(Pneumonia)

1. ?
How? upper airway microaspiration lower airway host defense system

host defense system
virulent microorganism
(, , , , ) .

typical
CAP
atypical
Pneumonia
HAP : 48
VAP : 48~72

2.
- , , , , , , , , /
- P/E : , crackle
Typical vs Atypical

Typical Atypical
Legionella: , N/V, hyponatremia(SIADH)
S.pneumoniae(m/c):
()
H.influenzae
Mycoplasma: (, ),
S.aureus: infection site
Chlamydia
Klebsiella pneumoniae : Hx.
Virus (Influenza )
Pseudomonas aeruginosa :
Pneumocystis .jirovecii(PCP):
,
mild fever
productive & prulent sputum( )
watery, scant, non-productive sputum
crackle
CXR localized consolidation CXR P/E match

Gram stain, culture Gram stain, culture

3. : &
- CXR (gold standard) : lobar consolidation, interstitial infiltrates, bulging fissure(Klebsiella)
-
: 5~14% , S.pneumoniae
optional. (Routine )
, methenamine silver&Wright-Giemsa(P.jirovecii)
:
(ELISA) : Legionella, S.pneumoniae specificity
Serology : Atypical pneumonia

4. :
- : Typical -lactam(Amoxicillin/Clavulanate), Atypical Macrolide(~mycin)
new fluoroquinolone(Levofloxacin)
typical atypical -lactam+macrolide or new FQ alone
- .
- PCP : Bactrim(TMP-SMX)
- : Metronidazole, Piperacillin/tazobactam, Imipenem, Ampicillin/sulbactam, Clindamycin
(Lung abscess)

1. ?
aspiration ,
d/t , ,

2.
- , ( )
- CXR : mass-like consolidation + cavity with air-fluid level
- CT

cf.empyema

3.
- Bronchoscopy BAL

4.
-
: Clindamycin, -lactam/-lactamase inhibitor, Carbapenem
4~6 ( scar )
- (postural drainage)
- (percutaneous drainage, lobectomy) :

(Empyema) : pleural space

: closed thoracotomy, open surgical drainage
(Bronchiectasis)

1. ?
?
: , airway obstruction, clearance , ,
2.
- : ,
- mucoprulent sputum
- Hx.
- bronchial a.
- crackles, inspiratory rhonchi(), wheezing

3.
- CXR : cystic shadows, tram tracks, ring shadow
- HRCT : airway( 1.5 ), tree-in-bud

4.
*Underlying disease
*Acute exacerbation : control, , hygiene
1) control :
- H.influenaze, M.Catarrhalis, P.aeruginosa
-lactam+ciprofloxacin
2) : glucocorticoid
3) Bronchial hygiene
- Hydration
- Mucolytics
- Bronchodilators
- Chest physiotherapy : (postural drainage), mechanical chest percussion