MBL1 BACTERIAL PNEUMONIA

LOWER RESPIRATORY TRACT INFECTIONS (LRTI)

- Bacteria are dominant pathogens in LRTI
ACUTE INFECTIONS CHRONIC INFECTIONS PARASITIC
INFECTIONS
- Bronchitis - Specific conditions (TB,
- Acute exacerbations of chronic Aspergillosis)
bronchitis - Lung abscess & empyema
- Bronchiolitis - Infections in cystic fibrosis
- Pneumonia (may be fatal)

PNEUMONIA

PNEUMONIA
- Inflammation of lung parenchyma
- Consolidation seen in physical examination & X-Ray
COMMUNITY-
LOBAR NOSOCOMIAL ASPIRATION
BRONCHOPNEUMONIA AQCUIRED
PNEUMONIA PNEUMONIA PNEUMONIA
PNEUMONIA
- Alveolar - Alveolar - Healthy - Hospitalized - Involving
process process here & persons not patient gastric
in there hospitalised confined to acid,
entire - Contaminant & recently serious
lobe autoimmune
disease cause
pneumonia

TYPES OF PNEUMONIA BASED ON ETIOLOGY

BACTERIAL ATYPICAL ASPIRATION

Most common - Not typical bacterial - Passage of food, H2ZO,

in acute lobar stomach acid, material into
Streptococcus
community - Mycoplasma lungs
pneumoniae
acquired pneumonia - Anaerobic organism from
pneumonia - Legionell pneumophila periodontal disease
-Hemorrhagic -Legionnaire’s disease - Culture show a mixed
Stretococcus - Chlamydia spp causing growth of
pneumonitis
pyogenes pneumonitis o Actinomyces
-Empyema
o C.trachomatis o Bacteroides
H.influenza &
Common in o C.psittaci o Peptostreptococcus
Kleb
elderly o C.pneumoniae o Veilonella
pneumoniae
- Coxiella burnetii o Propionibacterium
P.aeruginosa, Nosocomial o Eubacterium
E.coli pneumonia o Fusobacterium
 VIRAL PNEUMONIA
- Rare in healthy adults
- Influenza viruses has high mortality in elderly and in patients with underlying diseases
- Complication of influenza is secondary to bacterial pneumonia
- RSV pneumonia in infants & institutionalized adults
- Adenoviruses, 1,,3,7,7a – fatal pneumonia in adults
- VZV pneumonitis -19 years old. Morality high 10 to 30%
- Measles pneumonnia may occur in adults

OTHER PNEUMONIAS & IMMUNOSUPPRESSION

CMV & HSV
Actinomyces & Nocardia
Cryptococcus & Sporothrix
Blastomyces, Coccidioides
immitis, Histoplasma &
Paracoccidioides
Aspergillus & Candida spp.
Pneumocystis carinii.
- Cause fatal pneumonitis in immunocompromised pt
- Giant-cell pneumonia-complication of measles & seen in
immunodeficiency or cancers, chidren who receive live
attenuated measles vaccine
- Pneumonitis in immunocompromised pt
- Chronic pneumonia
- Serious in immunoc pts
- Found worldwide
- Cause chronic pneumonia
- Serious in immunoc pts
- Found in specific geographic distribution
- Cause pneumonias in severely ill or immunosuppressed pts
& neonates
- Cause pnumonia in immunosupp by AIDS, hematologic
cancers or medical therapy
- Most common in AIDS pt with CD4 count <200/mm3

PATHOGENESIS

1. Infectious agents enter LRT by inhalation of aerosols aspiration of URT flora or hematogenous
seeding
2. Pneumonia occurs when lung defense mechanisms are diminished or overwhelm
 COMPLICATIONS
SYMPTOMS

- Cough
- Chest pain - Abscesses
- Fever - Respiratory failure
- Shortness of breath - Bacteraemia
- Sputum production - Pleural effusions and empyema
- Tachycardic - Collapsed lung
- (Depend on pt : headache, confusion, - Hemoptysis
abdominal pain, nausea, vomiting, - Dissemination to heart and other parts of
diarrhea) body

MICROBIOLOGIC DIAGNOSIS

Sputum examine for organism in pt with bacterial pneumonia

Blood & plural fluid culture
Acid-fast stains & cultures
Acid-fast stains & cultures
Culture of sputum or
fungal pneumonias
lung tissue
viruses, M.pneumonia, C.burnetii, Chlamydia sp, Legionella, Francisella &
Serology
Yersinia
Rise in serum cold
seen in M.pneumoniae infection but +ve in only 60% of pts
agglutinins
Rapid diagnostic test PCR & DNA probe for viruses
FTAB Legionella
Sputum Quellung test For S.pneumoniae by serotype
ELISA, DNA probe, PCR Available for many agents
 PREVENTION AND TREATMENT
- Therapy based on :
o Clinical history & history of exposure
o Age
o Underlying disease & past pneumonias
o Geograpphy location
o Severity, symptoms & sputum examination
- On diagnosis, therapy specific to organism
PNEUMOCOCCAL VACCINE Given to high risk & splenic pts, eldery & immunoc pts
YEARLY INFLUENZA
For the above groups
VACCINATION
ENTERIC-COATED VACCINE Certain adenovirus serotype used only in military recruits
Trimethoprim /
AIDS pts
sulfamethoxazole
Aerosolized pentamidine /
For prophylaxis of Pneumocystis carinii infection
other antimicrobials
 TUBERCULOSIS
- Primary infection of lungs
- Lung infection by atypical mycobacterium – MOTT & NTM
- Serious infection in immunoc pts

PATHOGENESIS - TB taken up by alveolar macrophages

- Non-resistat mcrphage engulf them & deposit in lymph nodes
- CMI initiated, detectable after 4-6 weeks by skin tesrt
- +ve test seen as induration & erythema in 48-72 hours
- CMI response curb spread by containing in tubercles
- Tubercles heal – fibrotic & calcify persist life long
SYMPTOMS Primary TB often asymptomatic
COMPLICATIONS Extra pulmonary infection
DIGNOSIS Ziehl-Neelsen, IF, PCR, Culture
PREVENTION BCG Vaccine