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Pneumonia

Pneumonia. Andriy Lepyavko, MD, PhD Department of Internal Medicine № 2. Definition. Pneumonia – this is an inflammation in the lung parenchyma caused by bacteria, viruses or fungi which is characterized by intraalveolar exudation. Morphology. Classification. Etiology (if it is known)

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Pneumonia

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  1. Pneumonia Andriy Lepyavko, MD, PhD Department of Internal Medicine № 2

  2. Definition • Pneumonia – this is an inflammation in the lung parenchyma caused by bacteria, viruses or fungi which is characterized by intraalveolar exudation

  3. Morphology

  4. Classification • Etiology (if it is known) • Variants: • Community-acquired pneumonia • Nosocomial pneumonia – when patient was hospitalized with any another diagnosis, and after 48 hours in the hospital (not earlier!) pneumonia was diagnosed, or pneumonia after artificial lung ventilation • Pneumonia due to aspiration. It results from the aspiration of gastric contents in addition to aspiration of upper respiratory flora in secretions. • Pneumonia in immunocompromised host – patients with AIDS or immunodeficit of other origin. Causes of pneumonia – viruses, fungi of saprofites (E.coli etc.)

  5. Classification III. Localization (side, lobe, segment) IV. Stages of severity: • Mild stage –conciousness is clear, t less than 38, heart rate less than 90, BP normal, dyspnea mild in case of physical activity, CXR – small infiltration • Moderate – conciousness is clear, sweating, general weakness, t 38-39, heart rate 90-100, moderate dccreased BP, dyspnea, large size of infiltration • Severe – t 39-40, conciousness is not clear, heart rate more than 100, low BP, severe dyspnea, cyanosis, large size of infiltration and presence of complications V. Complications.

  6. Pathogenesis • Route of entry - Inhalation - Aspiration - Bloodborne • Host/ organism dynamics tipped by - Defect in host defences - Virulent organism - Overwhelming inoculum

  7. Host Defences • Nasal hair • Dynamics of airflow • Cough • Mucous • Mucociliary apparatus • Bacterial interference • Immunoglobulin • Surfactant • Fibronectin • Complement • Cytokines • Alveolar macrophages • Polymorphonuclear leucocytes • Cell-mediated immunity

  8. Diagnostic criteria • Predisposition – CHF, diabetes, alcoholism, COPD • Classic symptoms – cough, fever, sputum production, dyspnea • Clinical syndrome – fever, pleuritic chest pain, productive cough with mucopurulent sputum • Focal pulmonary findings (rales, crapitation or signs of consolidation) – less sensitive than CXR • General blood analysis – increased ESR, leucocytosis, shift to the left • Sputum analysis – causative microorganism and its sencitivity to antibiotics may be found

  9. Diagnostic criteria • CXR with infiltrates – diagnosis “pneumonia” is invalid without it

  10. Community-acquired pneumonia Most common pathogens: • Streptococcus pneumoniae (9% to 75%; mean, 33%), • Haemophilus influenzae (0 to 50%; mean, 10%), • Legionella species (0 to 50%; mean, 7%), • Chlamydia pneumoniae (0 to 20%; mean, 5%). • Mycoplasma pneumoniae

  11. Community Acquired Pneumonia Incidence # in 1000s Adeel A. Butt, MD

  12. Community Acquired Pneumonia Mortality # in 1000s Adeel A. Butt, MD

  13. Duration of treatment • At least 5 days • Until afebrile for 48-72 hours • Stable vital signs • Longer course needed if Initial antibiotic choice did not cover the pathogen Extrapulmonary infection (meningitis) Lung abscess, cavitation or empyema Gram negative pathogen or S.aureus

  14. Nosocomialpneumonia • Staphylococcus aureus • Gram-negative microorganisms - Pseudomonas, Klebsiella, Proteus, enterobacteria, E.coli • Fungi - Candida, Aspergillus, Rizopus.

  15. Aspiration pneumonia Most effective are: • Aminoglycozyde (tobramycin, sizomycin)+ Metronidazol • Cephalosporini III-IV generation+Metronidazol

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