year and occurring in every part of the world, particularly in
young children and elderly adults.
Prevalence Worldwide
As per the World Health Organization (WHO), pneumonia accounts for nearly
15% of all deaths among children under 5 years old, making it a significant
health concern.
The newborn lung is more vulnerable to bacterial and viral infections, and
neonatal pneumonia is a significant cause of morbidity and mortality
worldwide. Between 152,000 - 490,000 infants aged < 1 year die of pneumonia
annually.
PATHOPHYSIOLOGY
Causes
Bacterial Infection Viral Infection Fungal Infection
Common bacterial causes of
Viruses like influenza can lead to Fungal pneumonia is caused due to
pneumonia.
pneumonia. already existing chronic health issues
Streptococcus pneumonia is the
Coronavirus causes the flu and colds, or a weak immune system.
common type occurring in patients
which lead to pneumonia. The fungi causing it lie in the bird
with symptoms of flu or cold
viruses are common causes of the droppings or soil, varying depending
It affects the lobe and causes lobar
disease, especially in children below on the geographical factor.
pneumonia.
five years of age.
Clinical Features
Signs
Symptoms
Dull percussion note
Fever
Reduced breath sounds
Malaise
Bronchial breathing (transmission of
Cough (purulent sputum)
bronchial sounds to peripheries due to
Dyspnoea
consolidation)
Pleuritic pain
Coarse crepitations
Increased vocal fremitus (increased
transmission of ’99' through
consolidated lung)
Tachycardia
Hypotension
Confusion
Cyanosis
Risk factors
● Age over 65 yrs and under 5 yrs
● Smoking
● Chronic Diseases
● Weakened Immunity
● Malnutrition
● Lung disease
DIAGNOSIS
SPUTUM CULTURE :This is the mainstay of diagnosis for pneumococci and H influenza.
BLOOD CULTURE – frequently positive in pneumococcal pneumonia
THROAT / NASOPHARYNGEAL SWABS may be helpful in children or during an influenza epidemic
BLOOD INVESTIGATIONS
- If oxygen saturation is less than 92% mostly it shows compromised lung function and pneumonia should
be checked.
- WBC is usually marginally raised .
- C-reactive protein (CRP) is usually elevated)
- UECs and LFTs should also be checked.
CHEST XRAY :
In lobar pneumonia CXR reveals a homogenus opacity localized to the affected lobe or
segmemt.CXR may also identify complications eg. Effusion, empyema (pus-filled pockets that
develop in the pleural space.)
Types of Pneumonia
Anatomic classification
1.Lobar pneumonia
2.Multi-lobar pneumonia
3.Bronchial pneumonia
4.Interstitial pneumonia
Lobar Pneumonia
An infection involving a single lobe in which an
exudate homogenously fill the lobe and this exudate
can be visualized on radiograph.
Multilobar pneumonia
● It involves more than one lobe and often cause
more severe illness.
Broncial pneumonia
● It implies a patchy distribution of inflammation
involving more than one lobe. It is initial infection
of bronchi with extension into adjacent alveoli.
Interstitial pneumonia
● It involves connective tissue between alveoli and it
may be called interstitial pneumonitis. It also
involves fibrosis and inflammation.
Clinical classification
1. Community acquired pneumonia
2. Hospital acquired pneumonia
3. Aspiration pneumonia
4. Ventilator associated pneumonia
COMMUNITY ACQUIRED PNEUMONIA
• CAP is a pneumonia that is contracted in the community.
• It has as traditionally been divided into typical and atypical pneum onia.
Typical pneumonia
These tend to present with features 'typical' of pneumonia; a
productive cough, fever and pleuritic chest pain. Likely infecting
organisms include:
Streptococcus pneumoniae (most commonly)
Haemophilus influenzae
Moraxella catarrhalis
ATYPICAL PNEUMONIA
These tend to have a more insidious, subacute onset.
They often present with a combination of pulmonary and extrapulmonary symptoms.
Likely infecting organisms may be divided into nonzoonotic and zoonotic causes:
Nonzoonotic
•Mycoplasma pneumoniae
• Legionella pneumophila
•Chlamydophila pneumoniae
Zoonotic- Chlamydophila psittaci (psittacosis), Coxiella burnetii (Q fever), Francisella
tularensis (tularemia).
DIAGNOSIS CRITERIA
1.CONFUSION
2. UREA >7MMOL/L
3. RESPIRATORY RATE
Diagnosis...> 30/MIN
4. BP (< 90/60)
CURB- 65 SCORE
5. AGE > 65
SCORE 1 POINT FOR
EACH FEATURE
PRESENT
(CURB -65 SCORE)
(3 OR MORE)MANAGE AS
(0-1)LIKELY (2)CONSIDER HOSPITAL SEVERE PNEUMONIA IN
SUITABLE FOR SUPERVISED TREATMENT HOSPITAL
HOME TREATMENT MAY BE SHORT STAY ASSESS FOR ICU ESP IS
INPATIENT CURB-65
TREATMENT
MRSA RESISTANT CAP
If methicillin-resistant S aureus (MRSA) is suspected, vancomycin 15 mg/kg every 12 hours adjusted based
on levels or linezolid 600 mg every 12 hours should be added.
