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Pneumoniile dobandite in comunitate la copil

Pneumoniile dobandite in comunitate la copil. Curs studenti anulV Facultatea de Medicina 2009. Definitie. Boli inflamatorii de etiologie infectioasa afectand structurile pulmonare: - CA intrapulmonare -alveolele -interstitiul pulmonar.

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Pneumoniile dobandite in comunitate la copil

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  1. Pneumoniile dobandite in comunitate la copil Curs studenti anulV Facultatea de Medicina 2009

  2. Definitie • Boli inflamatorii de etiologie infectioasa afectand structurile pulmonare: - CA intrapulmonare -alveolele -interstitiul pulmonar

  3. Clasificare anatomopatologicasi clinico-radiologica • Pneumonii acute interstitiale • Pneumonii lobulare si segmentare (alveolite) • Bronhopneumonii(bronhoalveolite)

  4. Clasificare etiologica • 1 Pneumonii neinfectioase • Chimice(NO2,SO2,alti poluanti) • Medicamentoase • Postiradiere • Alergice(de hipersensibilizare)

  5. Clasificare etiologica(cont) • Pneumonii infectioase • Virale • Mycoplasma si Chlamydii • Rickettsiene • Bacteriene(10-30%) • cu agenti specifici(M.tuberculosis) • cu bacterii nespecifice: • (pneumococ streptococ,stafilo • coc,Klebsiella,HIB si nontipabili) • Mixte(viromicrobiene) • Fungice(Candida,Aspergillus,Histoplasma etc) • Produse de protozoare(PPC) • Produse de helminti(Ascaris etc)

  6. Clasificare dupa modul de realizare • Pneumonii comunitare(pneumococ,streptococ,stafilo-coc,HIB,/Klebsiella,Legionella) • Pneumonii nosocomiale(MRSA,G-enterici, • Pseudomonas spp,anerobi) • Pnemonii la copilul imunodeprimat,produ- • se de agenti oportunisti(G-enterici, • CMV,PCP,fungi)

  7. Clasificare evolutiva • Pneumonii acute(<3 sapt.) • Pneumonii subacute(3-6 sapt.) • Pneumonii cronice(>6 sapt.) • Pneumonii recurente

  8. Clasificare in raport cu complicatiile • Pneumonii necomplicate • Pneumonii complicate • -complicatii supurative • .locale(pleurezie,abces • pulmonar) • .de vecinatate(pericardita • purulenta) • .la distanta(artrita septica, • meningita purulenta, • septicemie) • _complicatii nesupurative(I Res.ac.,cord pulmonar, • turburari de ritm cardiac,ECA)

  9. Patogenie • Sursa de infectie • Calea de transmisie • -aerogena • -prin maini contaminate • Organismul receptiv • Factori favorizanti: • -infectiile virale respiratorii • -tinand de bolnav(varsta ,starea de • nutritie,conditii de mediu nefavora- • bile,afectarea mecanismelor de apa- • rare)

  10. Etape in producerea infectiei respiratorii • Colonizarea cailor aeriene superioare • Invazia CAI si alveolelor • Proliferarea germenilor in alveole-inflamatie alveolara(hiperemie,exudat) • Extinderea prin contiguitate la alveolele vecine(afectare segmentara,polisegmentara,lobara) • Complicatii • -necrotice(abcedare) • -extensie pe cale limfatica • -extensie hematogena • -prin toxine bacteriene

  11. SEMNE SI SIMPTOME IN PAC COMUNITARA LA COPIL • Febra • Frison • Tuse • Polipnee • Geamat expirator/wheezing • Tiraj • Batai ale aripilor nazale • Durere toracica • Durere abdominala • Varsaturi • Somnolenta/apatie • Inapetenta/dificultati de supt la sugar • Cianoza in formele severe

  12. Pneumonii virale Debut si evolutie progresive Absenta starii toxice Wheezing frecvent Pneumonii bacteriene Evolutie rapida a simptomelor Stare toxica Febra inalta,polipnee ,batai ale aripilor nazale Geamat expirator Sindrom de condensare Revarsat pleural Diferentierea intre pneumoniivirale si bacteriene

  13. Chlamydia Sugar(1-3 luni) Afebrilitate Severitate redusa Tuse coquelouchoida Conjunctivita, eozinofilie Mycoplasma Copil mare,adolescent Durere la deglutitie,cefalee Tuse spastica Examen fizic pulmonar negativ Elemente cheie pentru unele etiologii

