Pulmonary Medicine CAP 2024 PDF

Respiratory Medicine Respiratory infections Pneumonia 24/10/2024 Dr. Mahad Sadik Mukhtar Pulmonologist MD Respiratory Medicine  LECTURE CONTENTS  CASE SCENARIO INTRODUCTION  EPIDEMIOLOGY  TYPES OF PNEUMONIA  CAUSES OF PNEUMONIA  PAT...

Respiratory Medicine Respiratory infections Pneumonia 24/10/2024 Dr. Mahad Sadik Mukhtar Pulmonologist MD Respiratory Medicine  LECTURE CONTENTS  CASE SCENARIO INTRODUCTION  EPIDEMIOLOGY  TYPES OF PNEUMONIA  CAUSES OF PNEUMONIA  PATHOPHYSIOLOGY  CLINICAL FEATURES  DIAGNOSIS OF PNEUMONIA  MANAGEMENT OF PNEUMONIA  CASE SCENARIO  A 54-year-old smoker with multiple comorbidities (diabetes, hypertension, coronary artery disease) presents with a 2- day history of a productive cough with yellow sputum, chest tightness, and fever.  Physical examination reveals a temperature of 38.3°C (101°F), BP of 150/95 mmHg, heart rate of 85 bpm, and a respiratory rate of 20 breaths per minute. His oxygen saturation is 95% at rest; lung sounds are distant but clear, with crackles at the left base. Chest x-ray reveals a left lower lobe infiltrate.  Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages.  The word "pneumonia" takes its origin from the ancient Greek word "pneumon," which means "lung," so the word "pneumonia" becomes "lung disease."  Medically it is an inflammation of one or both lungs' parenchyma that is more often, but not always, caused by infections.  Pneumonia is defined as inflammation of the substance of the lungs. It is usually caused by bacteria but can also be caused by viruses and fungi Clinically.  it usually presents as an acute illness with cough, purulent sputum, breathlessness and fever, together with physical signs or radiological changes compatible with consolidation of the lung, However, it can present with more subtle symptoms, particularly in the elderly. EPIDEMIOLOGY EPIDEMIOLOGY  TYPES OF PNEUMONIA PNEUMONIA CLASSIFICATION ETIOLOGY Infectious and Non infectious ANATOMICAL Lobar bronchopneumonia Interstitial CLINICAL Typical Atypical SEVERITY Mild severe EMPRICAL Community acquired Pneumonia TREATMENT Hospital acquired Pneumonia Ventilator acquired Pneumonia Aspiration Pneumonia Immune compromised Pneumonia TYPES OF PNEUMONIA  Community-acquired pneumonia (CAP) is defined as pneumonia acquired outside hospital or healthcare facilities. Clinical diagnosis is based on a group of signs and symptoms related to lower respiratory tract infection with presence of fever >38ºC (>100ºF), cough, mucopurulent sputum, pleuritic chest pain, dyspnoea, and new focal chest signs on examination such as crackles or bronchial breathing.  The acute infection of lung tissue in a patient who has acquired it from the community or within 48 hours of the hospital admission. CAUSES AND RISK FACTORS Continue… Continue………. PATHOPHYSIOLOGY CLINICAL FEATURES  Physical Exam Physical findings also vary from patient to patient and mainly depend on the severity of lung consolidation, the type of organism, the extent of the infection, host factors, and the existence or nonexistence of pleural effusion. The following are major clinical findings:  Continue………  Increased temperature (usually more than 38 C or 100.4 F)  Decreased temperature (less than 35 C or 95 F)  Increased respiratory rate (more than 18 breaths/min)  Increased heart rate (more than 100/min)  Bradycardia (less than 60/min)  Cyanosis  Percussion sounds vary from flat to dull.  Tactile fremitus  Crackles, rales, and bronchial breath sounds are heard during auscultation.  Tracheal deviation  Lymphadenopathy  Pleural rub  Egophony  Some examination findings are specific for certain etiologies, such as: Bradycardia - Legionella Dental illnesses - Anaerobes Impaired gag reflex - Aspiration pneumonia Cutaneous nodules - Nocardiosis Bullous myringitis - Mycoplasma INVESTIGATIONS Continue…… IMAGING IMAGING IMAGING  TREATMENT OF CAP In all patients with bacterial pneumonia, empirical therapy should be started as soon as possible. The first step in treatment is a risk assessment to know whether the patient should be treated in an outpatient or inpatient setting. Cardiopulmonary conditions, age, and severity of symptoms affect the risk for bacterial pneumonia, especially CAP INPATIENT RECURRENT PNEUMONIA