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COMMUNITY ACQUIRED PNEUMONIA…..AN OVERVIEW

COMMUNITY ACQUIRED PNEUMONIA…..AN OVERVIEW. DR E. A. ODEGHE. OUTLINE. Introduction Aetiology Viral pneumonias Pathology Clinical features Examination findings Investigations Treatment Complications Poor prognostic factors Prevention. INTRODUCTION.

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COMMUNITY ACQUIRED PNEUMONIA…..AN OVERVIEW

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  1. COMMUNITY ACQUIRED PNEUMONIA…..AN OVERVIEW DR E. A. ODEGHE

  2. OUTLINE • Introduction • Aetiology • Viral pneumonias • Pathology • Clinical features • Examination findings • Investigations • Treatment • Complications • Poor prognostic factors • Prevention

  3. INTRODUCTION • Definition: inflammation of the lung parenchyma, which is characterized by consolidation of the affected part and a filling of the alveolar air spaces with exudate, inflammatory cells, and fibrin • Community acquired or Health care associated. • Lobar /Focal/ nonsegmental pneumonia • Multifocal/lobular (bronchopneumonia) • Interstitial (focal diffuse) • Important cause of morbidity and mortality worldwide. • Usually acquired through inhalation or aspiration of pulmonary pathogenic organisms into a lung segment or lobe; less common is the haematogenous route

  4. AETIOLOGY • Typical or atypical organisms • Typical organisms- commonest organisms are Strep. pneumoniae, H. influenzae, M. catarrhalis…account for approximately 85% of CAP cases. • Less common… S. aureus, E.coli, K. pneumoniae, S. faecalis

  5. AETIOLOGY… ATYPICAL ORGANISMS • Most common…Legionella species, Mycoplasma pneumoniae, Chlamydophila spp. • Less common… viruses (influenza virus, adenovirus, respiratory syncytial virus, human parainfluenza virus, measles, varicella zoster) mycobacteria, parasites

  6. VIRAL PNEUMONIAS • Can vary from a mild, self-limited illness to a life-threatening disease. • The commonest causes are influenza virus, respiratory syncytial virus, adenovirus, and parainfluenza virus. Less common are varicella-zoster virus and measles virus. • Routes include large-droplet spread over short distances, hand contact with contaminated skin and fomites with subsequent inoculation onto the nasal mucosa or conjunctiva, and small-particle aerosol spread

  7. PATHOLOGY • Pathogenesis of most viral pneumonias is not well known. • After contamination, viruses multiply in the epithelium of the upper airway, destroy respiratory cilia, cause disruption of the respiratory epithelium, clearing the way for bacterial infection • Severe pneumonias may result in extensive consolidation of the lungs • They also generally cause impairment of T cells, macrophages, and neutrophil function and thus increase risk of bacterial super-infection

  8. CLINICAL SYMPTOMS • Incubation period depends on the specific virus. • Symptoms: fever, chills, dry cough, rhinitis/rhinorrhoea, myalgias, headache, fatigue • Travel history is important. • With bacterial superinfection, symptoms last longer, cough becomes productive of sputum and the patients becomes more ill.

  9. EXAMINATION FINDINGS • Fever and/or chills • Cough • Tachypnoea and/or dyspnoea • Tachycardia or bradycardia • Wheezing/ Rhonchi • Crepitations • Dullness to percussion • Decreased breath sounds • Hypoxia

  10. INVESTIGATIONS • Full blood count: anaemia, leucocytosis (lymphocytosis or neutrophilia) • Sputum for microscopy, culture, sensitivity • Chest x-ray • Rapid antigen detection on nasal swabs by ELISA and immunofluorescence • Serologic tests • Gene amplification by RT-PCR • Blood culture • Examination of bronchoalveolar lavage samples • Viral culture of tissue from the respiratory tract, sputum, and samples obtained by nasopharyngeal washing, bronchoalveolar lavage • Lung biopsy for histopathologic studies and viral culture

  11. TREATMENT • General measures – Oxygen, bed rest, antipyretics, analgesics, fluids, respiratory isolation • Specific measures – mechanical ventilation if respiratory failure is present or impending, antibiotics (if infiltrate is seen on the chest radiograph)

  12. ANTIVIRAL AGENTS • Acyclovir for varicella or herpes pneumonia • Respiratory syncythial virus – ribavirin, immunoglobulin only for severe disease • Adenovirus – cidofovir • Parainfluenza virus – ribavirin • Influenza virus – Acyclovir, Oseltamivir, Zanamir 

  13. COMPLICATIONS • Complications of CAP include empyema, cavitation, precipitation of myocardial infarction or heart failure and overwhelming pneumococcal sepsis in asplenic/hyposplenic patients. • Viral pneumonias…Secondary bacterial infections, encephalitis, hepatitis

  14. POOR PROGNOSTIC FACTORS • Significant co-morbidity eg cardioresp disease • Increased respiratory rate • Hypotension • Fever • Anaemia • Hypoxia • Multilobar involvement • Immunosuppression eg asplenia/hyposlenia • Elderly patients • Virulent organisms.

  15. PREVENTION • INF…vaccination; zanamivir, oseltamivir, amantadine • RSV…RSV immunoglobulin, Palivizumab • Measles…intravenous Ig • VZV… VZV Ig

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