SECONDARY LOBULE

Normal lung histologyNormal lung histology Inflammatory Cells Inflammatory Cells lsPneumonialsPneumonia

WHAT IS PNEUMONIA ? WHAT IS PNEUMONIA ?

Pneumonia: DefinitionPneumonia: Definition

Syndrome Syndrome

caused by acute infection, usually bacterial (may be caused by acute infection, usually bacterial (may be

non bacterial)non bacterial)

Involving lung parenchyma distal to terminal Involving lung parenchyma distal to terminal

bronchioles bronchioles

Characterized by Characterized by clinicalclinical and/or and/or radiographic radiographic

signs signs of consolidation of a part or parts of one or of consolidation of a part or parts of one or

both lungs. both lungs.

What are symptoms of What are symptoms of Pneumonia ?Pneumonia ?

Symptoms in PneumoniaSymptoms in Pneumonia

CoughCoughFeverFeverShortness of BreathShortness of BreathRapid Breathing Rapid Breathing ConfusionConfusionRestlessnessRestlessness

What are signs of Pneumonia

General InspectionGeneral InspectionRespiratory InspectionRespiratory InspectionPalpationPalpationPercussionPercussionAuscultationAuscultation

Clinical Signs in PneumoniaClinical Signs in Pneumonia

FeverFever TachycardiaTachycardia Rapid Respiratory Rapid Respiratory Cyanosis in Severe casesCyanosis in Severe cases Signs of consolidationSigns of consolidation

Reduced movementReduced movement Dull Percussion sound Dull Percussion sound Bronchial Breathing and CracklesBronchial Breathing and Crackles

My be signs of Pleurisy/ Pleural EffusionMy be signs of Pleurisy/ Pleural Effusion

Radiological Signs of Radiological Signs of PneumoniaPneumonia

What is the Hall Mark ?What is the Hall Mark ?

Radiological Signs of Radiological Signs of PneumoniaPneumonia

What is the Hall Mark ?What is the Hall Mark ?

CONSOLIDATION CONSOLIDATION AIRBRONCHOGRAMAIRBRONCHOGRAM

What is this ?What is this ?

Pneumonia of RULPneumonia of RUL

Classification of Classification of PneumoniasPneumonias

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Classification of PneumoniaClassification of Pneumonia

According to Etiology According to Etiology

According to anatomical siteAccording to anatomical site

According to Clinical Settings According to Clinical Settings

Classification of Pneumonia Classification of Pneumonia

According to Etiological agent According to Etiological agent

Classification of Pneumonia Classification of Pneumonia

According to Aetiological agent According to Aetiological agent Bacterial PneumoniaBacterial Pneumonia Viral PneumoniaViral Pneumonia Bacteria like & Ricketsial PneumoniaBacteria like & Ricketsial Pneumonia Fungal PneumoniasFungal Pneumonias Parasitic PneumoniaParasitic Pneumonia Chemical Pneumonia (lipoid pneumonia)Chemical Pneumonia (lipoid pneumonia) Physical Pneumonia (ionizing radiation)Physical Pneumonia (ionizing radiation)

Classification of PneumoniaClassification of Pneumonia

According to anatomical siteAccording to anatomical site LobarLobar SegmentalSegmental Sub-segmentalSub-segmental Lobular/ Bronchopneumonia/ Diffuse Lobular/ Bronchopneumonia/ Diffuse

PneumoniaPneumonia

Lobar Pneumonia of RULLobar Pneumonia of RUL

Segmental Pneumonia Right Upper Segmental Pneumonia Right Upper lobelobe

Bronchopneumonia/ Diffuse Bronchopneumonia/ Diffuse PneumoniaPneumonia

Classification of PneumoniaClassification of Pneumonia

According to Clinical Setting According to Clinical Setting Community acquired Pneumonia ( CAP)Community acquired Pneumonia ( CAP) Hospital acquired/Health care associated Hospital acquired/Health care associated

PneumoniaPneumonia Ventilator Associated Pneumonia (VAP)Ventilator Associated Pneumonia (VAP) Aspiration PneumoniaAspiration Pneumonia Hypostatic PneumoniaHypostatic Pneumonia Pneumonia in immunocompromised hostPneumonia in immunocompromised host

““Community Acquired Community Acquired Pneumonia”Pneumonia”

Can U define ? Can U define ?

