Pneumonia PDF

Pneumonia Dr. Ahmed Hamad MBBS, PgDip (Therapeutics), MRCP (Respiratory Medicine), FRCP (London), FACP Consultant Pulmonologist PMAH, Riyadh  Background Epidemiology and classification...

Pneumonia Dr. Ahmed Hamad MBBS, PgDip (Therapeutics), MRCP (Respiratory Medicine), FRCP (London), FACP Consultant Pulmonologist PMAH, Riyadh  Background Epidemiology and classification Host defences Pneumonia Microbial aetiology Clinical features Management Not improving patient After discharge  Microbial infection + host inflammatory response= symptoms and signs of consolidation and impaired alveolar function Background Can be caused by bacteria, viruses, fungus, and parasites Occurs from inhalation, aspiration, or haematogenous spread  Epidemiology Common lower respiratory tract infection 0.1-1 % of the adult population each year Age: 40yrs adults 25 Years Hoyears Seasonal: Winter Co-morbidities: Smoking Alcohol abuse Immunosuppression 00 Respiratory comorbidity (COPD, Asthma, ILD, Bronchiectasis) Other comorbidity: Neurological, renal, cardiovascular, liver, etc 40% hospital admisssions, hospital mortality 5-12%  Types of pneumonia communityAcquired nosocomial Aspiration community nosocomial Aspiration Premonia in immunocomeramized Pneumonia immunocompromised Community acquired Nosocomial Pneumonia in the Aspiration pneumonia pneumonia pneumonia immunocompromised to  Respiratory Host defences lT aatII.in Anatomic factors inflammation innente antimionsiannnas.astin Adaptive – Cough ss.t.nmpnoust.es – Mucociliary transport Innate immunity – Antimicrobial peptides Lysozymes, lactoferrin, defensins, collectins – Phagocytic and inflammatory cells Adaptive immunity – Immunoglobulins – T lymphocytes Ig  Microbial aetiology Community-acquired pneumonia Nosocomial Pneumonia Common organisms Streptococcus pneumoniae Staphylococcus aureus Eta Haemophilus E influenzae Pseudomonas aeroginosa Influenze virus Bacteroids Adenovirus E. Coli, Klebsiella, Proteus Rare organisms Mycoplasma pneumoniae Serratia marcescens Moraxella catarrhalis Acinetobacter spp. Chlamydia pneumoniae viruses Legionella pneumophilia Staphylococcus aureus  Clinical Features o History of risk factors + Productive cough Breathlessness Pleuritic chest pain symptoms OF Fever Systemic features rea Examination I Tachypnoearapidbreathing Tachycardia ÉÉ Localizing chest signs ↓ air entry signs ↓ percussion note ↑ vocal resonance Bronchial breathing crackles  Management 1 Diagnosis Severity assessment Short history of acute lower respiratory CURB-65 infection B Pneumonia Severity Index New focal chest signs Presence of complications New radiographic shadowing (Consolidation) c confusion thorothospital Unsurea Immolor 20mg EYE R Respiratoryrate 30 CURB 3 medicalward B 90160 BloodPressure Management 2 CURB4 5 ICU 65 654.0 or older CURB 65 18.20 0 o To  Management 3 Investigations Treatment Vital signs  Oxygen sO2 , BP, HR, RR  Fluids CXR  Antibiotics Blood tests  Respiratory support FBC, U/E, LFTs, CRP, ABG  Monitoring Microbiological investigation Sputum, blood culture Viral swabs Specific serology  Not improving patient Incorrect/missed CRP >50% at day 4 Slow response diagnosis Secondary Inappropriate complication antibiotic or Impaired immunity Pulmonary unexpected Extrapulmonary pathogen Not improving patient Not improving patient Exclude underlying Consider alternate immunodeficiency, diagnosis underlying chronic lung disease Repeat CXR/ cultures Escalate antibiotics 0 so Consider bronchoscopy, pleural fluid sampling  After discharge Follow-up CXR Follow-up Vaccinations Exclude underlying Annual influenza conditions vaccination 17% lung cancer in Pneumococcal vaccine smokers >60 years