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Pneumonia

The Pathology, Presentation and Treatment of Pneumonia.
by

Laura Trew

on 31 May 2011

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Transcript of Pneumonia

Pneumonia Pathology, Presentation and Treatment Inflammation of the lung parenchyma in which some or all of the alveoli are filled with fluid and blood cells. It can be caused by viruses, bacteria, or other microorganisms, and is sometimes caused by physical and chemical irritants. Classification Community Acquired
Pneumonia Hospital Acquired Pneumonia Community acquired pneumonia:
Developed in outpatient setting or less than 48 hours post admission.
May be primary infection in previously healthy individuals
Or may be in association with another disease (e.g COPD) Hospital Acquired Pneumonia:
Developed in hospital setting or at least 48 hours post admission.
Often more serious than CAP as patients who have been in hospital for some time are more likely to have impaired defence mechanisms against infection.
Often occurs in ventilated patients. Ventilator Associated Pneumonia Developed >48 hours post intubation.
Common in ICU patients.
Severe form of pneumonia, often fatal.
Mechanical ventilation increases the risk of infection.
Increased risk of ARDS Lobar Pneumonia Bronchial Pneumonia Interstitial Pneumonia Healthcare Associated Pneumonia A recently introduced type of pneumonia lying between CAP and HAP.
In patients living outside the hospital who have recently been in close contact with the health care system. Stages of Pneumonia 1) Infammatory or Congestion Stage 2) Red Hepatisation Stage 3) Grey Hepatisation Stage 4) Resolution Stage Patterns Inflammatory Stage:
Occurs within 24 hours of infection.
There are signs of vascular congestion.
An influx of fluid into the alveoli. Red Hepatisation
Vasodilation of the capillaries supplying alveoli.
Alveolar spaces become packed with neutrophils, RBCs and fibrin.
The exudate begins to consolidate. Grey Hepatisation
RBCs start to disintegrate.
Fibrinous exudate still remains, but exudate is now becoming clearer in colour.
A small amount of blood stained sputum may now be expectorated. Resolution
The final stage of infection
The enzymes in the lungs break down the substances causing inflammation.
The white blood cells fight off the invading organism and the remains may be coughed up.
This is the stage at which physiotherapy is required. Pathology Lobar Pneumonia
Single lobe, or section, of lung involved.
Organisms widely colonise alveolar spaces.
Localised pleuritic pain.
Commonly caused by Streptococcus pneumonia.
Less likely, and more severely caused by Klebsiella pneumonia. Bronchial Pneumonia
Patchy and diffuse
Organisms colonise bronchi then spread to alveoli
Favouring lower lobes
Common in the elderly and immobile Interstitial Pneumonia
Also known as interstitial pneumonitis
Involves the areas in between the alveoli
More likely to be caused by viruses or by atypical bacteria Typical Bacteria:
Gram Positive
Streptococcus pneumoniae
Staphylococcis aureus
Enterococcus
Gram Negative
Pseudomonas aeruginosa
Klebsiella pneumoniae
Haemophilus influenzae Atypical Bacteria:
Mycoplasme pneumonia
Chylamidophilia species
Legionella Species
Coxiella burnetii
Bordetella pertussis

Undetected on gram stain Aspiration pneumonia:
The spilling of gastric contents or foreign matter below the vocal cords.
Can be a postoperative complication.
Pneumonia usually occurs within 2 hours of aspiration.
Legionella pneumonia:
An atypical pneumonia occuring in local outbreaks.
Often in connection with cooling systems or inadequately cleaned small-volume nebulisers
Pneumocystis Carinii pneumonia:
In patients with impaired defense mechanisms against infection (i.e. HIV) Risk Factors • Winter months
• Immunosuppression
• Smoking
• Alcoholism
• Infancy or Old Age
• Chronic lung, heart, liver or renal diseases
• Diabetes Mellitus •Pyrexia
•Tachycardia
•Chest Pain
•Dyspnoea
•Decrease in exercise tolerance
•Cough (Productive according to stage of infection) Presenting Symptoms On Examination Using accessory muscles
Cyanosis
Decreased chest expansion
On auscultation- crackles or a wheeze, bronchial breath sounds
Dull percussion note
Chest x-ray- ill defined margins and patchy opacity Acute Stage
Oral or IV fluids
Antiviral or antibacterial drugs
Oxygen therapy
Positioning for V/Q matching
BiPAP for patients who have type II respiratory failure, especially if they have underlying COPD
CPAP for patients who have type I respiratory failure Treatment 1) In the acute stage 2)During the resolution stage Resolution stage:
Secretion clearance-
If patient has an effective cough ACBT can be used
Suctioning may be required if patient’s cough is ineffective.
Suctioning can be used in conjunction with postural drainage and expiratory vibs and shakes as well as nebulisers.
If suctioning is not tolerated then the cough assist can be used Other classifications
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