Pneumonia - PDF

Shared using Xodo PDF Reader and Editor Pneumonia Prof.Dr. Ahmed Hussein Jasim F.I.B.M.S (RESP),F.I.B.M.S (med)  Shared using Xodo PDF Reader and Editor radiol...

Shared using Xodo PDF Reader and Editor Pneumonia Prof.Dr. Ahmed Hussein Jasim F.I.B.M.S (RESP),F.I.B.M.S (med)  Shared using Xodo PDF Reader and Editor radiological manifestations ‫ميصير نكول عليه نيمونيا إذا معدنه‬ COMMUNITY-ACQUIRED PNEUMONIA ‫ مالتها الن يجي حراره عاليه وسعال ضيق بالنفس‬+sign CAP implies the presence of lung inflammation of sufficient extent to lead to signs, symptoms, or radiologic features of an opacity with acute onset and community acquisition PATHOPHYSIOLOGY Microorganisms gain access to the lower respiratory tract via microaspiration from the oropharynx (the most common route), hematogenous spread, or contiguous extension from an infected pleural or mediastinal space Classic pneumonia (typified by that due to Streptococcus pneumoniae) presents as a lobar pattern and evolves through four Viral pneumonia ‫ سببها‬viral pneumonia phases characterized by changes in the alveoli: Most common cause of bacterial pneumonia Streptococcus pneumonia  Edema: Proteinaceous exudates are present in the alveoli.  Red hepatization: Erythrocytes and neutrophils are present in the intraalveolar exudate.  Gray hepatization: Neutrophils and fibrin deposition are abundant.  Resolution: Macrophages are the dominant cell type Epidemiology  The incidence of CAP is highest at the extremes of age (i.e., 60 years). ‫مثل دور املسنني ودور االيتام‬  Risk factors for CAP include alcoholism, asthma, immunosuppression, institutionalization, and an age of ≥70 years (vs 60–69 years).  Many factors—e.g., tobacco smoking, chronic obstructive pulmonary disease, colonization with methicillin-resistant S. aureus (MRSA), recent hospitalization or antibiotic therapy—influence the types of pathogens that should be considered in the etiologic diagnosis  Shared using Xodo PDF Reader and Editor Infectious pneumonia Classification of pneumonia Non infectious pneumonia Interstitial pneumonia (Pathogenic) 1- Radiological : Lobar Bronchopneumonia Interstitial pneumonia: 2- Location of acquiring : Community acquired pneumonia: pneumonia acquired outside a hospital or long-term care facility Hospital acquired pneumonia: or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 48 hours or more after ‫للمستشفىفيڤر‬ ‫مريض دخل‬ ‫ورا يومني صار عنده‬ ‫هنا يداومون باملستشفى ويعيشون باملجتمع يصير عدهم‬ ‫وسعال نصاب بيها‬ hospitalization. mixed community +hospital ‫ يعني‬associated infection Healthcare associated pneumonia: pneumonia in non-hospitalized patients who had significant experience with the healthcare system. Such contact could include (1) intravenous antibiotics therapy within the preceding 30 days (2) residence in a long-term care facility (3) hospitalization in an acute-care hospital within the preceding 90 days (4) outpatient treatment in a hospital or hemodialysis clinic within the preceding 30 days. Ventilator associated pneumonia: as pneumonia that present more than 48 hours after endotracheal intubation. Shared using Xodo PDF Reader and Editor ‫شرحه الدكتور بس ما أعرف إذا حفظ أو ال‬  Shared using Xodo PDF Reader and Editor Microbiology Typical verses atypical PNEUMONIA Although many bacteria, viruses, fungi, and protozoa can cause CAP, most cases are caused by relatively few pathogens. Variable Typical (Bacterial pneumonia) atypical Streptococcus pneumonia Mycoplasma pneumonia ……. In >50% of cases, a specific etiology is never determined.  Typical bacterial pathogens include S. pneumoniae, Haemophilus Onset Acute Less acute proceeded by influenzae, Staphylococcus aureus, and gram-negative bacteria _ flue or URTI Subacute such as Klebsiella pneumoniae and Pseudomonas aeruginosa. Cause Classical bacteriamostly Mostly  Atypical organisms include Mycoplasma pneumoniae, Chlamydia Pneumococcus Mycoplasma pneumoniae, Legionella spp., and respiratory viruses (e.g., Chlamydia influenza viruses, adenoviruses, human metapneumovirus, Legionella respiratory syncytial viruses). ‫دائما‬ Inflammatory markers High Less  Of CAP cases, 10–15% are polymicrobial and involve a combination of typical and atypical organisms.  The incidences of cases due to M. pneumoniae and C. pneumoniae CXR lobar Interstitial are increasing, particularly among young adults. ‫تشكل‬ Most common cause of acquired pneumonia of %35 age any Teenage & young adult cases Severity more Walking pneumonia Leukocytes deficiency Normal secondary bacterial infection ‫ممكن مصاب بفايروس يتحول بكتريا نسمي‬ Neutrophil high Lymphopenia typical and atypical ‫ علمود يعالج‬mixed ‫لذلك من ننطي عالج ننطي‬ Shared using Xodo PDF Reader and Editor  Shared using Xodo PDF Reader and Editor Clinical features : Diagnosis: Typical pneumonia: ‫اكثر حده‬ 1-Imaging studies:  Usual bacteria X‐Ray chest P/A & lateral view, Compute tomography  Sudden/subacute onset 2-Lab. Tests Bacterial Viral  CBC with differential: neutrophilia –bacterial , lymphopenia—atypical  Fever with chills, rigors  BUN/Cr and electrolytes: hyponatremia –legionella & the BUN for severity  Productive cough, Mucopurulent Atypical assessment sputum  Glucose, liver enzymes: abnormal liver function---mycoplasma infection  Tachypnea and tachycardia  Blood culture are positive in 5–14% of cases, most commonly yielding  breathlessness S. pneumoniae. ‫ ج‬organisms resistant to circulation ‫ الن‬sepsis ‫ يعني‬sever pneumonia ‫ يعني‬positive ‫دائمامن يطلع‬ sputum‫يعني‬  Pleuritic chest pain 3-Microbiological tests: to detect the causative agent not needed routinely  Breath sound: crackles only for patients with severe CAP, need hospitalization or ICU or not Atypical PNEUMONIA ‫اقل حده‬ responding to treatment as:  Gradual onset 1- Sputum Gram stain  Afebrile 2- Sputum for culture Sputum samples must have >25 WBCs and