• Wed. Sep 28th, 2022

Pneumonia Part-1 | Types | QuadBloggers

pneumonia

Pneumonia is a condition that results in infection of the lung parenchyma that leads to inflammation of the air sacs in one or both the lungs .

It is classified following these types :

  • 1) Community acquired pneumonia
  • 2) Hospital acquired
  • 3) Ventilator associated
  • 4) Health care associated
pneumonia

Pathophysology for pneumonia:

  • Microorganisms, furthermore, enter the lower respiratory tract via aspiration or inhalation to the oropharynx ,hematogenous spread or an extension from a pleural space .
  • Alterations in the host defense mechanism may result in overgrowth of one or more components of normal bacterial microbiota on the whole .
  • Classic pneumonia presents additionally as a lobar pattern and leads to certain changes in the parenchyma :
    • 1) Edema -Alveoli presents with proteinaceous exudates also .
    • 2) Red hepatization – Presence of neutrophils and erythrocytes in the intra alveolar exudate
    • 3) Gray hepatization – Presence of neutrophils and fibrin.
    • 4) Resolution – Macrophages are especially the most dominant type

1) Community acquired pneumonia :

  • Community acquired pneumonia caused due to etiologies related to bacterial infection .
  • A) Typical bacterial pathogens especially like staphylococcus pneumoniae , staphylococcus aureus , haemophilus pneumoniae , klebsiella pneumoniae and pseudomonas .
  • B) Atypical organisms like Mycoplasma pneumoniae , Chlamydia pneumoniae virus like influenza virus and adenovirus all in all .
  • Risk factors :
    • Alcoholism
    • Asthma
    • Immunosuppression
    • Age > 70 years
    • Tobacco smoking

Clinical manifestations for pneumonia:

  • Patients usually present frequently with fever, chills, sweats, cough, pleuritic chest pains and also dyspnea .
  • Other products following this, include nausea , vomiting , diarrhea , fatigue , headache , myalgia and arthralgia .
  • Furthermore, On physical examination it reveals tachypnea (abnormal rapid breathing ) , increased or decreased tactile fremitus , dull or flat percussion and also crackles with bronchial breath sounds .
  • Elderly affected faster leading to other manifestations .

Diagnosis :

Assessment and diagnosis of a critically ill or acute patients done in order to come to a conclusion as to the severity of the disease .

  • A) For instance, chest x-ray to differentiate community acquired pneumonia from other conditions
  • B) CT chest in patients associated with suspected cavitary disease .
  • C) Sputum sampling should be done i.e. with >25 WBC and <10 squamous epithelial cells for culture .
  • D) Blood cultures results up to 5-10 % of cases, hence yielding staphylococcus pneumoniae .
  • E) Urine antigen tests for staphylococcus pneumoniae and legionella also are performed.
  • F) PCR for nasopharyngeal swab employed method for detection of respiratory viral infection in conclusion .

Treatment :

  • To decide whether the patient has to be hospitalized or not should be assessed by the following methods :
    • Pneumonia severity index : Points are given especially up to 20 variables , based on age , illness , abnormal physical findings and laboratory findings .
    • CURB-65 :
      • Confusion
      • Urea >7 mmol/l
      • Respiratory rate >30/min
      • Blood pressure – <90/60 mmhg
      • >65 years old
  • In contrast, Selecting the antibiotic therapy for the patient :
Outpatients :
1. A patient who was previously healthy and had no antibiotics for the past 3 months :
a) Macrolide (Clarithromycin 500 mg BD OR Azithromycin 500 mg once , followed by 250 mg)
b) Doxycycline 100 mg BD
2. Comorbidities or antibiotics in the last 3 months following this :
a) Fluoroquinolone ( Moxifloxacin 500 mg , Gemifloxacin 320 mg , Levofloxacin 750 mg ) or
b) Amoxicillin or amoxicillin + potassium clavulanate or ceftriaxone 1-2 gm IV or cefuroxime 500mg with a macrolide
Inpatients , Non-ICU :
1. Fluoroquinolone ( Moxifloxacin 500 mg , Levofloxacin 750 mg )
2. Beta lactam ( Ceftriaxone 1-2 gm IV or Ampicillin 1-2 gm IV or Cefotaxime 1-2 gm IV or Ertapenem 1gm IV )
Inpatient ICU :
1. Beta lactam

Complications :

  • Common complications hence are as follows :
    • Respiratory failure
    • Shock
    • Multiorgan failure
    • Coagulopathy
    • Myocardial Infarction
    • Congestive Heart Failure
    • Brain abscess
    • Endocarditis
  • Others like :
    • Moreover, Lung abscess may occur in association with aspiration or infection caused by pathogens .
    • Drainage established hence, with proper management of antibiotic therapy .
    • Additionally, Pleural effusion assessment and fluid drained if the x-ray shows massive accumulation of pleural fluid

Follow up :

Chest x-ray abnormalities may require up to 4-12 weeks to heal markedly.

Additionally, for more content do visit here

Furthermore, Please refer this book for a detailed description of the disease : Harrisons book of internal medicine

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