PNEUMONIA DEFINITION Infection of lung parenchyma that inflammes

DEFINITION: • Infection of lung parenchyma that inflammes the air sacs in one or

CLASSIFICATION • A) Hospital or community acquired • B) Immunological Based on Pathology: Lobar

LOBAR PNEUMONIA • Homogenous consolidation of one or more lung lobes associated with pleural

BRONCHOPNEUMONIA • Patchy alveolar consolidation associated with bronchial and bronchiolar inflammation, often affecting both

COMMUNITY ACQUIRED PNEUMONIA • 5 -12% of all. • At extremes of age. •

PREDISPOSING FACTORS • Cigarette smoking • Upper respiratory tract infections • Alcohol • Corticosteroid

• Travel also facilitates spread of illneses such as severe acute respiratory Syndrome

CLINICAL FEATURES • Fever • Rigors and chills • Shivering • Malaise • Delirium

ON EXAMINATION • Tachypnia, Tachycardia, hypotention • Chest signs: dull percussion note bronchial breathing

• Score 1 point for each feature present • CURB Score 0 -1

INVESTIGATIONS • Full blood count • Urea And Electrolytes • Liver function tests •

• Sputum samples • Oropharyngeal swabs • Urine antigens • Pleural fluid

MANAGEMENT: • ASPECTS OF MANAGEMENT: • Oxygen • Fluid balance • Antibiotic therapy •

• Flucloxacillin 1 -2 gm QID IV plus • Clarithromycin 500 mg BD

DISCHARGE AND FOLLOWUP • The decision depends upon their home circumstances and the likelihood

HOSPITAL ACQUIRED PNEUMONIA • Reduced host defences • Aspiration of nasopharyngeal or gastric secretions

• Management is same as of CAP. • Pneumonia in Immunocompromise patient: •

COMPLICATIONS • Para-Pneumonic Effusion common • Empyema • Retention of sputum causing lobar Collapse

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PNEUMONIA

DEFINITION: • Infection of lung parenchyma that inflammes the air sacs in one or both lungs. • May be filled with pus or fluid. BOR • Recently developed radiological pulmonary shadowing which may be segmental, lobar or multilobar. .

CLASSIFICATION • A) Hospital or community acquired • B) Immunological Based on Pathology: Lobar Bronchopneumonia

LOBAR PNEUMONIA • Homogenous consolidation of one or more lung lobes associated with pleural inflammation. • Inflammatory stages: • 1)Congestion • 2)Red hepatization • 3)Grey hepatization • 4) Resolution

BRONCHOPNEUMONIA • Patchy alveolar consolidation associated with bronchial and bronchiolar inflammation, often affecting both lower lobes.

COMMUNITY ACQUIRED PNEUMONIA • 5 -12% of all. • At extremes of age. • Kills more children worldwide Cause is viral. • Old man’s friend. • Droplet spread • Strep Pneumoniae most common cause. • Mycoplasma in young. • Harmophilus influrnzae in elderly. • Legionella in contaminated cooling towers in hotels, buildings.

PREDISPOSING FACTORS • Cigarette smoking • Upper respiratory tract infections • Alcohol • Corticosteroid therapy • Old age • Recent influenzae infection • Pre-existing lung disease • HIV • Indoor air pollution

• Travel also facilitates spread of illneses such as severe acute respiratory Syndrome (SARS), caused by a form of corona virus arising in guangdong province of China , which spread rapidly through Hong kong and vietnam, and then throughout the world. • Certain occupations may be associated with exposure to specific bacteria.

CLINICAL FEATURES • Fever • Rigors and chills • Shivering • Malaise • Delirium • Appetite lost • Headache • Cough dry at first then productive • Pleuritic chest pain

ON EXAMINATION • Tachypnia, Tachycardia, hypotention • Chest signs: dull percussion note bronchial breathing crackles throughout when consolidation present. • CURB-65 • Any of • Confusion • Urea>7 mmols/L • Respiratory rate >30/ mint • BP systolic<90 or Diastolic <60 • Age>65

• Score 1 point for each feature present • CURB Score 0 -1 : • likely to be suitable for home treatment. • Score 2 : • Consider hospital supervision • Options are short stay or supervised outpatient • Score 3 or more: • Severe pneumonia; Assess for ICU admission, especially if score i= 4 or 5.

INVESTIGATIONS • Full blood count • Urea And Electrolytes • Liver function tests • ESR and CRP • Blood Culture • Serology • Cold Agglutinins • Arterial blood gases • Chest Xray

• Sputum samples • Oropharyngeal swabs • Urine antigens • Pleural fluid

MANAGEMENT: • ASPECTS OF MANAGEMENT: • Oxygen • Fluid balance • Antibiotic therapy • ANTIBIOTICS FOR UNCOMPLICATED PNEUMONIA: 1)Amoxicillinn 500 mg TDS or 2)Clarithromycin 500 mg BD or Erythromycin 500 mg QId 3) If staphylococcus is cultured or suspected

• Flucloxacillin 1 -2 gm QID IV plus • Clarithromycin 500 mg BD IV • IF mycoplasma or Legionella suspected • Claritheomycin 500 mg Bd orally or IV • Erythromycin 4 oomg Qid orally or IV • Rifampicin 6 oomg BD IV in severe Cases • SEVERE CAP: • CLARICID 500 mg Bd IV or Erythro 500 mg Qid Iv plus • Co. Amoxiclav 1. 2 gm TDS IV or Ceftriaxone 1 -2 gm daily IV or Cefuroxime 1. 5 gm 3 times daily IV or • Amoxillin 1 gm QID daily IV plus 2 gm Qid daily IV

DISCHARGE AND FOLLOWUP • The decision depends upon their home circumstances and the likelihood of complications. • Review around 6 weeks • CXR if persistent symptoms • Prevention: • Smoking cessation • Influenzae and Pneumococcal vaccination. • Mode of spread controlled.

HOSPITAL ACQUIRED PNEUMONIA • Reduced host defences • Aspiration of nasopharyngeal or gastric secretions • Bacteria introduced into lower respiratory tract e. g tracheaostomy, sinus infection etc • Bacteraemia

• Management is same as of CAP. • Pneumonia in Immunocompromise patient: • As in disease or by drugs • Management is by broad spectrum antibiotics.

COMPLICATIONS • Para-Pneumonic Effusion common • Empyema • Retention of sputum causing lobar Collapse • DVT and pulmonary Embolism • Pneumothorax • Suppurative pneumonia /Abscess • ARDS , renal failure , MOD • Ectopic Abscess formation • Hepatitis, pericarditis, meningoencephalitis • Pyrexia due to drug hypersensitivity