PNEUMONIA

pneumonia
JAMITO │LIBAN │ MACARUBBO │ OLIVEROS │ PAMITTAN
 What is Pneumonia?
❑ Pneumonia is an infection of the
pulmonary parenchyma. It is often
misdiagnosed, mistreated, and
underestimated.

❑ Most common infectious cause of death

❑ Describe as OLD MAN'S FRIEND because

it is relatively painless of
death

❑ A pathological process in which the

alveoli are filled with a mixture of
inflammatory exudate, bacteria and
white blood cells
Classifications of Pneumonia
❑Lobar Pneumonia
❑Broncho Pneumonia
❑Health care-associated
Pneumonia
❑Community-Acquired Pneumonia
❑Hospital-acquired Pneumonia
❑Ventilator-Associated Pneumonia
Classifications of Pneumonia
Lobar pneumonia is

PNEUMONIA
acute bacterial

LOBAR
infection of a part of
lobe, the entire lobe, or
even two lobes of one
or both the lungs.
Classifications of Pneumonia
Bronchopneumonia is infection
of the terminal bronchioles

PNEUMONIA
BRONCHO
that extends into the
surrounding alveoli resulting in
patchy consolidation of the
lung.
Classifications of Pneumonia
Health care associated pneumonia is a new category that precipitated due to
development and widespread use of potent oral antibiotics, earlier transfer of
patients out of acute-care hospitals to their homes or various lower-acuity
facilities, increased use of outpatient IV antibiotic therapy, general aging of
the population, and more extensive immunomodulatory therapies.
Pathologic Phases of Pneumonia
D éfen se Mechanisms Against
Lung Infection
❑Anatomic Barriers: Epiglottis, Larynx
❑Cough Reflexes
❑Tracheo-bronchial Secretion
❑Mucocilliary lining
❑Cell & humoral mediated immunity
❑Dual phagocytic system: alveolar
macrophages & neutrophils
Clini cal M ani fe station s
• TYPICAL MANIFESTATIONS
❑I ndolent to
•Fever
f u l m i n a n t in •C h i l l s
p r e s e n t a t i on •Cou gh
• rus t-coloured s p u t u m
❑El ev ated white
•M u c o p u r u l e n t s p u tu m
blood c e l l s •Dys pnea

❑Mild to fatal in severity •P l e u r i ti c c hes t p a i n

❑B a c t e r a e m i c
Clini cal D iagno si s

✓History
✓Signs and Symptoms
✓Chest X-ray
✓CT
E tiologi c D iagno si s
✓Gram’s Stain and culture of Sputum
✓Blood Cultures
✓Urinary Antigens tests
✓Polymerase Chain Reaction
✓Serology
✓Biomarkers
Compli cation s
❑ Acute Respiratory Distress Syndrome( ARDS)
❑ Pleural Effusion :fluid around the lungs
❑ Respiratory Failure: requires ventilator
❑ Sepsis: which may lead to organ failure
❑ Lung Abscesses
COMMUNITY -ACQUIRED Pneumonia
MORTALITY which develops
in an otherwise
1%- Non hospitalized
PNEUMONINA

patients healthy person

13 . 7 %- Hospiatalized
outside of
patients hospital or have
19 . 6 %- Bacteremic patients
been in hospital
<36.5%- Intensive care unit for less than
48hrs
 RI SK FACTORS
COMMUNITY -ACQUIRED

1. Comorbidity- Neoplastic disease,

PNEUMONINA

neurological problem
2. Alcoholism
3. Advanced age
4. Asthma
5. Immunosuppression
 CAUSATIVE
COMMUNITY -ACQUIRED
O R G AN IS M S

Streptococcus pneumonia
PNEUMONINA

Haemophilus influenza Typical Bacterial

Staphylococcus aureus
Pathogens
Klebsiella pneumonia
Legionella pneumophila
Mycoplasma pneumonia
Chlamydophila pneumonia Atypical Bacterial
Chlamydophila psittaci Pathogens
Coxiella burnetii Viruses
 CLINICAL
COMMUNITY -ACQUIRED
FEAT U R ES
Pneumococcal lobar pneumonia presents
PNEUMONINA

with a cough
Initially dry but later producing purulent
or blood-stained
Rust-coloured sputum
Dyspnoea
Fever
Pleuritic chest pain
 P N E U M O N I A THAT WAS
• D E V E LO P I N G IN A PAT I E N T NOT I N C U B AT I N G UPON
• H O S P I TA L I Z E D FOR A D M I SS I O N
• G R E AT E R T H A N 4 8 HRS.

