PNEUMONIA

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Definisi
Pneumonia: Radang pada parenkim paru yg dapat disebabkan oleh mikroorganisme (bakteri, virus, dan jamur) maupun karena faktor-faktor lain (inhalasi bahan kimia atau makanan, radiasi, dll)

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Klasifikasi
Anatomi Patogen: untuk mengobati pasien dengan antimikrobial yang tepat Didapat dari lingkungan (Acquired environment)

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Patogen

Pneumonia Bakterial
1. Bakteri aerob Gram positif (Streptococcus pneumoniae, Staphylococcus aureus, Group A hemolytic streptococci) 2. Bakteri aerob Gram negatif (Klebsiella pneumoniae, Hemophilus influenzae, E. coli) 3. Bakteri Anaerob

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Patofisiologi (Streptococcus pneumoniae)

Organisme patogen teraspirasi ke bag. tepi paru dari sal. nafas bag. atas atau nasofaring edema reaktif multiplikasi menyebar ke bag. paru lain yg berdekatan. Tersering mengenai lobus bagian bawah paru karena adanya efek gravitasi Stadium Kongesti o Kapiler kongesti dan melebar Hepatisasi merah o Paru tampak merah dan bergranula karena sel-sel darah merah, fibrin dan lekosit PMN mengisi alveoli. oLobus dan lobulus yang terkena menjadi padat dan tidak mengandung udara, warna menjadi merah dan pada perabaan seperti hepar

Patogen

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Patogen

Hepatisasi Kelabu o Lobus paru masih tetap padat, warna merah menjadi tampak kelabu karena lekosit dan fibrin mengalami konsolidasi di dalam alveoli dan permukaan pleura yang terserang melakukan fagositosis terhadap pneumococcus. o Kapiler tidak lagi mengalami kongesti. Resolusi Eksudat mengalami lisis dan direabsorpsi oleh makrofag sehingga jaringan kembali pada strukturnya semula

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Patogen

Manifestasi Klinis (S. pneumoniae)

Didahului infeksi sal. nafas bag. atas Suhu secara mendadak hingga >390C, menggigil Nyeri dada Dispneu, friction rub di atas jaringan yang terserang, pernafasan cuping hidung, retraksi pada daerah supraklavikuler, interkostal dan subkostal batuk dan adanya sputum berwarna seperti karat Nadi Simptom GI (mual, muntah, nyeri abdomen, diare)

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Patogen

Pemeriksaan Radiologis (S. pneumoniae)

Gambaran radiologis dapat berupa konsolidasi pada satu atau beberapa lobus. Jika sudut kostofrenikus tumpul efusi pleura Posisi PA dan lateral penting untuk deteksi pneumonia

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Patofisiologi S. aureus

Patogen

Stafilokokus menghasilkan berbagai toksin dan enzim (hemolisin, lekosidin, stafilokinase dan koagulase). Koagulase akan berinteraksi dg faktor plasmazat aktif yang mengubah fibrinogen menjadi fibrinpembentukan koagulan. Permukaan pleura biasanya diselubungi oleh lapisan eksudat fibropurulen tebalabses yang mengandung koloni stafilokokus, lekosit, eritrosit dan debris nekrosis. Bila abses pecah terbentuk trombus2 sepsis pada daerah yang mengalami kerusakan dan peradangan luas. Gambaran radiologis berupa infiltrat yang menyatu dan biasanya terbatas, atau dipadatkan dan homogen dan melibatkan seluruh lobus paru atau hemitoraks Isra Baly
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Patogen

Gram stain of the sputum provides earliest diagnostic clue Chest X-ray early in the disease shows many small round areas of densities that enlarge and coalesce to from abscess, and leave evidence of multiple cavities

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Patogen

Pneumonia Atipikal
Legionnaies pneumonia, Mycoplasmal pneumonia, Chlamydia pneumonia.

