PNEUMONIA

PRESENTER :
JONATHAN KATANA
CLINICAL OFFICER.
 DEFINITION

Pneumonia is an inflammatory condition of the lung

primarily affecting the lung alveoli characterized by
productive or dry cough, chest pain, fever and difficulties in
breathing.
 SIGNS AND SYMPTOMS
The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type
of germ causing the infection, and your age and overall health. Mild signs and symptoms often are
similar to those of a cold or flu, but they last longer.
Signs and symptoms of pneumonia may include
 Chest pain when you breathe or cough
 Confusion or changes in mental awareness (in adults age 65 and older)
 Cough, which may produce phlegm
 Fatigue
 Fever, sweating and shaking chills
 Lower than normal body temperature (in adults older than age 65 and people with weak immune
systems)
 Nausea, vomiting or diarrhea
 Shortness of breath
Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and
cough, appear restless or tired and without energy, or have difficulty breathing and eating.
 RISK FACTORS
 Adults older than age 65
 Children younger than age 2 with signs and symptoms
 People with an underlying health condition or weakened immune system
 People receiving chemotherapy or taking medication that suppresses the
immune system
 For some older adults and people with heart failure or chronic lung
problems, pneumonia can quickly become a life-threatening condition.
 CAUSES

 Many micro organisms can cause pneumonia. The most

common are bacteria and viruses in the air we breathe.
Your body usually prevents these microbs from infecting
your lungs. But sometimes these organisms can overpower
your immune system, even if your health is generally
good.
 CLASSIFICATION

Pneumonia can be classified into many ways including:

1, PLACE OF ACQUISATION.
(a) Community-acquired pneumonia (CAP) is infectious pneumonia in a person who has not recently been
hospitalized. CAP is the most common type and mostly caused by streptococcus pneumoniae in adults and
heamophilus influenza in children.

(b) Hospital-acquired pneumonia, also called nosocomial pneumonia, is pneumonia acquired during or after

hospitalization for another illness or procedure with onset at least 72 hrs after admission. Up to 5% of patients
admitted to a hospital for other causes subsequently develop pneumonia due to some risk factors including 
mechanical ventilation, prolonged malnutrition, underlying heart and lung diseases, decreased amounts of stomach
acid, and immune disturbances. Prognosis is poor since the microorganisms a person is exposed to in a hospital are
often different from those at home and also may include resistant bacteria such as MRSA, Pseudomonas, 
Enterobacter, and Serratia. Because individuals with hospital-acquired pneumonia usually have underlying
illnesses and are exposed to more dangerous bacteria, it tends to be more deadly than community-acquired
pneumonia. Ventilator-associated pneumonia (VAP) is a subset of hospital-acquired pneumonia. VAP is pneumonia
which occurs after at least 48 hours of intubation and mechanical ventilation.
2. AETIOLOGICAL CLASSIFICATION.
(a) bacterial pneumonia- The most common cause of bacterial pneumonia is Streptococcus pneumoniae.
This type of pneumonia can occur on its own or after you've had a cold or the flu. It may affect one part (lobe)
of the lung, a condition called lobar pneumonia.

(b) Viral pneumonia -including COVID-19. Some of the viruses that cause colds and the flu can cause
pneumonia. Viruses are the most common cause of pneumonia in children younger than 5 years. Viral
pneumonia is usually mild. But in some cases it can become very serious. Coronavirus 2019 (COVID-19) may
cause pneumonia, which can become severe.

(c) Fungal pneumonia-This type of pneumonia is most common in people with chronic health problems or
weakened immune systems, and in people who have inhaled large doses of the organisms. The fungi that
cause it can be found in the lung as a commensal e.g. . Pneumocystis jirovesi, or can be found in the soil.

(d) Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces
milder symptoms than do other types of pneumonia. Walking pneumonia is an informal name given to this
type of pneumonia, which typically isn't severe enough to require bed rest.
3. ANATOMICAL CLASSIFICATION.

(a) lobar pneumonia- is an infection that only involves a single lobe, or section, of a lung. Lobar pneumonia
is often due to Streptococcus pneumoniae (though Klebsiella pneumoniae is also possible.)

(b) Multilobar pneumonia- involves more than one lobe, and it often causes a more severe illness.

(c) Bronchial pneumonia- affects the lungs in patches around the tubes (bronchi or bronchioles).

(d) Interstitial pneumonia -involves the areas in between the alveoli, and it may be called "interstitial
pneumonitis." It is more likely to be caused by viruses or by atypical bacteria.
 DIAGNOSIS

The main stem of diagnosis is primarily dependent on history and physical examination while investigations
account for 20%.

INVESTIGATIONS
1,LABORATORY INVESTIGATIONS
(a) CBC. -
(b), CRP. -Elevated c -reactive protein >20%
(c), ATERIAL BLOOD GAS.- reduced blood oxygen
(d), SERUM ELECTROLYTE LEVELS.- reduced
(e) SPUTUM CULTURE.- isolated specific micro organisms

2, RADIOLOGICAL INVESTIGATIONS
(a) CHEST X RAY.- lung consolidation seen esp. in community acquired pneumonia
(b) CT SCAN.
 MANAGEMENT.

