PNEUMONIA
DEFINITION:
Pneumonia is an acute inflammation of the lung parenchyma caused by a
microbial organism.
PREDISPOSING FACTORS:
Aging
Air Pollution
Altered consciousness (Alcoholism, head injury, seizures, anesthesia,
drug overdose, stroke)
Altered oropharyngeal flora
Chronic lung diseases, diabetes mellitus, heart disease, End-Stage Renal
Disease.
Debilitating illness
HIV infection
Immunosuppressive drugs
Malnutrition, Smoking, Tracheal Intubation
Upper Respiratory Tract Infection.
MODE OF ENTRY:
1. Aspiration Aspiration from the Nasopharynx or oropharynx.
2. Inhalation inhalation of microbes present in the air.
3. Haematogenous spread It is mainly from a primary infection
elsewhere in the body.
TYPES OF PNEUMONIA:
Community Acquired Pneumonia (CAP)
Hospital Acquired Pneumonia (HAP)
Ventilator Associated Pneumonia (VAP)
Health Care Associated Pneumonia (HCAP)
Community Acquired Pneumonia It is defined as the lower respiratory tract
infection of the lung parenchyma with onset in the community or during the
first 2 days of hospitalization.
Hospital Acquired Pneumonia It is defined as the pneumonia occurring 48
hours or longer after hospital admission and not incubating at the time of
hospitalization.
Ventilator Associated Pneumonia It refers to pneumonia that occurs more
than 48 to 72 hours after endotracheal intubation.
Health Care Associate Pneumonia It includes any patient with a new onset
of pneumonia was hospitalized in an acute care hospital for 2 or more days
within 90 days of the infection.
Fungal Pneumonia Fungi may also be a cause of pneumonia. Pneumocystitis
jiroveci is an opportunistic fungus rarely causes pneumonia in healthy one.
Aspiration Pneumonia It refers to the sequeale occurring from abnormal
entry secretions or substances into the lower airway. It usually follows
aspiration of material from the mouth or stomach into the trachea and
subsequently from the lungs.
Opportunistic Pneumonia Certain patients with altered immune response are
highly susceptible to respiratory infections such as protein-calorie malnutrition.
PATHOPHYSIOLOGY:
After the pneumococcus organisms reach the alveoli
There is an out pouring of fluid into the alveoli
CONGESTION
The organisms multiply in the serous fluid
The infection spread and interferes with lung function
There is a massive dilation of the capillaries
Alveoli is filled with organisms, neutrophils, RBCs
The lung appears red and granular
RED
HEPATIZATION
Lungs resembles similar to liver
Blood Flow decreases
Leukocytes and fibrin consolidate in affected part of lung
Complete resolution and healing occurs
CLINICAL MANIFESTATIONS:
Early:
Fever
GRAY
HEPATIZATION
RESOLUTION
Shaking chills
Shortness of breath
Productive cough
Purulent Sputum (Rust Colored Sputum)
Pleuritic chest pain.
Confusion and Stupor (elderly people)
Crackles sound (in physical examination)
Atypical :
Dry cough
Headache
Myalgias
Fatigue
Sore throat
Nausea
Vomitting
Diarrhoea
DIAGNOSTIC FEATURES:
1. History collection regarding the allergens, bad habits, chronic diseases.
2. Physical Examination Crackles sound on auscultation, dullness seen
during percussion, body temperature and skin turgor.
3. Chest X-Ray Shows a typical pattern and consolidation of the lobar or
segmental regions. Cavitary shadows suggest the presence of a
necrotizing infection with viruses.
4. Gram stain of Sputum it should be sent to laboratory for culture
before antibiotic therapy starts.
5. Arterial Blood Gases (ABG) It reveals hypoxemia [PaO2 < 80 mm hg]
hypercapnea [PaCo2 >45 mm hg] and acidosis.
6. Complete
Blood
Count
and
Routine
Blood
Chemistries
Leukocytosis is found in the majority of patients with bacterial
pneumonia [WBC > 15,000/ul with presence of immature neutrophils]
MANAGEMENT:
MEDICAL MANAGEMENT:
Administration of oxygen in order to treat the hypoxemia.
Administration of analgesics such as Brufen, NSAIDS to relieve the
chest pain for patient comfort.
Antipyretics such as aspirin, acetaminophen to restore the normal body
temperature.
During the febrile the patient activity should be restricted and rest should
be encouraged.
Amantadine (Symmetrel) and Rimantadine (Flumadine) are used with 48
houts