Fungal Pneumonia
Candida dan aspergilosis

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Patogen

Viral Pneumonia
Adenoviruses Respiratory syncytial virus Influenza Cytomegalovirus Herpes simplex

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Anatomi

Patogen

Infiltrate Patterns
Pattern Lobar Patchy Interstitial Cavitary Possible Diagnosis S. pneumo, Kleb, H. flu, GN Atypicals, viral, Legionella Viral, PCP, Legionella Anaerobes, TB, abses, fungi Staph, anaerobes, Kleb

Large effusion

Anatomi

Klasifikasi anatomis
1. Lobar : melibatkan seluruh lobus 2. Lobular :melibatkan bagian2 lobus saja, segmental atau alveolus hingga bronkus (bronchopneumonia). 3. Interstitial :peny. parenkim paru difuse

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Anatomi

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Anatomi

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Anatomi

Pneumonia Lobaris
S. pneumoniae. Previously healthy individuals. Abrupt onset. Unilateral stabbing chest pain on inspiration (due to fibrinous pleurisy).

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Anatomi

Pneumonia Lobaris

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Anatomi

Image in a 49-year-old woman with pneumococcal pneumonia. The chest radiograph reveals a left lower lobe opacity with pleural effusion.
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37-year-old man with a 9- day history of fever, nonproductive cough, right-sided chest pain 3 days after the onset of symptoms, headache, malaise

(a) PA view shows lobar pneumonia in the right middle lobe (b) Lateral view shows some loss of volume in the consolidated middle lobe, evidenced by a slight upward displacement of the major fissure Isra Baly
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Anatomi

Komplikasi Pneumonia Lobaris

1. Pembentukan abses 2. Empyema 3. Kegagalan Revolusi intra-alveolar scarring ('carnification') permanent loss of ventilatory function of affected parts of lung. 4. Bakteraemia: - Infective endocarditis - Cerebral abscess / meningitis - Septic arthritis
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Lobular Pneumonia

Anatomi

Infants + young children and the elderly. Usually secondary to other conditions associated with local and general defence mechanisms: - viral infections (influenza, measles) - aspiration of food or vomitus - obstruction of a bronchus (foreign body or neoplasm) - inhalation of irritant gases - major surgery - chronic debilitating diseases, malnutrition
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Anatomi

Lobular pneumonia

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Interstitial pneumonia (Bronchopneumonia)

Anatomi

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Anatomi

Interstitial pneumonia

Bilateral interstitial infiltrates in a 31-year-old patient with influenza pneumonia.

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Tempat Terjadinya (Acquired environment)

Environment

Pneumonia-masyarakat (communityacquired pneumonia), bila infeksinya terjadi di masyarakat

Pneumonia-RS atau pneumonia nosokomial (hospital-acquired pneumonia).

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Environment

Community Acquired Pneumonia

CAP refers to pneumonia acquired outside of hospitals or extended-care facilities . Streptococcus pneumoniae remains the most commonly identified pathogen. Other pathogens include Haemophilus influenzae, mycoplasma pneumoniae, Chlamydophilia pneumoniae, Moraxella catarrhalis and etc.

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Environment

Hospital Acquired Pneumonia

HAP refers to pneumonia acquired in the hospital setting. Enteric Gram-negative organisms, S. aureus, Pneudomonas aeruginosa, ects. Aspirasi :Microaspiration of contaminated oropharyngeal secretions seems to be the most important of these factors, as it is the most common cause of HAP. Inhalasi kontaminasi

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A 53-year-old patient with severe Legionellapneumonia. Chest radiograph shows dense consolidation in both lower lobes.
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A 40-year-old patient with Chlamydia pneumonia. Chest radiograph shows multifocal, patchy consolidation in the right upper, middle, and lower lobe

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A 38-year-old patient with Mycoplasma pneumonia. Chest radiograph shows a vague, ill-defined opacity in the left lower lobe.

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Pneumonia in the left lower lobe

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