Pneumonia Overview and Types
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Questions and Answers

What is the primary causative organism associated with community-acquired pneumonia (CAP)?

  • Haemophilus influenzae
  • Escherichia coli
  • Streptococcus pneumoniae (correct)
  • Staphylococcus aureus

    • Which type of pneumonia is specifically associated with patients on a ventilator?

  • Healthcare-associated pneumonia (HCAP)
  • Ventilator-associated pneumonia (VAP) (correct)
  • Community-acquired pneumonia (CAP)
  • Aspiration pneumonia

    • Which of the following types of pneumonia is most likely to occur in long-term care facilities?

  • Community-acquired pneumonia (CAP)
  • Healthcare-acquired pneumonia (HAP)
  • Ventilator-associated pneumonia (VAP)
  • Healthcare-associated pneumonia (HCAP) (correct)

    • What content typically fills the air sacs in the case of pneumonia?

    <p>Fluid and pus</p> Signup and view all the answers

    Which of the following statements regarding the trends in pneumonia cases and deaths is accurate?

    <p>Cases are decreasing and deaths are increasing.</p> Signup and view all the answers

    Which type of pneumonia is characterized by inflammation in the structural spaces between the alveoli?

    <p>Interstitial pneumonia</p> Signup and view all the answers

    What is one of the bacteria commonly responsible for pneumonia in infants who are sick?

    <p>Staphylococcus</p> Signup and view all the answers

    Which of the following is NOT listed as a general risk factor for pneumonia?

    <p>High physical activity</p> Signup and view all the answers

    Which symptom of pneumonia may present as altered mental state in affected individuals?

    <p>Confusion</p> Signup and view all the answers

    Which age group is associated with a higher risk of pneumonia due to factors like previous respiratory illness?

    <p>Elderly</p> Signup and view all the answers

    What is the main consequence of the multiplication of pathogens in pneumonia?

    <p>Consolidation due to inflammatory responses</p> Signup and view all the answers

    Which vital signs indicate a potential state of sepsis in pneumonia patients?

    <p>Low BP and increased respiratory rate</p> Signup and view all the answers

    In viral pneumonia, what happens to ciliated cells in the respiratory tract?

    <p>They experience necrosis and become paralyzed</p> Signup and view all the answers

    Which test is crucial for confirming the presence of an infection in pneumonia?

    <p>Sputum culture and sensitivity test</p> Signup and view all the answers

    What pathological change characterizes the later stages of viral pneumonia?

    <p>Formation of hyaline membranes and edema in alveoli</p> Signup and view all the answers

    Which bacterium is identified as the third most common cause of pneumonia according to the data?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    What is one of the identified risk factors associated with pneumonia?

    <p>Smoking</p> Signup and view all the answers

    Which of these factors is NOT listed as a risk for pneumonia?

    <p>Daily yoga</p> Signup and view all the answers

    Which of the following organisms is part of the first two most common bacterial causes of pneumonia?

    <p>Klebsiella</p> Signup and view all the answers

    Hospitalization for more than how many days is considered a risk factor for pneumonia?

    <p>5 days</p> Signup and view all the answers

    What type of bacteria is most commonly associated with pneumonia based on the data presented?

    <p>Gram-negative bacteria</p> Signup and view all the answers

    Which option is not a comorbidity that increases the risk of pneumonia?

    <p>Coronary artery disease</p> Signup and view all the answers

    In the provided data, which organism is specifically mentioned as a common respiratory pathogen?

    <p>Chlamydia pneumoniae</p> Signup and view all the answers

    What is the defined time frame for ventilator-associated pneumonia (VAP) according to the CDC?

    <p>Occurs either during intubation or within 48 hours after</p> Signup and view all the answers

    Which of the following is a major risk factor for nosocomial pneumonia?

    <p>Improper handling by healthcare professionals</p> Signup and view all the answers

    Which strategy is NOT part of the VAP prevention bundle?

    <p>Limit fluid intake to decrease aspiration risk</p> Signup and view all the answers

    What preventive measure should be taken to improve personal hygiene in the context of pneumonia prevention?

    <p>Wash hands frequently</p> Signup and view all the answers

    How does the pooling of secretions contribute to the risk of VAP?

    <p>It creates channels for bacteria to reach the lungs.</p> Signup and view all the answers

    Which of the following conditions most often enhances colonization of the oropharynx and stomach, thus increasing pneumonia risk?

    <p>Mechanical intubation</p> Signup and view all the answers

    What is a potential consequence of contaminated respiratory equipment?

