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PNEUMONIA

Pneumonia is an inflammatory condition of the lung which affects the alveoli.

Causes

Bacterial causes include Streptococcus pneumonia, Haemophilus influenza, Chlamydophila pneumonia,

Mycoplasma pneumonia, Staphylococcus aureus, Moraxella catarrhalis and Legionella pneumophila

Viral causes include: rhinoviruses, coronaviruses, influenza virus, respiratory syncytial virus (RSV),
adenovirus, and parainfluenza.

Fungal causes include Histoplasma capsulatum, Blastomyces, Cryptococcus neoformans, Pneumocystis

jiroveci (pneumocystis pneumonia, or PCP). These occur mostly in immune compromised patients

Parasites; a number of parasites are known to cause pneumonia. These include Toxoplasma gondii,
Strongyloides stercoralis, Ascaris lumbricoides, and Plasmodium malariae. These organisms enter the
body through direct contact with the skin, ingestion, or via an insect vector.

Classification of pneumonia

Pneumonia can be classified in several ways, most commonly by where it was acquired (hospital versus
community), but may also by the area of lung affected or by the causative organism

Community Aquired Pneumonia (CAP)

Community-acquired pneumonia (CAP) is infectious pneumonia in a person who has not recently been
hospitalized. This is the most common type of pneumonia. The causes of CAP vary depending on a
person's age, but they include Streptococcus pneumoniae, viruses, the atypical bacteria, and
Haemophilus influenzae. Gram-negative bacteria cause CAP in certain at-risk populations. The term
"walking pneumonia" has been describes a type of community-acquired pneumonia of less severity
(because the sufferer can continue to "walk" rather than requiring hospitalization). Walking pneumonia is
usually caused by the atypical bacterium, Mycoplasma pneumoniae.

Hospital-acquired pneumonia

Hospital-acquired pneumonia (HAP) or nosocomial pneumonia refers to any pneumonia contracted by a

patient in a hospital at least 48–72 hours after being admitted. It is distinguished from community-
acquired pneumonia. It is usually caused by a bacterial infection, rather than a virus.

Other types of Pneumonia include (By cause)

 Bronchiolitis obliterans organizing pneumonia

 Chemical pneumonia
 Aspiration pneumonia
 Dust pneumonia
 Necrotizing pneumonia
 Opportunistic pneumonia
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 Double pneumonia (bilateral pneumonia)

 Severe acute respiratory syndrome

Classification by area of lung affected

A lobar pneumonia:This involves only involves a single lobe, or section, of a lung. Lobar pneumonia is
often due to Streptococcus pneumoniae (though Klebsiella pneumoniae is also possible.)

Multilobar pneumonia: This involves more than one lobe and it often causes a more severe illness.

Bronchial pneumonia: This affects the lungs in patches around the tubes (bronchi or bronchioles).

Interstitial pneumonia: This involves the areas in between the alveoli, and it may be called "interstitial
pneumonitis." It is likely caused by viruses or by atypical bacteria.

Signs and symptoms of Pneumonia

 Productive cough
 Fever accompanied by chills
 Shortnes of breath
 Sharp or stbbing chest pain during deep breaths
 Increased rate of breathing
 Confusion ( especially in the old People)

In children the typical signs and symptoms include fever, cough, fast or difficult breathing. In children
less than two years of age cough is usally absent. Severe signs and symptoms in children incude Blue-
tingled skin, unwillingness to drink, convulsions, ongoing vomitin, extremes of temperature and a
decreased level of consciousness.

Bacterial specific signs and symptoms include

Bacteria Signs and symptom

Legionella Abdominal pain, diarrhorea, confussion
Streptococcus pneumoniae Rusty colored sputum
Klebsiella Bloody sputum (Hemotysis)
Mycoplasma pneumonia Swelling of the lymp nides in the neck, joint pain
or a middle ear infection

Viral pneumonia most times presents with wheezing

Predisposing factors include:

 Malnutrition
 Old age
 Immunosuppression (HIV, cancer, alcohol dependence
 Measles
 Pertussis
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 Pre existing lung or heart diseases

 diabetes

PREVENTION

Vaccinations against potential casuses like Haemophilus influenzae and Streptococcus pneumonia can
prevent the disease.

Cessation of smoking.

Diagnosis

 Listening to the lungs, with a stethoscope, for a crackling or bubbling sound

 Chest X-ray
 Blood test: a complete blood count (CBC), blood culture
 Sputum tests: For Gram stain, Ziehl-Neelsen (ZN) stain, culture for Acid Fast Bacillus to rule out
tuberculosis and also identify potential causes of pneumonia
 A pulse oximetry test: This a noninvasive and painless test that measures oxygen saturation level,
or the oxygen levels in blood.

TREATMENT AND MANAGEMENT ACCORDING TO UGANDA CLINICAL GUIDELINES

Treatment of pneumonia depends on age that is to say, Adult and infants are handle slightly differently.

INFANTS
Non severe pneumonia

Paracetamol 10 mg/kg every 4-6 hours for fever

Amoxicillin dispersible tabs 40 mg/kg 12 hourly for 5 days

If wheezing presents administer Salbutamol inhaler 1-2 puffs every 4-6 hours

Severe pneumonia

If oxygen saturation is less than 90% administer oxygen with nasal prongs and monitor through pulse
oximetry

Ampicillin 50mg/kg IV 6 hourly or Benzyle penicillin 50,000IU/Kg IM or IV

Plus gentamicin 7.5 mg/kg IM or IV once daily

Second line:

Ceftriaxone 80mg/kg or IV once daily

Administer Chloramphenicol 25mg/kg IV every 6 hours if there is no response to above medication

For convulsions, give diazepam 0.5 mg/kg rectally or 0.2 mg/kg Ivor
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Phenobarbital 10-15 mg IM as a loading dose, then a maintainance dose of 3-5 mg/kg every 8-12 hours

ADULTS

Moderate pneumonia (ambulatory patients)

Amoxicillin 500mg-1g 8 hourly for 5 days or incase of penecilin allergy give Doxycycline 100 mg every
12 hours for 7-10 days or Erythromycin 500 mg every 6 hours for 5 days

Severe pneumonia e.g for hospitalized patients

Give oxygen and monitor oxygen saturation using oximeter

Benzyl penicillin 2 MU IV or IM daily every 4-6 hours

Ceftriaxone 1 g IV or IM every 24 hours

If Staphylococcus aureus is suspected administer Cloxacillin 500 mg IV every 6 hours

Administer Chloramphenicol 1g IV six hourly for 7 days

Management by specific microorganism

Stapylococcus pneumonia:

Cloxacillin 1-2 g 1v or IM every 6 hours for 10-14 days

Plus gentamicin 7.5mg/kg IV in 1-3 divided doses daily.

Mycoplasma pneumonia

Doxycycline 100 mg every 12 hours for 7-10 days or

Erythromycin 500 mg every 6 hours for 5 days

Klebsiella pneumonia

Gentamicin 5-7 mg/kg IV daily in divided doses Or ciprofloxacin 500 mg every 12 hours

Pneumococcal pneumonia

Benzylpenicillin 50,000 IU/kg IV or IM every 6 hours for 2-3 days then switch to oral

Amoxicillin 500 mg-1 g every 8 hours for 5 days

COMPLICATIONS OF PNEUMONIA

 Bacteremia and Septic Shock

 Lung Abscesses
 Pleural Effusions, Empyema, and Pleurisy
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 Kidney Failure
 Kidney failure

References

https://www.webmd.com/lung/complications-pneumonia

https://en.wikipedia.org/wiki/Pneumonia

Uganda Clinical guidelines