PNEUMONIA

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PNEUMONIA

• Nikola Blaževic
• Mentor A. Žmegac Horvat

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• inflammation of the lungs caused by infection
• many different causes bacteria, viruses,
  fungi, idiopathic
• damages ALVEOLI gt exudate (fluid) gt consolidates
  gt lack of oxygen

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• NORMAL ALVEOLI ?
• PNEUMONIA ?

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DIAGNOSIS

• Symptoms (dyspnea, cough)
• Physical examination
• X-ray (not always reliable)
• Blood test (high white cell count gt inflammation)
• Sputum cultures
• CT (most reliable)

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COMBINED FINDINGS

• Prediction rule for the frequency of
  inflammation
• Temperature gt 100 degrees F (37.8
  degrees C)
• Pulse gt 100 beats/min
• Crepitations
• Decreased breath sounds
• Absence of asthma
• Probability of inflammation based on the number
  of findings
• 5 findings - 84 to 91 probability
• 4 findings - 58 to 85
• 3 findings - 35 to 51
• 2 findings - 14 to 24
• 1 finding - 5 to 9
• 0 findings - 2 to 3

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Classification

• Early classification schemes
• Anatomical 1. lobar pneumonia(streptoccocus
  or klebsiella pneumoniae)
• 2. multilobar
  pneumonia
• 3. interstitial
  pneumonia(viruses or atypical bacteria)
  
• Radiological
• Microbiological
• Combined clinical classification
• 1. ACUTE(less than three weeks
  duration)
• - classic bacterial
  bronchopneumonia
• - atypical(interstitial
  pneumonitis)
• - aspiration pneumonia
  syndromes
• 2. CHRONIC
• - non-infectious
• - mycobacterial
  
  Streptococcus pneumoniae
• - fungal
• - bacterial infections caused
  by airway obstruction

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• Community-acquired pneumonia (CAP)
• - in a person who has not recently been
  hospitalized!
• - most common type of pneumonia
• - home care, oral antibiotics
• Most common cause of CAP ? H. influenzae
• Streptococcus pneumoniae ? most common cause
  of CAP worldwide
• 
  viruses
• 
  atypical bacteria
• Fourth most common cause of death in UK and sixth
  in US
• Hospital-acquired pneumonia (nosocomial)
• - acquired during or after hospitalization for
  another illness or procedure, 72h latency time
  after admission
• - 5 patients develop HAP
• - more deadly

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• Microorganisms (more resistant)
• MRSA (methicillin-resistant Staphylococcus
  aureus)
• Pseudomonas
• Enterobacter
• Serratia
• Risk factors
• mechanical ventilation
• decreased amounts of stomach acid
• immune disturbances
• heart and lung diseases

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Other types of pneumonia

• Severe acute respiratory syndrome (SARS)
• Bronchiolitis obliterans organizing pneumonia
  (BOOP)
• Eosinophilic pneumonia
• Aspiration pneumonia
• Dust pneumonia
• 
  
• 
  SARS

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Treatment

• oral antibiotics, rest, lots of fluid!
• home care ? no hospitalization needed
• people with other medical problems and elderly ?
  hospitalization if pneumonia persists
• Bacterial pneumonia ? treated with antibiotics
  
• 
  - amoxicillin
• 
  - fluoroquinolones
• 
  - cephalosporins
• 
  - aminoglycosides
• Viral pneumonia ? influenza A ? rimantadine ,
  amantadine

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Prognosis and mortality

• Bacterial pn. ? resolves within 2 to 4 weeks
• - 1/20 people with pneumococcal
  pneumonia die
• - half of the people who develop MRSA
  on ventilator die
• Viral pn. ? lasts longer than bacterial
• Mycoplasmal pn. ? 4 to 6 weeks to resolve
• -
  low mortality

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Prevention

• Vaccination ? H. influenzae and S. pneumoniae in
  the 1st year
• - repeat after
  5-10 years
• Abtibiotics ? Group B Streptococcus and Chlamydia
  trachomatis positive pregnant women
• Treating underlying illnesses (e.g. AIDS) can
  decrease the risk of pneumonia
• Smoking ? cigarette smoke interferes with many of
  the body's natural defenses against pneumonia

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References

• http//en.wikipedia.org/wiki/Main_Page
• Med. English seminars