Pneumonia PDF

Pneumonia Sally Magdy ElBoughdady, MD Lecturer of Chest diseases  Pneumonia - Acute infection, with clinical and/or radiological signs of consolidation - Involves part/parts of one/both lungs Pneumonia CAP Acquired in Community HAP In Hospital ≥ 48h of admissi...

Pneumonia Sally Magdy ElBoughdady, MD Lecturer of Chest diseases  Pneumonia - Acute infection, with clinical and/or radiological signs of consolidation - Involves part/parts of one/both lungs Pneumonia CAP Acquired in Community HAP In Hospital ≥ 48h of admission VAP On MV ≥ 48h on Ventilator CAP = community acquired pneumonia HAP = hospital acquired pneumonia Different Organisms VAP = ventilator associated pneumonia Different Treatment (antibiotics)  Pathogenesis Lung Immunity - Suppressed cough (e.g., cerebrovascular stroke) - Inhibited Cilia (e.g., smoking, Immotile Cilia) - Defective alveolar macrophages, neutrophils defective phagocytosis of microorganisms (old age, chronic diseases, HIV, corticosteroid, chemotherapy) - Impaired Immunoglobulin production in lungs (IgA) Transmission Route Smoking Inhalation Aspiration Colonization Blood Spread - Pre-existing Bacteremia Lung Diseases: - IV drug - Bronchiectasis addiction - Chronic - Intravenous Bronchitis cannula - - Pathology 1 2 3 Resolution 7 – 10 days Incomplete resolution Permanent Scaring  Microbiology Common pathogens: Streptococcus pneumoniae Haemophilus influenaza Atypical Bacteria Others: Bacteria, virus, fungi, parasites Risk Factors for Specific/Resistant Bacteria 1. Recent Hospitalization + Receipt of IV antibiotics in last 90 days 2. Previous isolation of Pseudomonas aeruginosa or Methicillin-resistant Staphylococcus aureus (MRSA) 3. Comorbidities (chronic heart, lung, liver, or renal disease (dialysis); diabetes mellitus; alcoholism; malignancy; or asplenia. Diagnosis In Elderly “Vague symptoms” - GIT upset - Confusion Clinical Picture - Absent fever Radiological Atypical Examination Pneumonia Vital Signs Examination - Fever Cyanosis - Tachycardia Inspection: Working accessory Muscles - Hypotension (Shock) Percussion: Dullness - Tachypnea Auscultation: - Reduced SpO2 % (respiratory -Diminished breath sounds failure) -Bronchial breathing - - Crackles (crepitations) Chest X- ray - CT Chest Laboratory Complete Blood Picture Arterial Blood Gases Blood Urea Nitrogen PCR for viral antigen detection in sputum/nasopharyngeal swab Sputum Gram stain Sputum Culture & Sensitivity Blood Culture & Sensitivity The last 3 only in high risk or severe pneumonia Treatment – Site of Care CURB-65 Score *Score 0 – 1 Home (outpatient) *Score 2 Ward *Score 3 – 5 (or Severe CAP) ICU  Dose - inpatient Dose - Antibiotic Outpatient )beta lactam( NA g/8h 1 Amoxicillin NA gm/12h 100 Doxycycline g/24h 1-2 NA Ceftriaxone Dose - inpatient Dose - Outpatient Antibiotic Macrolides mg/24h 500 mg 1st day, then 500 azithromycin 250 mg/24h fluroquinolone mg/24h 750 mg/24h 750 Levofloxacin  Dose Antibiotic gm/6h 4.5 piperacilli Pseudomona n- s tazobacta m meropene gm/8h 1 15 Vancomyc mg/kg/12 MRSA m h in mg/12 h 600 Linezolid  Molecular test for Influenza Virus Add Anti-Viral drug to Empirical Antibiotics Regimen Example: Oseltamivir Aspiration Pneumonia Anaerobic Bacteria Add Specific anti-anaerobic Antibiotic to empirical antibiotic ONLY if LUNG ABCESS or EMPYEMA is Suspected  Antibiotic therapy should be for no less than a 5 days. Corticosteroid should not be used in treatment of CAP EXCEPT in patients with Septic Shock refractory to adequate fluid resuscitation and vasopressor support  Molecular After 72 h: Criteria of Responsive test for Pneumonia Influenza 1. Temperature =< 37.8°C Virus 2. Heart rate=< 100 beat/min 3. Respiratory Rate ==90 mmHg 5. SpO2 >= 90% on Room air 6. Normal Mental Status 7. Normal Oral Intake Radiological resolution lags behind clinical improvement  Non-responding Pneumonia A situation in which an inadequate clinical response is present despite antibiotic treatment Organism-related Doctor-related *Virulent (e.g., P. aeruginosa) *Improper Antibiotic selection *Resistant (e.g., MDR) *Improper Diagnosis *Unusual (e.g., TB) - Heart failure - P.E Patient-related - Cancer *Comorbidities (e.g., DM) - Vacuities *Complication (e.g., Abscess) - ILD *Not adherent to treatment THANK YOU