1 PNEUMONIA-.. [YR 4] APRIL 2022_102703.pptx

1 PNEUMONIA-.. [YR 4] APRIL 2022_102703.pptx

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  C B U- S O M / N D O L A T E A C H I N G H O S P I T A L I N T E R N A L M E D I C I N E A P R I L 2 0 2 2 PNEUMONIA Dr C Nyirenda
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  Learning objectives  Atthe end of this unit the student will be able to: 1. Define Pneumonia 2. List the etiologic agents of Pneumonia occurring in different settings 3. Describe the mode of transmission of Pneumonia 4. Understand the epidemiology of Pneumonia. 5. Describe the pathophysiology of Pneumonia 6. Identify the clinical manifestations of Pneumonia 7. List the complications of Pneumonia 8. Describe the most common investigations for the diagnosis of Pneumonia 9. Make an accurate diagnosis of Pneumonia 10. Manage most cases of Pneumonia appropriately 11. Refer complicated cases of Pneumonia
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  Definition  Pneumonia isan acute infection of the lung parenchyma including alveolar spaces and interstitial tissue.  Involvement may be confined to an entire lobe -Lobar pneumonia  A segment of a lobe-Segmental or lobular pneumonia  Alveoli contiguous to bronchi - Bronchopneumonia  Interstitial tissue - Interstitial pneumonia  These distinctions are generally based on x-ray observations.
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  Risk factors Predisposing factorsfor pneumonia include:-  Preceding respiratory viral infections  Alcoholism  Cigarette smoking  Underlying diseases such as Heart failure, COPD  Age extremes  Immunosuppressive therapy and disorders  Decreased consciousness, comma, seizure etc.  Surgery and aspiration of secretions
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  Pathogenesis  The usualmechanisms to develop pneumonia are either to inhale droplets small enough to reach the alveoli, or to aspirate secretions from the upper airways. Other means include  hematogenous dissemination, via the circulation, or directly from contiguous infections.
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  Epidemiology CAP versus HAP •Community-acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital-acquired (nosocomial) pneumonia (HAP). • CAP is a common and potentially serious illness . It is associated with considerable morbidity and mortality, particularly in older adult patients and those with significant comorbidities.
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  Pneumonia in specialpopulations  aspiration pneumonia,  Hypostatic pneumonia  Pneumonia in the immunocompromised patients,  ventilator-associated pneumonia (VAP) etc.
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  Etiopathogenetic basis  CAP;Streptococcus pneumonia, Haemophilus influenza and Mycoplasma pneumoniae. Others- Staph. Aureus, Legionella species  HAP; Pseudomonas, Klebsiella, Bacteroides, Clostridia and also Staph aureus  Aspiration e.g in stroke, oesophageal disease, myasthenia..; mainly oropharyngeal anaerobes but also gram positives and possibly negatives  Immunocompromised; PJP, other fungal species, viruses (e.g HSV, CMV), Strep pneumonia, H. Influenza, M. Pneumonia also
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  Clinical presentation  Subjective:fever, rigors, malaise, anorexia, dyspnoea, cough, purulent sputum, haemoptysis and chest pains  Objective: febrile, cyanosis, confusion, tachypnoea, tachycardia, hypotension, reduced air entry, crepitations,bronchial breath sounds and increased vocal resonance
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  Investigations  Laboratory; FBC/DC,U&E,LFT, CRP, blood cultures, sputum m/c/s, urine Ag –legionella and pneumococcus. Pleural fluid for culture??  Bronchoscopy and bronchoalveolar lavage  Radiological; CXR, CT or MRI in case of complicated cases
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  Complications  Pleural effusions,empyema, lung abscess, respiratory failure, septicaemia, brain abscess pericarditis, myocarditis etc
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  Severity scale  CURB-65 score  C- confusion, U- urea> 7 mmol/l, R- rate >=30/min,  BP < 90 systolic and /or 60 mmHg diastolic, age > 65  Scores 0-1; home treatment; 2 hospitalization, >=3 severe pneumonia  Increased mortality in co-morbidity and reduced arterial partial pressure of oxygen e.g < 8 kpa
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  Management  Oxygen therapydepending on severity; BLS as appropriate  IV fluids e.g in dehydration and shock.  Antibiotic therapy; oral in mild disease e.g CURB 0-1 or if not vomiting. IVs in severe disease  Empirical options:  CAP; mild-penicillins or macrolides or fluoroquinolones. Severe-Co-amoxyclav iv or cephalosporin iv . Erythromycin iv in case of Mycoplasma pneumonia
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  Management contn  HAP;Aminoglycoside iv + penicillin or 3rd generation cephalosporin iv  Aspiration; Cephalosporin iv + metronidazole iv  Others; PJP- high dose co-trimoxazole
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  END…  Q/Cs??