  14. Bordetella pertussis Tuse severa ,chintoasa Cianoza,cornaj la finele accesului Varsaturi la finele accesului,secretie mucoasa,filanta Apnee la sugar Examen pulmonar negativ Leucocitoza si limfocitoza Pneumonia stafilococica Sugar,copil mic Infectie virala in antecedente-gripa,rugeola Stare “toxica”,meteorism abdominal Agravare rapida Dispnee severa,soc Condensare,plurezie Evolutie abcedanta Hiperleucocitoza,nutrofilie Reactie leucemoida,granulatii toxice Anemie Rg:pneumatocele,piopneumotorax,pleurezie Elemente cheie npentru unele etiologii-2

  15. EXPLORARI DIAGNOSTICE • Rg toracica • VSH,fibrinemie,CRP,examen citobacteriologic al sputei • Hemocultura • Culturi din SLT,aspirat bronsic,lichid pleural • SaO2 • ECG • (Determinarea antigenelor VRS sa virusuri in secretiile respiratorii) • (Determinarea antigenelor bacteriene in lichidele biologice)

  16. TERAPIE SUPORTIVA • Hidratare,nutritie • Antitermice • Drenaj,aspirare secretii • Fluidifiante ale secretiilor • Administrare suplimentara de O2

  17. NOU NASCUT(0-1 l) Etiologie: Virusuri respiratorii,CMV,HSV Bacterii-GBSH,Listeria,G- coliformi Altii:Mycoplasma,Ureaplasma,Chlamydia ANTIBIOTICOTERAPIA INITIALA: <7 zile:AMPICILINA+ AMNOGLICOZID >7 zile:CEFTAZIDIMA +OXACILINA(VANCOMICINA in caz deMRSA;LINEZOLID in caz de VRSA) SUGAR MIC(1-3 l) Etiologie: Virusuri:VRS,virusuri gripale,paragripale Chlamydia Bacterii:S.pneumoniae,Bordete-lla pertussis,Staph.auraeus(rar) ANTIBIOTICOTERAPIA INITIALA: CEFTRIAXONA+OXACILINA ERITROMICINA po pentru Chlamydia ANTIBIOTICOTERAPIA IN PAC LA COPIL

  18. SUGAR-COPIL MIC(4l-5a) Virusuri:VRS,gripale, paragripale,myxovirusu- ri,adenovirusuri,rinovi- rusuri,hantavirusuri. .Mycoplasma .Bacterii:S,pneumoniae, HIB/tulpini nontipabile, S.Auraeus .Germeni specifici:M.tuberculosis In zonele endemice ANTIBIOTICOTERAPIA INITIALA Forme usoare:AMOXICILINA+ ACID CLAVULANIC po SAU CEFUROXIM AXETIL po Forme severe:CEFTRIAXONA iv,continuat cu antibiotic po:Amoxicilina+acid clavulanic SAU Cefuroxim axetil-total 10-14 zile ANTIBIOTICOTERAPIA INITIALA2

  19. COPIL MARE/ADOLES- CENT(6-15 a) Stare generala satisfacatoare: Virusuri respiratorii Mycoplasma,Chlamydia S.pneumoniae(complicatie a unei infectii virale) COPIL MARE/ADOLES- CENT Stare generala modificata,spitalizat: S.Pneumoniae M.Pneumoniae S.auraeus Legionella spp M.tuberculosis in zonele endemice ANTIBIOTICOTERAPIA INITIALA3

  20. ANTIBIOTICOTERAPIA INITIALA4 • Copil mare/adolescent • Forme usoare:Macrolide po(Eritromicina, Claritromicina,Azitromicina)sau Doxiciclina po la copilul>8 a 10-14 zile • Forme severe,spitalizat:Penicilina iv sau Ceftriaxona iv =Oxacilina iv-suspiciune de S.auraeus

  21. DURATA EVOLUTIEI PANA LA VINDECARE IN FORMELE NECOMPLICATE • Pneumonii virale:7-14 zile • Pneumonii bacteriene(sub tratament):10-14 zile • Pneumonia cu Mycoplasma/Bordetella per tussis:6-8 sapt. • In pneumonia stafilococica complicata cu empiem pleural/piopneumotorax evolutie prelungita(saptamani)Mortalitate:10-30%

  22. COMPLICATII • Nesupurative:I Resp Ac,cord pulmonar ac,ECA • Supurative locale:pleurezie,pericardita,abces pulmonar • Supurative la distanta/sistemice:meningita,artrita septica,abcese ale partilor moi,septicemie

  23. PROFILAXIE • Masuri generale antiinfectie • Profilaxia infectiilor virale respiratorii:vacci-nare antigripala.VRS • Vaccinare antiibacteriana:Act-HIB,antipneumoccica • Nutritie adecvata • Regim de viata igienic

  24. MULTUMESC!

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