Pneumonia and Tuberculosis

Types of Infections: Pneumonia

• Pneumonia is an inflammation of lung tissue (bronchioles and alveoli) caused by infection.
• Infectious agents include bacteria (like Streptococcus pneumoniae), viruses, fungi, and protozoa.
• Streptococcus pneumoniae is responsible for roughly 50% of pneumonia cases
• Infections can occur through inhalation, aspiration, or from the bloodstream.

Pathophysiology of Pneumonia

• Organisms colonize alveoli, triggering an inflammatory response.
• Vascular congestion, edema, and fluid accumulation occur.
• Exudate and infectious debris fill the alveoli.
• Lung tissue can solidify, leading to consolidation.

Etiology of Pneumonia

• Infections can be broadly categorized as infectious and non-infectious.
• Infectious factors include bacteria, viruses, fungi, and parasites.
• Non-infectious factors cover aspiration of gastric contents, inhaled irritants, and chemical injuries.

Bacterial Pneumonia

• Bacterial pathogens circulate in the bloodstream and reach the lungs causing cellular debris.
• This can lead to airway obstruction.
• The infection typically affects one or more lobes of the lung, sometimes a full lobe, referred to as lobar pneumonia

Viral Pneumonia

• Viruses frequently enter through the upper respiratory tract and infect the alveoli.
• They multiply and destroy lung cells, releasing debris, which often results in a scattered, patchy inflammatory pattern known as bronchopneumonia
• Viral pneumonia is typically a mild disease compared to bacterial forms.

Aspiration Pneumonia

• Causes include aspiration of food, emesis, gastric reflux, or hydrocarbons
• These materials trigger an inflammatory response, often with a lower pH leading to more severe inflammation, creating conditions ideal for bacterial invasion.

Specific Types of Pneumonia (based on acquisition)

• Community-acquired pneumonia (CAP): Often pneumococcal, spread through respiratory droplets.
• Hospital-acquired pneumonia (HAP): Develops during a hospital stay, often related to ventilators (VAP).
• Healthcare-associated pneumonia (HCAP): Occurs in individuals with recent exposure to healthcare facilities.
• Opportunistic pneumonia: Affects immunocompromised patients (AIDS, cancer patients).

Complications of Pneumonia

• Pleuritis, a chest wall inflammation
• Pleural effusion (fluid accumulation in the pleural space)
• Lung abscess
• Empyema (pus in the pleural cavity).

Clinical Manifestations

• Fever, chills
• Dyspnea (shortness of breath), crackles in lungs
• Productive cough, purulent sputum, hemoptysis.
• Chest pain (pleuritic)
• Confusion
• Headache, fatigue, muscle pains, diminished appetite.
• Possible systemic spread: meningitis, endocarditis, peritonitis, septic shock

Diagnostic Tests

• Chest X-ray: To assess extent, pattern of lung involvement.
• Computed tomography (CT) scan: Provides a more detailed image of lung tissue.
• Sputum gram stain: To identify bacteria (gram-positive or gram-negative)
• Sputum culture: To identify specific bacteria causing infection
• Complete blood count (CBC): Identifies an elevated white blood cell count ("left shift," immature leukocytes) suggesting infection.
• Arterial Blood Gas (ABG): Measures gas exchange in lungs, identifying respiratory compromise.
• Pulse oximetry: Tracks oxygen saturation.
• Bronchoscopy: Allows for sputum collection, removal of secretions, and visual examination of the lungs.
• Procalcitonin levels: Helps distinguish between bacterial and non-bacterial causes of inflammation
• Nucleic acid amplification (NAA) tests: Identify microorganisms in specimens.
• Sepsis criteria: Elevated temperature, heart rate, respiratory rate; increased or decreased white blood cells; metabolic acidosis.

Prevention

• Early identification of the infecting agent
• Vaccination (pneumococcal).
• Patient education.
• Preventative measures to reduce spread of infection.

Treatment (Pharmacologic)

• Antibiotics: To eradicate infection, based on gram stain results.
• Bronchodilators: Reduce bronchospasm and improve ventilation.
• Mucolytics: Break up mucus.
• Oxygen therapy: Based on hypoxia level.
• Antipyretics: Reduce fever
• Analgesics: Reduce pain

Treatment (Non-Pharmacologic)

• Supportive care: Airway management, fluids, rest.
• Chest physiotherapy: Percussion, postural drainage, vibration.
• Pulmonary hygiene measures.

Lifespan Considerations (Older Adults)

• Higher risk for pulmonary infection.
• Weakened immune system.
• Frequent use of multiple medications.
• Impaired mobility.
• Nutritional deficiencies/malnutrition.

Implementation (Nursing Actions)

• Instructing patients to adhere to medication schedules.
• Close monitoring and evaluation of respiratory status, including arterial blood gas (ABG) values, and assessment of clinical manifestations.
• Respiratory support if needed.
• Fluid balance monitoring and management., including intravenous (IV) fluids, when indicated.

Tuberculosis (TB)

• Overview, Pathophysiology, and Etiology:
  • Mycobacterium tuberculosis is the causative agent.
  • Infection begins when aerosols enter the lungs and initiate an inflammatory response.
  • Macrophages engulf the bacteria, leading to granuloma (tubercle) formation, containing the infection.
  • The infection can become inactive (dormant) or active.
• Active vs Dormant TB Classifications:
  • Active TB individuals are infectious, showing clinical symptoms.
  • Dormant TB is non-infectious, but the infection remains. An inadequate immune response can reactivate latent disease.
• Risk Factors:
  • Immigrants (foreign born).
  • HIV/AIDS, immunocompromised individuals.
  • Homelessness, overcrowded facilities.
• Clinical Manifestations
  • Often asymptomatic initially.
  • Possible symptoms: Fever, night sweats, fatigue, weight loss, chronic cough, pleuritic chest pain, hemoptysis (bloody sputum).
• Diagnostic Tests:
  • PPD skin test (Mantoux test or other) to detect exposure.
  • Chest X-rays for lung lesion identification. Crucial to distinguish from other lung infections.
  • Sputum culture (and AFB smear): Critical for confirming TB diagnosis; multiple specimens are required.
  • Interferon-gamma release assays (IGRAs): Alternative diagnostic tool, useful in those who've been vaccinated.
• Drug Treatment
  • Antibiotics (e.g., isoniazid, rifampin, ethambutol, pyrazinamide).
  • Treatment duration is variable, depending on active or latent TB, and the presence of HIV.

Collaboration during Treatment

• Communication with the patient is important
• Pharmacotherapy is key in treatment of TB
• Patient adherence is critical

Additional important information

• The provided notes are based on the slides.
• Always consult reliable medical sources for definitive information and patient care.

Test your knowledge on pneumonia, particularly Pneumocystis jiroveci infections. This quiz covers various aspects such as causes, complications, diagnostic tests, and risk factors associated with pneumonia. Understand the impact of substance use and the significance of diagnostic findings in managing pneumonia.