Community Acquired Community Acquired Pneumonia Pneumonia

(CAP)(CAP)Pneumonia Pneumonia

that begins outside hospital that begins outside hospital or is or is diagnosed diagnosed within 48 hours of admission within 48 hours of admission in hospitalin hospital

in a patient who has not been in a patient who has not been hospitalized hospitalized

or residing in a long- term care facility or residing in a long- term care facility for 14 days or more before the onset of for 14 days or more before the onset of

symptomssymptoms

AETIOLOGYAETIOLOGY No cause found in 40-60% of casesNo cause found in 40-60% of cases In more than 20% cases, more than one organismIn more than 20% cases, more than one organism Bacteria are more commonly identified than virusesBacteria are more commonly identified than viruses Commonest OrganismsCommonest Organisms

Strept pneumonaie Strept pneumonaie MycoplasmaMycoplasma H influenzaH influenza Chlamydophilla pneumonaie Chlamydophilla pneumonaie MRSAMRSA Respiratory VirusesRespiratory Viruses

Which lobe is involvedWhich lobe is involved What is the organismWhat is the organism

60 years old woman is brought to 60 years old woman is brought to hospital in confusional state. She is hospital in confusional state. She is febrile and short of breath. On febrile and short of breath. On auscultation there are few crackles in auscultation there are few crackles in the mid zone bilaterally.the mid zone bilaterally.

She is anaemic. WBC count is 6X10She is anaemic. WBC count is 6X109. 9.

Her chest x-ray is : Her chest x-ray is :

What is the diagnosis ?What is the diagnosis ?

Mycoplasma Pneumonia)Mycoplasma Pneumonia)

Legionella PneumoniaLegionella Pneumonia

RISK FACTORS FOR PNEUMONIARISK FACTORS FOR PNEUMONIA

RISK FACTORS FOR PNEUMONIARISK FACTORS FOR PNEUMONIA

COPDCOPD Pulmonary OedemaPulmonary Oedema Altered consciousnessAltered consciousness Recent Viral respiratory Recent Viral respiratory

tract infectiontract infection Cigarette smokingCigarette smoking AlcoholAlcohol BronchiectasisBronchiectasis Bronchial obstructionBronchial obstruction ImmunosupressionImmunosupression Intravenous drug abuseIntravenous drug abuse

How the organism reaches Lung ?How the organism reaches Lung ?

Inhalation of micro-organism Inhalation of micro-organism

Aspiration of gastric contentAspiration of gastric content

Spread from contagious siteSpread from contagious site

Hematological spread from distant Hematological spread from distant

sitesite

AspirationAspiration

What investigations will What investigations will you carry out ?you carry out ?

INVESTIGATIONSINVESTIGATIONS Blood Complete picture Blood Complete picture Chest X Ray Chest X Ray Sputum Gram stain ?Sputum Gram stain ? Sputum CultureSputum Culture Blood culturesBlood cultures Urea, creatinine, electrolytesUrea, creatinine, electrolytes Serological studiesSerological studies Arterial blood gases (ABGs) in severe Arterial blood gases (ABGs) in severe

casescases Thoracocentesis if effusion is presentThoracocentesis if effusion is present

Serological testsSerological tests

Pneumococcal antigenPneumococcal antigen Latex test on urine, sputum & serumLatex test on urine, sputum & serum

Mycoplasma antibodies (IgM & IgG)Mycoplasma antibodies (IgM & IgG) Cold agglutinin in 50% casesCold agglutinin in 50% cases

Legionella antibodiesLegionella antibodies Immunoflorescence testImmunoflorescence test

MANAGEMENT OF PNEUMONIA

Doctor should assess severity of the Pneumonia and should decide whether patient can be treated at

home or in hospital

When to admit ?When to admit ?

