Devdutt Singh

Shekhawat
Ph.D. Scholar

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 Introduction
Pneumonia is a general term in widespread use, defined as infection
within the lung. It is due to material, usually purulent, filling the alveoli.

• Pneumonia is a form of acute respiratory infection that is most

commonly caused by viruses or bacteria. It can cause mild to life-
threatening illness in people of all ages, however it is the single
largest infectious cause of death in children worldwide.

• Pneumonia killed more than 808 000 children under the age of 5 in
2017, accounting for 15% of all deaths of children under 5 years.
People at-risk for pneumonia also include adults over the age of 65
and people with preexisting health problems
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⦿ Pneumonia is an inflammation of the lung parenchyma (i.e.
alveoli rather than the bronchi) of infective origin.

⦿ It is the most common infectious cause of

death.

⦿ It is usually characterized by
consolidation.

⦿ Consolidation is a pathological process

in which the alveoli are filled with a
mixture of inflammatory exudate, bacteria
& WBC
 Terms and Definitions

Aspiration-Aspiration occurs when a person accidentally inhales

particles into their airway.
Pneumonia-Pneumonia is an infection that inflames the air sacs in one
or both lungs. The air sacs may fill with fluid or pus (purulent material),
causing cough with phlegm or pus, fever, chills, and difficulty breathing.
A variety of organisms, including bacteria, viruses and fungi, can cause
pneumonia.
Dysphagia- Dysphagia is difficulty swallowing — taking more time and
effort to move food or liquid from your mouth to your stomach.
Blood tests. Blood tests are used to confirm an infection and to try to
identify the type of organism causing the infection.
Chest X-ray. This helps your doctor diagnose pneumonia and determine
the extent and location of the infection. A chest x-ray can't
tell the physician what kind of germ is causing the pneumonia.
◾ Occurs throughout the year
◾ Results from different etiological agents varying with the
seasons
◾ Occurs in persons of all ages
◾ Clinical manifestations severe in very young, elderly & in chronically
ill patients

 Bacteria : Streptococcus pneumoniae, Legionella pneumophila,

Chlamydophila pneumoniae, Staphylococcus aureus, Moraxella
catarrhalis, Streptococcus pyogenes, Neisseria meningitidis, Klebsiella
pneumoniae, and Haemophilus influenzae , Pneumocystis jiroveci .
 Viruses : Influenza virus, Adenoviruses, Rhinovirus
 Other infectious agents, such as fungi : Pneumocystis carini

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 Signs and Symptoms
Aspiration Pneumonia
• Chest pain
Sudden coughing, • Shortness of breath
wheezing, or
• Wheezing
hoarseness
• Fatigue
Drooling • A blue tinge to the
Changes in breathing face or lips
patterns • Cough, especially
involving bloody or
Regular coughing or green sputum
sneezing while eating • Bad breath
Gurgling sounds or • Difficulty swallowing
voice after eating • Perspiration
• Fever
Excessive throat
clearing

(Gamache, 2018)
 RISK
FACTORS
Transmission
The viruses and bacteria that are commonly found in a child's nose or throat, can infect
the lungs if they are inhaled.

They may also spread via air-borne droplets from a cough or sneeze. Social distancing
helps reduce the spread, so important in COVID 19 pandemic.

Pneumonia may spread through blood, especially during and shortly after birth.

Research regarding the different pathogens causing pneumonia and the ways they are
transmitted is of critical importance for treatment and prevention.

On inhalation oxygen entering the lung where crosses into the bloodstream, via the
capillaries, for distribution around the body.
Carbon dioxide, a waste product of cell metabolism, enters the lungs from the body in
the bloodstream and crosses over into the lungs where it is then exhaled into the
atmosphere. moving out of the lungs.
During a Pneumonia infection, the alveoli of one or both lungs fill up with pus or fluid.
This increases the work of breathing, and thus gaseous exchange cannot occur as it
normally would.
Lower respiratory and pleural disease

Pneumonia -- infection of alveoli

(viral or bacterial)
vs. Pneumonitis -- immune-mediated
inflammation of alveoli
Empyema:
purulent exudate in
the pleural cavity
Bronchitis --
inflammation of bronchi,
may be immune-
mediated, e.g. asthma,
COPD, or infectious
Abscess: circumscribed (usually viral but can be
collection of pus within bacterial)
the lung parenchyma
Bronchiolitis:
inflammation of
bronchioles (often viral but
can be bacterial)

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 Diagnosing

• Blood tests. Blood tests are used to confirm an infection and to try
to identify the type of organism causing the infection.
• Chest X-ray. An x-ray helps your doctor diagnose pneumonia and
determine the extent and location of the infection. A chest x-ray
can't tell the physician what kind of germ is causing the pneumonia.
• Pulse oximetry. This measures the oxygen level in the blood.
Pneumonia can prevent the lungs from moving enough oxygen into
the bloodstream.
• Sputum test. A sample of fluid from the lungs (sputum) is taken
after a deep cough and analyzed to help pinpoint the cause of the
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infection.
Classified based on two types

1. Type 1
⦿ Lobar pneumonia
⦿ Bronchopneumonia

2. Type 2
⦿ Community- acquired pneumonia (CAP)
⦿ Hospital-acquired pneumonia (HAP)

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⦿ Lobar pneumonia is acute bacterial infection of a
part of lobe the entire lobe, or even two lobes of
one or both the lungs.

