Pneumonia

 Clinical Features:
 A) Depending on Route of Infection:-

By Inhalation – Initially respiratory

complaints followed by Constitutional
Symptoms. Cough,Expectoration:
initially mucoid then purulent &
mucopurulent, sometimes blood
tinged.
 Pneumonia
 By Hematogenous Route: --
Initially constitutional follwed by repiratory
symptoms.
Fever , Arthralgia , Myalgia
Abdominal Pain, Vomiting ,
Loose-motion.
 Pneumonia
 B)Depending upon Type Of Pneumonia:-

1) Typical Community Acquired P. :--

Short History,
Cough with Expectoration,
Pleuritic Chest Pain(over affected lobe),
Hemoptysis,
Fever usually High grade with
Chills & Rigors.
 Pneumonia
 2) Atypical Pneumonia :
Subacute presentation-indolent course.
Dry Cough,
if Productive cough- sputum is scanty &
mucoid,
Low grade fever,
Loss of appetite,
Malaise,
Signs of Anaemia.
 Pneumonia
 3)Aspiration Pneumonia :-
History of Aspiration,
Chronic Cough,
Low grade fever,
Breathlessness,
Sputum is Foul Smelling,
Anorexia,
Weight Loss.
 Pneumonia Clinical Findings:
 Patient: presents with
Sweating,
Dehydration,
Ill Look,
Fever,
Tachypnoea,
Tachycardia,
Breathing- shallow,Rapid <= Pleuritic Pain
Herpes Labialis
Pneumonia Systemic Exam :-
Over Affected Area
 Respiratory Movements Decrease.
 No Mediastinal Displacement,
 Tactile Vocal Fremitus Increases,
 PERCUSSION:
Mild Tenderness,
Impaired note,
Flat note- if Synpneumonic Effusion .
 Pneumonia
 AUSCULTATION:
Initially -- vesicular sounds decrease in
intensity, Early inspiratory crackles.
Later -- High pitched Bronchial breathing,
coarse crepitations,aegophony,whispering
pectoriloquy,increased vocal resonance,
pleural rub,other signs of complications if
present.
 Pulm.Function: mild restrictive effect,
decrease in VC , FEV.
 Investigations Pneumonia:
 Sputum Microscopy: Gram stain & other
specific stains.
 Sputum Culture: Limitations –contamination
by oropharyngeal flora.
 Blood Culture: +ve in 20-30 percent cases
 Counter-immuno-electrophoresis (C.I.E)
on blood,urine,sputum to detect pneumo-
coccal antigen,
 Serological Tests- for specific organisms-
mycoplasma, legionella.
 Pleural Fluid- to exclude empyema.
Biochemical,microbiological,cytological ex-
amination.
 Bronchoscopy,TTNA,Trans-bronchial lung
biopsy -- more invasive when other tests
NON-CONCLUSIVE.
 Chest-X-ray: Homogenous/Nonhomogenous
opacity,Air-bronchogram.
Localisation: Silhoutte sign,
Lateral chest x ray.
 Inv: CXR
 Radiographic response to Treatment :
Usually lags behind clinical response.
 Various Patterns -
Confluent lobar : Strep.pneumoniae.
Cavitation; Necritizing pneumonia -
stap. ,gram neg. organisms.
Bulging Fissures: Klebsiella,PTB. Etc.
Miliary pattern- MTB, Viral, H.capsulatum
Pneumatoceles: S.aureus,S.pyogenes,
Kleb.pneumoniae.
Cavities:M.TB,Anaerobes,Fungal pneum.
 Investigations Pneumonia :
 Blood Gas Analysis (A.B.G): Hypoxaemia.
 Routine H'gram- PMNs Leukocytosis, if
severe sepsis- Leukopenia.
 Cold Agglutinins – Mycoplasma.
 Gas Liquid Chromatography- Anaerobic
organisms.
 Complications of Pneumonia
 Pleural Effusion- Exudate,small-self limited
 Empyema.
 Pericarditis-Persistent fever,chest pain,
pericardial rub, cxr: cardiomegaly.
 Septicaemia.
 Meningitis.
 Infective Endocarditis.
 Jaundice -- Hepatocellular injury or
hemolysis in G-6PD Deficiency.
 Pumonary Oedema or A.R.D.S.
 S.I.A.D.H,Rhabdomyolysis, Pneumothorax