of all hospital acquired

10-15%

pneumonia, usually presenting with

sepsis or&/or respiratory failure
50% acquired on ICU

NOSOCOMIAL PNEUMONIA (HAP)

 REDUCED HOST DEFENCEAGAINST
PREDISPOSIN G
BACTERIA
FEATURES
Reduced immune defences
(Corticosteroid treatment, diabetes,
malignancy)
Reduced cough reflux (Post
operative)
Disordered mucocilliary clearance
(Anaesthetic agents)

NOSOCOMIAL PNEUMONIA (HAP)

PREDISPOSIN G ASPIRATION OF NASOPHARYNGEAL
FEATURES
OR GASTRIC SECRETIONS

Immobility or reduced conscious

level
Vomiting, Dysphagia
Nasogastric intubation

NOSOCOMIAL PNEUMONIA (HAP)

 E S C H E R IC H IA CAUSATIVE
C O LI O R G AN IS M S
K LE B S I E LLA
SP . GRAM +
PS E U D O M O N AS
AE R U G I N O S A
ST R E PTO C O C C U S
PN E U M O N IA E
GRAM - ST APH Y LO C O C C U S
AU R E U S
*common

NOSOCOMIAL PNEUMONIA (HAP)

 AN AE R O B IC B AC TE R IA CAUSATIVE
F U N G I - CAN D I D A
O R G AN IS M S
ALB IC AN S ASP E R G I LLU S
F U M IG ATU S E N TE R O B AC TE R
V IR U S E S - SP .
C Y TO M E GALO V IR U S PR O TE U S SP .
( C M V ) , H E R PE S S I M PLE X S E RATIA
M AR C E S C E N S
C IT R O B AC TE R SP .
GRAM - bacilli colliforms AC I N O B AC TE R SP .
LE G I O N E LLA
*less common PN E U M O PH I LLIA

NOSOCOMIAL PNEUMONIA (HAP)

TREATMENT
 E R A D I C AT ION OF THE
OFFENDING OR GA NI S M

S E L E C T I ON OF AN
A P P R OP R I AT E
A NT I B I OT I C
GOALS OF
TO MI NI MI Z E
THERAPY
A SS OC I AT E D MORBIDITY
 ADEQUACY OF RESPIRATORY
FUNCTION
HUMIDIFIED OXYGEN FOR
H Y P OX EMI A
B RON C H ODI LATORS
( ALBUTEROL)
General CHEST P H Y S I OTH E RA P Y
WITH P O S T U R AL DRAINAGE
Approach ADEQUATE HYDRATION IF
to N E C E SSA RY
E X P E C TO R A N TS S U C H AS
Tr eatment GUAIFENESIN
CHEST PA I N - A N A L G E S I C S
 PNEUMONIA
SEVERITY
ASSESSMENT

Pneumonia Se ve r i ty Index ( P S I )
A P R O G N O S TI C MODEL USED TO
I D ENTI FY PAT I E N T S AT LOW
R I S K OF DYING

C U RB - 6 5 Criteria
A S E V E R I TY- OF- I L L N E S S S CORE
CAP :
EMPIRICAL
TREATMENT
FOR OUT-
PATIENTS
CAP :
EMPIRICAL
TREATMENT
FOR IN-
PATIENTS
CAP :
EMPIRICAL
TREATMENT
FOR SPECIAL
CONCERNS
HAP :
EMPIRICAL
TREATMENT
 Fever and leukocytosis usually resolve within 2–
4 days in otherwise healthy patients with CAP,
but physical findings may persist longer.

P N EU M ON I A : Chest radiographic abnormalities are slowest

to resolve and may require 4–12 weeks to clear
FOLLOW- UP
Patients may be discharged from the hospital
once their clinical conditions are stable, with no
active medical problems requiring hospital
care.
.
 For a patient whose condition is improving and
who (if hospitalized) has been discharged, a
follow-up radiograph can be done ~4–6 weeks

P N EU M ON I A : later.

FOLLOW- UP If relapse or recurrence is documented,

particularly in the same lung segment, the
possibility of an underlying neoplasm must be
considered
Thank
You!