    <p>Increased risk of VAP</p> Signup and view all the answers

    Why is it important to promote early mobilization in VAP prevention strategies?

    <p>It helps maintain muscle tone and prevent weakness.</p> Signup and view all the answers

    Study Notes

    Pneumonia

    • An acute infection that inflames the air sacs in one or both lungs.
    • Caused by various agents: bacterial, viral, fungal, parasites, and non-infectious causes (idiopathic interstitial pneumonia)
    • Content in the air sacs: fluid, pus
    • Trend: Less cases, more deaths, with males having a higher mortality rate than females.

    Types of Pneumonia Based on Origin

    • Community-acquired (CAP): Developed in the community setting.
    • Healthcare-associated (HCAP): Developed in long-term care facilities such as nursing homes, outpatient clinics, or extended-stay clinics.
    • Healthcare-acquired (HAP): Developed during or following a stay in a healthcare setting.
    • Ventilator-associated (VAP): Developed after being on a ventilator, a machine that supports breathing.
    • Aspiration pneumonia: Aspiration of food, saliva, or gastric contents into the airways.

    CAP vs HAP

    Characteristic CAP HAP
    Causative organisms S. Pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Haemophilus influenzae, Chlamydia pneumoniae MRSA, Multiply-resistant Staphylococcus aureus, Enteric gram-negative bacteria (e.g., E. coli, Proteus, Enterobacter, Klebsiella, Serratia spp.), Chlamydia pneumoniae, Pseudomonas aeruginosa, Anaerobic bacteria, Fungi
    Risk factors Smoking, Alcoholism, COPD, Congestive heart failure (CHF), Immunocompromise, Seizure, Dementia Hospitalisation > 5 days, Previous infection with resistant organisms, Surgery, Pleural effusion, Chemotherapy, Dialysis, Prolonged wound care, Residence in a nursing home
    • According to QEH (2011-2013), the most common HAP causative organisms are E. coli, Klebsiella, and Pseudomonas aeruginosa.

    Types of Pneumonia Based on Affected Sites

    • Bronchopneumonia: Descending infection starting around bronchi and bronchioles, which spreads to the lung.
    • Lobar pneumonia: Acute exudative inflammation of the entire lobe.
    • Interstitial pneumonia: Inflammation in the structural spaces between the alveoli.

    Causes of Pneumonia Based on Different Age Groups

    • Infants (6): RSV, Adenovirus, and bacterial infections (normal infants); Staphylococcus, E. coli, and gram-negative bacteria and viruses (sick infants).
    • Children (4): Viruses, Staphylococcus, Mycoplasma, Haemophilus influenzae (leading to bronchitis).
    • Adults (8): Viruses, Staphylococcus, Mycoplasma, Haemophilus influenzae, pneumococcus, Chlamydia psittaci (from bird/farm animals), Legionella (from contaminated water systems), and HIV (leading to Pneumocystis pneumonia).
    • Elderly/Previous Respiratory Illness (10): Staphylococcus, Mycoplasma, Haemophilus influenzae, Pneumococcus, Legionella, HIV, Klebsiella, and gram-negative organisms, aspiration pneumonia, TB, and carcinoma.

    General Risk Factors of Pneumonia

    • Advanced age
    • Smoking history
    • Alcohol consumption
    • Malnutrition
    • Loss of consciousness (LOC)
    • Underlying lung disease (e.g., COPD, cystic fibrosis, bronchiectasis)
    • Impaired swallowing and endotracheal intubation
    • Post-operation (especially with poor pain control)
    • Immobilization
    • Cardiac and/or liver disease
    • Medications that decrease gastric pH (e.g., H2 receptor blockers)
    • Immunocompromise (e.g., HIV/AIDS, chemo)

    Symptoms of Pneumonia

    • High fever (up to 40 degrees Celsius) / swinging fever (fever with large daily conciliation)
    • Fatigue
    • Loss of appetite
    • Confusion or altered mental state
    • Cough with yellow, green, or bloody mucus
    • Shortness of breath (SOB)
    • Chest pain, especially with coughing and deep breathing
    • Tachypnoea (rapid breathing)
    • Tachycardia (rapid heart rate)
    • Sweating or chills
    • Cyanosis (due to hypoxia)

    Pathophysiology of Pneumonia

    • Multiplication of pathogen: Bacterial pathogens escape respiratory defenses and multiply within the alveoli and airways.
    • Intense immune and inflammatory response: Macrophages in the lower airways and alveoli recognize pathogens.
    • Consolidation: Inflammatory cytokines, white blood cells, and edema flood the alveoli and bronchi.
    • Hypoemia: V/Q mismatch (ventilation/perfusion mismatch).
    • Spreading: The infection can spread to the bloodstream (bacteremia and sepsis), pleura (empyema), or other organs (e.g., meningitis).