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Consolidation confined
to one or more lobes (or
segments of lobes) of
lungs.
⦿ Bronchopneumonia is infection of the terminal
bronchioles that extends into the surrounding
alveoli resulting in patchy consolidation of the
lung.

Pneumoni 12/12/201 9
(Bronchitis and Pneumonia occur
together)
•Patchy
consolidation
usually in the
bases of both
lungs.

Bronchopneumonia
⦿ It includes 4 stages

1. congestion

2. red
hepatization

3. gray
hepatization

4. resolution
Congestion: This is the initial stage, where the lung becomes congested
with blood and fluids, leading to edema (fluid accumulation) and a reddish
appearance.

Red Hepatization: In this stage, the lung becomes firmer and more solid
due to the accumulation of inflammatory cells and fibrin within the alveoli.

Gray Hepatization: The lung tissue becomes grayish as the inflammatory

cells break down and the condition progresses.

Resolution: In this final stage, the infection is gradually resolved, and the
lung tissue returns to its normal state.
• Occurs in the first 24 hours
• Cellular exudates containing neutrophils, lymphocytes and
fibrin replaces the alveolar air
• Capillaries in the surrounding alveolar walls become
congested
• The infection spreads to the hilum and pleura fairly rapidly
• Pleurisy (condition in which the pleura — two large, thin
layers of tissue that separate your lungs from your chest wall
— becomes inflamed) occurs
• Marked by coughing and deep breathing
• The organism multiplies in the serous fluid and infection spreads
• Occurs in the 2-3 days after consolidation.
• At this point, the consistency of the lungs resembles that of the liver.
• The lungs become Hyperemia (Hyperemia is an increased amount of blood in the
vessels of an organ or tissue in the body.).
• Alveolar capillaries are engorged with blood.
• Fibrinous exudates fill the alveoli.This stage is "characterized by the presence of
many erythrocytes, neutrophils, and fibrin within the alveoli.
• The massive dialation of the capillaries and alveoli that are filled with this organism,
neutrophils, RBC, and fibrin.
• The lung appears red and granular, similar to that of liver which is why the process is
called hepatization.
• Occurs in the 2-3 days after Red Hepatization
• This is an avascular stage
• The lung appears "grey-brown to yellow because of
fibrinopurulent exudates, disintegration of red cells, and
hemosiderin"
• The pressure of the exudates in the alveoli causes
compression of the capillaries
• Leukocytes migrate into the congested alveoli
• Blood flow decreases and leukocytes and fibrin consolidate in the
affected part of lung.
• This stage is characterized by the "resorption and restoration of the pulmonary
architecture"
• A large number of macrophages (white blood cell that helps eliminate
foreign substances by overcoming foreign materials and initiating an
immune response) enter the alveolar spaces

• Phagocytosis of the bacteria-laden leucocytes occurs (process by which

particles, microbes or fragments of dead cells are engulfed and
internalized, usually by specific membrane receptors).

• Consolidation tissue re-aerates and the fluid infiltrate causes sputum"

• Complete resolution and healing occurs if there is no complications.
• The exudates become lysed (destruction of cells ) and is processed by
macrophages.
• The normal lung tissue is restored and the persons gas exchange ability
returns to normal.
 High fever, Shaking Chills
 Shortness of breath (Dyspnoea)
 Increased breathing rate
 Chest pain when you breathe deeply or cough
 Dusky or purplish skin colour (cyanosis) from
poorly oxygenated blood
 Fatigue and muscle aches
 Nausea, vomiting or diarrhoea
 Cough, particularly cough productive of
sputum
 Pneumonia which develops in an otherwise healthy person
outside of hospital or have been in hospital for less than 48hrs

Hospital Acquired Pneumonia

Pneumonia that was not incubating upon admission developing in a

patient hospitalized for greater than 48 hrs.
 Bacteria in the bloodstream (bacteremia)
 Lung abscess.
 Build up of fluid in the space between the

lung and chest wall (pleural effusion).

 Difficulty breathing.
 Shock and respiratory failure
 Septic arthritis
 Endocarditis
 Don't smoke.
 Practice good hygiene.
 Stay rested and fit.
 Wearing surgical masks by the sick may also prevent
illness.
 Appropriately treating underlying illnesses (such as

HIV/AIDS, diabetes mellitus, and malnutrition) can

decrease the risk of pneumonia.

 Get a Pneumonia Vaccination.
 Pneumococcal conjugate vaccine
(Prevnar):
For children less than 2 years of age or
between two and four years with certain
medical conditions.

 Pneumococcal polysaccharide
vaccine (Pneumovax) :
Adults who are at increased risk of
developing pneumococcal pneumonia, such
as the elderly, diabetics, those with chronic
heart, lung, or kidney disease, alcoholics,
smokers, and those without a spleen.