Pneumonia Aming ChorMing Lin Pneumonia Inflammation or infection

Pneumonia Aming Chor-Ming Lin

Pneumonia ► Inflammation or infection of the lungs. ► The lungs' air sacs fill with pus, mucus, and other liquid and can not function properly. ► Oxygen can’t reach the blood--insufficient oxygen in the blood--body cells can not function properly --die.

Classification of Pneumonia ► Typical vs. Atypical ► Practical classification § Community Acquired Pneumonia (CAP) § Hospital Acquired Pneumonia (HAP) ► Ventilator Associated Pneumonia (VAP) ► Health Care Associate Pneumonia (HCAP) § Aspiration Pneumonia § Pneumonia in the Immunocompromised Patients

發生CAP的危險因子 ► 年長者 ► 同時存在的疾病 § COPD § DM § Renal insufficiency § CHF § CAD § Malignancy § Chronic neurological disease § Chronic liver disease

Pneumonia ► Clinical Presentation § Fever § Increased WBC § Productive cough § Increased respiratory rate § Breath sound: rales/ronchi § Chest X-ray: infiltrate / consolidation

判讀的步驟 ► A: Airway ► B: Bone ► C: Cardiac, mediastinum and hilar ► D: Diaphragm ► E: Else (soft tissue, pleura, breast…) ► F: Lung Field

► 32 Y/O male ► Cough for 1 wk ► Fever for 2 days ► Rales over LLL

Pneumonia Pathogens ► Microorganisms § Viruses § Bact Pneumonia § Mycoplasma, Chlamydia, Legionella § M. tuberculosis § Fungi § Protozans and parasites Age <6 months-5 Yr Adol/Adult >65 Yr Etiologic agents C. trachomatis, RSV, H. influenza Mycoplasma, Chlamydia H. influenzae, L. pneumoniae v except Streptococcus pneumoniae

Pneumonia: Community Acquired ► Common pathogens § Viruses ( most common type) § Bacteria: ►S. pneumoniae, H. influenzae § M. pneumoniae § C. pneumoniae § Legionella pneumophila § Mycobacterium

Aspiration Pneumonia ► Common pathogens § Mixed flora § Mouth anaerobes ►Peptostreptococcus spp, Actinomyces spp. § Stomach contents ►Chemical pneumonitis ►Enterobacterium

Typical pneumonia: Clinical presentation ► Usual § § § § bacteria Sudden onset Fever with chills, rigors Productive cough, Mucopurulent sputum Tachypnea and tachycardia Pleuritic chest pain Breath sound: crackles and rales CXR: air-bronchogram, consolidation

Atypical pneumonia: Clinical presentation Atypical § § § § Gradual onset Afebrile Dry cough Breath sound: Rales Uni/bilateral patchy, infiltrates WBC: usual normal or slight high Sore throat, myalgia, fatigue, diarrhea Common etiology ► Mycoplasma pneumoniae ► Chlamydia pneumoniae ► Legionella pneumophilla ► Mycobactria ► Virus ► Others

Pneumonia ► Diagnosis § Sputum gram stain and culture § Good specimen ► PMN’s>25/LPF ► Few epithelial cells<10/LPF ► Single predominant organism

Pneumonia ► Gram stain § Organisms not visible on gram stain ► M. pneumonia, Chlamydia ► Legionella pneumophila ► Viruses ► Mycobacterium § Common organisms ► Gram positive: diplococci (pairs and chains) ► Gram positive: clusters, ie staphylococcal pneumonia ► Gram negative: coccobacillary, ie K. P. ► Gram negative: rods

Pneumonia 的 治療 ► Keep vital signs: Airway, Breathing, Circulation ► Symptom treatment ► Antibiotics: § Bacteria § Atypical pathogens

須住院治療的條件 ► 原則上，病人有多項危險因子，病情複雜者，都要 住院治療。 ► The Pneumonia Patient Outcomes Research Team (PORT) risk factors (Wishwa N Kapoor : Agency for Health Care Policy and Research, 1997)： § 65 歲以上 § 其他並存的疾病如COPD、Bronchiectasis 、Malignancy 、 DM 、CRF 、CHF 、 Chronic liver disease 、 Chronic alcohol abuse 、Malnutrition 、CVA 、 Postsplenectomy.