    Diagnosis of Pneumonia

    • Physical signs + abnormal chest X-ray (CXR)
    • Vital signs: Especially fever, tachycardia, low blood pressure, desaturation, and increased respiratory rate.
      • Low blood pressure + increased respiratory rate indicates sepsis.
    • Elevated White Blood Cell (WBC) count in Complete Blood Count (CBC).
    • Elevated C-reactive protein (CRP): Normal CRP is 0.25 ng/mL. Elevated CRP indicates infection.
    • Sputum culture and sensitivity test (C/ST)
    • Fiberoptic bronchoscopy (FOB)

    Further Testing

    • Rule out pulmonary embolism and other conditions: CT thorax.
    • Rule out deep vein thrombosis (DVT): Well's score.
    • Aspiration and testing with bronchoscopy and bronchoalveolar lavage (BAL)

    Viral Pneumonia

    • Route of infection: Droplet.
    • Frequent site of infection: Ciliated cells of the respiratory tract.

    Pathophysiology of Viral Pneumonia

    • Ciliated cell paralysis and degeneration: Some ciliated cells become paralyzed and degenerate, leading to necrosis and desquamation (shedding).
    • Thin layer of non-ciliated basal replacement cells: This occurs in the mucociliary blanket.
    • Inflammatory responses leading to exudation: Fluid and erythrocytes (red blood cells) exude into both the alveolar space and airways.
    • Formation of intra-alveolar hyaline membrane: Leads to congestion (alveoli filled with blood) and edema.
    • Susceptibility to superimposed bacterial infections: The involved lung becomes vulnerable to secondary bacterial infections.

    Clinical Presentation of Viral Pneumonia

    • Fever
    • Dyspnoea (difficulty breathing)
    • Persistent and non-productive cough
    • Auscultation: Scattered inspiratory crackles.

    Prevention of Pneumonia

    • Improve body resistance
    • Improve personal hygiene
    • Avoid crowded areas
    • Wear masks if suffering from respiratory symptoms
    • Wash hands.

    VAP (Ventilator-Associated Pneumonia)

    • Definition (CDC): Pneumonia that occurs at the time of intubation and ventilation or within 48 hours after intubation.
    • Definition (ATS and IDSA): Arise > 48-72 hours after intubation.

    Importance of VAP Prevention

    • Common in mechanically ventilated patients.
    • Second most common infection in the ICU, leading to prolonged hospital stays.
    • VAP is preventable.

    Risk Factors for Nosocomial Pneumonia (Hospital-Acquired)

    • Major risk factors: Improper handling by healthcare professionals, enhancing colonization of the oropharynx /or stomach.
      • Mechanical intubation
      • Administration of antibiotics
      • Underlying chronic lung disease
    • Favoring aspiration into the respiratory tract/reflux from GI tract:
      • Supine positioning
      • Nasogastric tube placement
      • Immobilization
      • Surgery of the head, neck, thorax, or upper abdomen
      • Coma

    Pathogenesis of VAP

    • Pooling of secretions: Through microchannels to the lung under suction (ETT – endotracheal tube / Tracheostomy).
    • Aspiration: Through microchannels to the lung.
    • Biofilm formation
    • Intubation procedures
    • Contaminated respiratory equipment

    VAP Prevention Bundle (6)

    1. Elevation of the Head of the Bed 30°-45°: Avoid supine positioning.
    2. Daily sedative interruption and daily assessment of readiness for extubation.
    3. Daily oral care with chlorhexidine.
    4. Maintain airway pressure:
      • Maintenance of PEEP (positive end-expiratory pressure) and minimize MHI (manual lung hyperinflation).
      • Avoid routine suctioning and keep lowest suction pressure and shortest suction duration.
    5. Peptic ulcer disease and deep venous thrombosis prophylaxis.
    6. Promote early mobilization.

    PT Aspect to Prevent VAP

    • Physical therapists play a crucial role in preventing VAP.

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    Description

    This quiz covers the essentials of pneumonia, including its causes, symptoms, and different types based on origin. Explore community-acquired, healthcare-associated, healthcare-acquired, and aspiration pneumonia, along with key characteristics. Understand the trends in cases and mortality rates to deepen your knowledge of respiratory infections.

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