PNEUMONIA

Dr. Syamsudin Abdillah
Faculty of Pharmacy Pancasila
University
Postdoctoral Researcher at IIUM

E.mail: syamsudin.abdillah@yahoo.co.id

Pneumonia
Infection of the pulmonary parenchyma
caused by various bacterial species, virus,
fungi and parasites
 Not a single disease, but a group of specific
infection, each having different epidemiology,
pathogenesis, clinical manifestations and
clinical
course
 Not a single disease, but a group of specific

Epidemiology Indonesia morbid------10-20% (<5 yo) mortal ------ 6/1000 .

atau Klebsiella sp Chlamydia trachomatis  Children o o o Streptococcus pneumoniae Haemophillus influenzae tipe B Staphylococcus aureus . Colli.Etiology  Neonatus o o o Streptokokus grup B Bakteri gram negatif seperti E. Pseudomonas sp.

 adult o o Mycoplasma pneumoniae Streptococcus pneumoniae .

Etiology o o o Respiratory Syncytial Virus (RSV) Rhinovirus Virus Parainfluenzae .

Pathogenesis pneumonia    Know routes of infection Mechanisms of defense Factors impairing defense .

Know routes of infections    Aspiration Inhalation hematogenous .

Know routes of infection .

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Factors that determine the etiologic agent 1. Community Hospital Age Comorbid condition . 3. Setting from which infection is acquired   2.

stagnation and sediment accumulation:  Legionella species .< 10% of HAP  Enteric Gm (-) bacilli & Pseudomonas aeruginosa>50% of HAP  Water storage system with warm temp.Community acquired infection: Streptococcus pneumonia  Haemophilus influenza  Chlamydia pneumonia  Mycoplasma pneumonia  Hospital Acquired Pneumonia (HAP) Staphyloccocus aureus.

catarhallis .Age Factor:  Infants < 6 months:  RSV  Chlamydia trachomatis  6 months to 5 years:  H. pneumonia  C. influenza  M. influenza  Young adults:  M. pneumonia  Hantavirus  Elderly  H.

Co-morbidities HIV  Pneumocystis carinii  M. tuberculosis .

Clinical Manifestation Community Acquired Pneumonia Atypical  Typical  Nosocomial Pneumonia Aspiration Pneumonia .

pleuritic chest pain. mixed aerobic & anaerobic oral flora Onset gradual Abrupt Cough Dry cough Productive cough Sputum scanty Purulent Pulmonary signs and symptom Shortness of breath Shortness of breath. C. Mycoplasma.Atypical Pneumonia Syndrome Typical Pneumonia Syndrome Etiology M. Klebsiella sp. viruses S. rales Extrapulmona Prominent (headache. diarrhea) Not prominent . vomiting. sign of pulmonary consolidation. pneumonia. nausea. Legionella sp. ry symptoms myalgia. fatigue. H. influenza. pneumonia. pneumonia.

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Laboratory Examination A. Chest X ray (PALateral views)  New parenchymal infiltrate  Confirms the diagnosis  Assess the severity / prognostication  May suggest the etiology .

Causes of Pulmonary Cavities INFECTIOUS Bacteria: oral anaerobes (Bacteroides spp. enteric aerobic Gm (-) bacilli.. Strep pneumoniae serotype III. Staphylococcus aureus.). infected bullae and cysts . Nocardia spp Fungi: Histoplasma capsulatum. Pseudomonas aeruginosa. Actinomyces spp. infarction. Coccidioides immitis. Legionella spp.Fusobacteria. Blastomyces spp NON-INFECTIOUS Neoplasm. Wegener’s granulomatosis. Mycobacterium tb..

Laboratory Examination B. LA  not routinely done  Better specificity . PSB. TTA. Sputum Examination  Gram stain  Good specimen: >25 PMN. <10 epith cell per LPF  Sensitivity: 60-80%  Specificity: 85% in identifying pneumococcus  Culture  40-60% specificity  BAL.

Gold standard in Dx of Pneumonia E. Serologic Test  Urinary antigen test  Legionella pneumophila  Indirect immunoflourescence  IgM>1:20. Blood Culture. creatinine . IgG>1:128 – diagnostic for Chlamydia pneumoniae  IgM>1:16. liver function. IgG>1:128 .diagnostic of Mycoplasma peumoniae D. electrolytes.Laboratory Examination C. Other tests  CBC.

Pharmacotherapy Self-Assessment Program. Pneumonia.) Adapted with permission from Fish D. (CAP = communityacquired pneumonia. Mo.Algorithm for the management of CAP.: . Kansas City. PSAP.

aeruginosa: IV non-pseudomonal B lactam w/ or w/o B lactamase inhibitor plus IV macrolide OR IV antipneumococcal fluoroquinolone W/ risk of P.aminoglycoside or IV ciprofloxacin .Empiric Treatment  LOW RISK CAP Previously healthy: amoxicillin or extended macrolide. alternative: cotrimoxazole with stable co morbid illness: co-amoxyclav or sultamicillin or 2nd gen cephalosporin or extended macrolide MODERATE RISK CAP .IV non pseudomonal B lactams w/ or w/o B lactamese inhibitor plus macrolide OR antipneumococcal fluoroquinolone HIGH RISK CAP No risk for P. aeruginosa: IV antipseudomonal B lactam w/ or w/o B lactamase inhibitor plus IV macrolide or IV antipeumoccocal fluoroquinolone +/.

Others  Mucolytics  N-acetylcysteine (fluimucil).Treatment A. Empiric Antibiotic Therapy B. ambroxol  Expectorant  Glyceryl Guiacolate  Nebulization  salbutamol . Specific Antimicrobial based on isolated organism culture C.

c om .pots6a.usuhs.mil/fap/capcon07 images.multiplycontent.multiply.References   www.