Risk factors for MRSA include hemoptysis, recent influenza, neutropenia, hemodialysis, and congestive heart
failure
If Pseudomonas is suspected, therapy is as follows:
Anti-pneumococcal and anti-pseudomonal beta-lactam (piperacillin/tazobactam 4.5 g every 6 hours, cefepime
2 g every 8 hours, ceftazidime 2 g every 8 hours, meropenem 1 g every 8 hours, or imipenem 500 mg every 6
hours).
In patients with severe penicillin allergy, aztreonam 2 g every 8 hours may be used instead of the beta-lactam
in the regimen listed above
SUPPORTIVE THERAPY
1. High concentrations (>35% ) of oxygen preferably humified should be given to all patients with tachypnea
,hypoxaemia, hypotension or acidosis aiming to keep SaO2 > 92% except in hypercapnia associated in
hypercapnia associated in COPD.
2. IV fluids are given in severe disease and in elderly or vomiting patients.
3. Consider analgesia for pleural pain and physiotherapy if cough is suppressed e.g due to pain
4. Refer to ICU if CURB score 4-5 and failing to respond to treatment, severe acidosis, progressive
hypercapnia, shock, depressed conscious level.
HOSPITAL ACQUIRED PNEUMONIA
- AKA Nosocomial pneumonia
- It is defined as a new episode of pneumonia occurring at least 2 days after admission to the hospital.
- The most important distinction between HAP and CAP is the difference in the spectrum of organisms with the
majority of HAP being caused BY GRAM NEGATIVE BACTERIA INCLUDING:
1. Escheriria coli
2. Pseudomonas aeruginosa
3. Kleibsiella spp.
PREDISPOSING FEATURES INCLUDE stroke, mechanical ventilation, chronic lung disease, recent surgery and
previous antibiotic exposure.
RISK FACTORS
TREATMENT
TREATMENT
CONT...
ASPIRATION PNEUMONIA
Aspiration is defined as the inhalation of either oropharyngeal or gastric contents into the lower airways, that
is, the act of taking foreign material into the lungs.
Aspiration of gastric acid causes a chemical pneumonitis which has also been called Mendelson syndrome.
Aspiration of bacteria from oral and pharyngeal areas causes aspiration pneumonia.
Aspiration pneumonias have typically been associated with patients who are unable to adequately protect their
airway, it may be seen in patients with:
• Reduced conscious level
• Neuromuscular disorders
• Oesophageal conditions
• Mechanical interventions such as endotracheal tubes.
TREATMENT
1. For patients without a toxic appearance, the antibiotic chosen should cover typical community-acquired
pathogens. Ceftriaxone plus azithromycin, levofloxacin, or moxifloxacin are appropriate choices
2. For patients with a toxic appearance or who were recently hospitalized, although community-acquired
pathogens are still the most common, gram-negative bacteria including Pseudomonas aeruginosa and
Klebsiella pneumoniae as well as methicillin-resistant S aureus (MRSA) must be covered.
Piperacillin/tazobactam or imipenem/cilastatin plus vancomycin would be appropriate.
3. The presence of chronic aspiration risks, putrid( rotting) discharge and necrotizing pneumonia should raise
the suspicion for anaerobic bacteria involvement and prompt consideration of adding clindamycin or
metronidazole to the antibiotic regimen.
4. The treatment of individuals with chemical pneumonitis should include maintenance of the airways and
clearance of secretions with tracheal suctioning, oxygen supplementation, and mechanical ventilation as
necessary
VENTILATOR ACQUIRED PNEUMONIA
Ventilator-associated pneumonia (VAP) is a lung
infection that develops in patients receiving
mechanical ventilation for 48 hours or longer, often
involving resistant bacteria and leading to increased
morbidity and mortality.
DIAGNOSIS
MANAGEMENT
PNEUMONIA IN CHILDREN
Supportive Therapy
Hospitalized Patients:
General Measures:
• Intravenous Fluids:
• Rest: • Oxygen Therapy:
• Hydration: • Mechanical Ventilation:
• Chest Physiotherapy: Techniques like postural
• Pain and Fever Relief:
drainage and percussion can help loosen and clear
• Avoid Smoking and Secondhand Smoke:
mucus from the lungs.
• Humidifier or Steam: • Bronchodilators:
• N-acetylcysteine: help thin mucus.
Case study
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