Oral antibiotics, rest, simple analgesics and fluids usually suffice for complete
resolution. However, those with other medical conditions, the elderly, or those with
significant trouble breathing may require more advanced care. If the symptoms worsen
or the pneumonia does not improve with home treatment, or complications occur,
hospitalization may be required.
 TREATMENT

Treatment is usually based on the causative agent, severity and presence of complications.

Bacterial pneumonia

Mild pneumonia

Antibiotics improve outcomes in those with bacterial pneumonia hence the first dose of antibiotics should be
given as soon as possible. Increased use of antibiotics, however, may lead to the development
of antimicrobial resistant strains of bacteria. Antibiotic choice depends initially on the characteristics of the
person affected, such as age, underlying health, and the location the infection was acquired. Treatment before
culture results with amoxicillin is recommended as the first line for community-acquired pneumonia,
with doxycycline or clarithromycin as alternatives. Amoxicillin, doxycycline, and in some areas
a macrolide (such as azithromycin or erythromycin) is the first-line outpatient treatment in adults. In children
with mild or moderate symptoms, amoxicillin taken by mouth is the first line. The use of fluoroquinolones in
uncomplicated cases is discouraged due to concerns about side-effects and generating resistance in light of
there being no greater benefit.
Severe bacterial pneumonia.

The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (3–5 days)
may be effective for certain types of pneumonia and may reduce the risk of antibiotic resistance. For pneumonia that is associated with
a ventilator caused by non-fermenting Gram-negative bacilli (NF-GNB), a shorter course of antibiotics increases the risk that the
pneumonia will recurre.

Recommendations for hospital-acquired pneumonia include third- and fourth-generation cephalosporins, carbapenems, 

fluoroquinolones, aminoglycosides, and vancomycin. These antibiotics are often given intravenously and used in combination. In those
treated in hospital, more than 90% improve with the initial antibiotics.

For people with ventilator-acquired pneumonia, the choice of antibiotic therapy will depend on the person's risk of being infected with
a strain of bacteria that is multi-drug resistant. Once clinically stable, intravenous antibiotics should be switched to oral antibiotics. For
those with Methicillin resistant Staphylococcus aureus (MRSA) or Legionella infections, prolonged antibiotics may be beneficial.

The addition of corticosteroids to standard antibiotic treatment appears to improve outcomes, reducing death and morbidity for adults
with severe community acquired pneumonia, and reducing death for adults and children with non-severe community acquired
pneumonia. There is some evidence that adding corticosteroids to the standard PCP pneumonia treatment may be beneficial for people
who are infected with HIV.
 Viral

Neuraminidase inhibitors may be used to treat viral pneumonia caused by influenza viruses (influenza A and influenza B). No
specific antiviral medications are recommended for other types of community acquired viral pneumonias including SARS
coronavirus, adenovirus, hantavirus, and parainfluenz virus. Influenza A may be treated with rimantadin or amantadine, while influenza A or B
may be treated with oseltamivi, zanamiv or peramivir. These are of most benefit if they are started within 48 hours of the onset of symptoms.
Many strains of H5N1 influenza A, also known as avian influenza or "bird flu", have shown resistance to rimantadine and amantadine. The use
of antibiotics in viral pneumonia is recommended by some experts, as it is impossible to rule out a complicating bacterial infection. The British
Thoracic Society recommends that antibiotics be withheld in those with mild disease. The use of corticosteroids is controversial.

Fungal pneumonia (pcp).

 We recommend trimethoprim-sulfamethoxazole (TMP-SMX) as the treatment of choice for PCP of any severity in HIV-uninfected patients .
The dose of TMP-SMX for patients with normal renal function is 15 to 20 mg/kg intravenously or orally daily in three or four divided doses.
Patients should receive intravenous therapy until they are clinically stable (eg, PaO2 ≥60 mmHg, respiratory rate <25) and have a functioning
gastrointestinal tract.

For patients with allergy to TMP-SMX, desensitization should ideally be performed since TMP-SMX is the most effective regimen. However, if
the patient has a history of a severe allergy (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis), TMP-SMX should be avoided and
desensitization should not be performed hence an alternative dapson can be used.
 PROGNOSIS

With treatment, most types of bacterial pneumonia will stabilize in 3–6 days though It
often takes a few weeks before most symptoms resolve.

 X-ray findings typically clear within four weeks and mortality is low (less than 1%). In
the elderly or people with other lung problems, recovery may take more than 12 weeks.
In persons requiring hospitalization, mortality may be as high as 10%, and in those
requiring intensive care it may reach 30–50%. Pneumonia is the most
common hospital-acquired infection that causes death.

Complications may occur in particular in the elderly and those with underlying health
problems.
 COMPLICATIONS

 Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can

spread the infection to other organs, potentially causing organ failure.

 Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you

may have trouble breathing in enough oxygen. You may need to be hospitalized and use a breathing

machine (ventilator) while your lung heals.

 Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to build up in

the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid

becomes infected, you may need to have it drained through a chest tube or removed with surgery.

 Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated

with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is

needed to remove the pus.

 PREVENTION

 Get vaccinated. Vaccines are available to prevent some types of pneumonia and the flue.

 Practice good hygiene. To protect yourself against respiratory infections that sometimes lead to
pneumonia, wash your hands regularly or use an alcohol-based hand sanitizer.

 Don't smoke. Smoking damages your lungs' natural defenses against respiratory infections.

 Keep your immune system strong. Get enough sleep, exercise regularly and eat a healthy diet
THANK YOU