SECONDARY LOBULE

2. SECONDARY LOBULE

4. Normal lung histology Inflammatory Cells lsPneumonia

5. WHAT IS PNEUMONIA ?

6. Pneumonia: Definition • Syndrome • caused by acute infection, usually bacterial (may be non bacterial) • Involving lung parenchyma distal to terminal bronchioles • Characterized by clinical and/or radiographic signs of consolidation of a part or parts of one or both lungs.

7. What are symptoms of Pneumonia ?

9. Symptoms in Pneumonia • Cough • Fever • Shortness of Breath • Rapid Breathing • Confusion • Restlessness

10. What are signs of Pneumonia • General Inspection • Respiratory Inspection • Palpation • Percussion • Auscultation

11. Clinical Signs in Pneumonia • Fever • Tachycardia • Rapid Respiratory • Cyanosis in Severe cases • Signs of consolidation • Reduced movement • Dull Percussion sound • Bronchial Breathing and Crackles • My be signs of Pleurisy/ Pleural Effusion

12. Radiological Signs of Pneumonia What is the Hall Mark ?

13. Radiological Signs of Pneumonia What is the Hall Mark ? CONSOLIDATION AIRBRONCHOGRAM

14. What is this ?

15. Pneumonia of RUL

17. Classification of Pneumonias ??????

18. Classification of Pneumonia • According to Etiology • According to anatomical site • According to Clinical Settings

19. Classification of Pneumonia • According to Etiological agent

20. Classification of Pneumonia • According to Aetiological agent • Bacterial Pneumonia • Viral Pneumonia • Bacteria like & Ricketsial Pneumonia • Fungal Pneumonias • Parasitic Pneumonia • Chemical Pneumonia (lipoid pneumonia) • Physical Pneumonia (ionizing radiation)

21. Classification of Pneumonia • According to anatomical site • Lobar • Segmental • Sub-segmental • Lobular/ Bronchopneumonia/ Diffuse Pneumonia

22. Lobar Pneumonia of RUL

25. Segmental Pneumonia Right Upper lobe

27. Bronchopneumonia/ Diffuse Pneumonia

28. Classification of Pneumonia • According to Clinical Setting • Community acquired Pneumonia ( CAP) • Hospital acquired/Health care associated Pneumonia • Ventilator Associated Pneumonia (VAP) • Aspiration Pneumonia • Hypostatic Pneumonia • Pneumonia in immunocompromised host

29. “Community Acquired Pneumonia” Can U define ?

30. Community Acquired Pneumonia (CAP) Pneumonia that begins outside hospital or is diagnosed within 48 hours of admission in hospital in a patient who has not been hospitalized or residing in a long- term care facility for 14 days or more before the onset of symptoms

31. AETIOLOGY • No cause found in 40-60% of cases • In more than 20% cases, more than one organism • Bacteria are more commonly identified than viruses • Commonest Organisms • Streptpneumonaie • Mycoplasma • H influenza • Chlamydophillapneumonaie • MRSA • Respiratory Viruses

32. Which lobe is involved • What is the organism

33. 60 years old woman is brought to hospital in confusional state. She is febrile and short of breath. On auscultation there are few crackles in the mid zone bilaterally. She is anaemic. WBC count is 6X109. • Her chest x-ray is :

34. What is the diagnosis ?

35. Mycoplasma Pneumonia)

36. Legionella Pneumonia

37. RISK FACTORS FOR PNEUMONIA

38. RISK FACTORS FOR PNEUMONIA • COPD • Pulmonary Oedema • Altered consciousness • Recent Viral respiratory tract infection • Cigarette smoking • Alcohol • Bronchiectasis • Bronchial obstruction • Immunosupression • Intravenous drug abuse

39. How the organism reaches Lung ? • Inhalation of micro-organism • Aspiration of gastric content • Spread from contagious site • Hematological spread from distant site

40. Aspiration

42. What investigations will you carry out ?

43. INVESTIGATIONS • Blood Complete picture • Chest X Ray • Sputum Gram stain ? • Sputum Culture • Blood cultures • Urea, creatinine, electrolytes • Serological studies • Arterial blood gases (ABGs) in severe cases • Thoracocentesis if effusion is present

44. Serological tests • Pneumococcal antigen • Latex test on urine, sputum & serum • Mycoplasma antibodies (IgM & IgG) • Cold agglutinin in 50% cases • Legionella antibodies • Immunoflorescence test

45. MANAGEMENT OF PNEUMONIA Doctor should assess severity of the Pneumonia and should decide whether patient can be treated at home or in hospital

46. When to admit ? • Age > 65 y • Comorbid condition • Abnormal vital signs • RR >30 • BP < 90/60 • Temp > 101 • Altered mental status • Sepsis/ multiorgan dysfunction • Abnormal Lab findings • TLC < 4000 or > 30000 • Po2 ,60 PCO2 > 50 • Multi-lobe involvement or pleural effusion

48. 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

49. General Measures • Care of mouth and skin • Fluids • Cough Suppressants • Analgesics for pain • Antipyretics for fever • Oxygen