Age > 65 yAge > 65 y Comorbid conditionComorbid condition Abnormal vital signsAbnormal vital signs

RR >30RR >30 BP < 90/60BP < 90/60 Temp > 101Temp > 101

Altered mental statusAltered mental status Sepsis/ multiorgan dysfunctionSepsis/ multiorgan dysfunction Abnormal Lab findingsAbnormal Lab findings

TLC < 4000 or > 30000TLC < 4000 or > 30000 Po2 ,60 PCO2 > 50Po2 ,60 PCO2 > 50 Multi-lobe involvement or pleural effusionMulti-lobe involvement or pleural effusion

Confusion Urea level (>19 mmol/L) Respiratory rate (>30 b/m) Blood Pressure SBP<90 mmHg or DBP <60 mmHg Age >65 yrs

Excellent indicator for mortality

General MeasuresGeneral Measures

Care of mouth and skinCare of mouth and skinFluidsFluidsCough Suppressants Cough Suppressants Analgesics for painAnalgesics for painAntipyretics for feverAntipyretics for feverOxygenOxygen

DURATION OF TREATMENTDURATION OF TREATMENT

Influnced by severity of illness, the agent, Influnced by severity of illness, the agent, responsible, and other medical problemsresponsible, and other medical problems

For Strept Pneumonia: treat for 72 hours For Strept Pneumonia: treat for 72 hours after the patient is afebrileafter the patient is afebrile

For S aureus and Psudomonas, klebsiella, For S aureus and Psudomonas, klebsiella, anaerobes, mycoplasma, legionella: two anaerobes, mycoplasma, legionella: two weeks at leastweeks at least

Lung AbcessLung Abcess EmpyemaEmpyema

COMPLICATIONS OF PNEUMONIA COMPLICATIONS OF PNEUMONIA

Parapneumonic effusionParapneumonic effusionEmpyemaEmpyemaSepsisSepsisARDSARDSLung abcessLung abcessFocal BronchiectasisFocal Bronchiectasis

PREVENTION OF PNEUMONIAPREVENTION OF PNEUMONIA Polyvalent pneumococcal vaccine Influenza vaccine Smoking Cessation Alcohol cassation

ThanksThanks

AETIOLOGYAETIOLOGY BACTERIAL

Streptococcus Pneumoniae

2/3rd of case > 30% Haemophilus influenzae Klebsiella Pneumoniae Staphylococcus aureus Moraxella catarrhalis

Atypical Bacterial Mycoplasma

pneumoniae (9%) Chlamydia pneumoniae

(10%) Legionella Pneumoniae Coxeilla burneti

AETIOLOGYAETIOLOGY

ViralViral Influenza A & BInfluenza A & B AdenovirusAdenovirus VaricellaVaricella Respiratry syncytial Respiratry syncytial

virus virus MeaslesMeasles Parainfluenza VirusParainfluenza Virus CMVCMV Corona VirusCorona Virus Coxsackie virusCoxsackie virus Rhino virusRhino virus

BACTERIALBACTERIAL Streptococcus Streptococcus

PneumoniaePneumoniae 2/32/3rdrd of case of case

Haemophilus influenzaeHaemophilus influenzae Klebsiella PneumoniaeKlebsiella Pneumoniae Staphylococcus aureusStaphylococcus aureus Moraxella catarhalisMoraxella catarhalis

Atypical BacterialAtypical Bacterial Mycoplasma pneumoniaeMycoplasma pneumoniae Chlamydia pneumoniaeChlamydia pneumoniae Legionella PneumoniaeLegionella Pneumoniae Coxeilla burnetiCoxeilla burneti

Hospital Acquired PneumoniaHospital Acquired Pneumonia

Two days after hospital admissionTwo days after hospital admission EtiologyEtiology

Gram negative bacteriaGram negative bacteria Staphylococcal aureusStaphylococcal aureus Anaerobic organismsAnaerobic organisms Lobar pneumonia causing organismsLobar pneumonia causing organisms

Staphylococcal Staphylococcal

Aetiological agents• Pneumocystis carinii• Pseudomonas aeroginosa• Aspergillus fumigatus• Cytomegalovirus• Herpesviruses• Mycobacterium

tuberculosis

Pneumonia in immunocompromised Pneumonia in immunocompromised hosthost