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Pneumonia

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by

Georgina Courquin

on 25 January 2015

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Transcript of Pneumonia

Pneumonia
Definition
Inflammation
of the lung in which the lung
consolidates
Epidemiology
-Leading infectious cause of death in children worldwide- 15% of deaths!

- In UK, major cause of death in the over 70s. Better treatment facilities mean less younger deaths.

-Common end process in many diseases

Aetiology
Risk Factors:

Age
Smoker
COPD
Occupation
Hospitalisation
Ciliary Dyskinesia
Immunocompromised
Alcohol Excess
IVDU




Classification
Site-
Lobar
Pneumonia vs
Broncho
pnuemonia

Aetiology -
Bacterial
,
Viral
or
Fungal
-
Community
Acquired vs
Hospital
Acquired
-
Typical
vs
Atypical
Bacteria
CAP-
S
treptococcus pneumoniae

Most common!

-
Mycoplasma pneumoniae
-common in institutions

-
Haemophilus influenzae -
common in COPD


-
Staphylococcus aureus
-v rare
http://www.who.int/mediacentre/factsheets/fs331/en/ (Nov 2014)
Lobar:- https://courses.stu.qmul.ac.uk/smd/kb/microanatomy/senior/resp2/images/rx3.jpg
Bacteria 2
HAP-
Gram negative
Bacteria

-
Klebsiella pneumoniae
- usually older patients

-
Pseudomonas aeruginosa
- CF patients
Atypical Bacteria
These do not culture- require
immunofluorescence
Chlamydia pnemoniae
- often a whole family.

Legionella pnemophila
- Travel history

Mycoplasma pneumoniae
- already mentioned
Viruses
Rare!
-
CMV
- if immunocompromised
-
Influenza A
- v high mortality
Funghi
PneumoCystis Pneumonia (PCP) caused by
Pneumocystis jiroveci
esp in
immunocompromised
-
sign of
HIV
!
Aspiration Pneumonia
-Aspiration of acidic
gastric contents
into the lungs leading to
damage
and
inflammation
of the lung tissue
-Due to
reduced consciousness
e.g. excess alcohol or
impaired swallow
e.g. stroke
Pathogenesis
Predisposition -->Infection-->
Inflammation-->
Exudate
-->
Consolidation
Signs and Symptoms
-Cough
-Dyspnoea
-Increased Respiratory Rate
-Pleuritic Pain
-Crackles
-Bronchial Breathing
-Dull Percussion
-Increased Vocal Resonance
-Fever
-Increased Heart Rate
-Decreased Blood Pressure
-Headache
-Nausea and Vomiting
Investigations
-
History and Examination
-Bloods inc.
ABG
-Cultures- both
blood
and
sputum
-Imaging-
CXR
http://radiologymasterclass.co.uk/tutorials/chest/chest_pathology/chest_pathology_page3.html#top_second_img
Complications
-
Abscess
- pus in lung tissues

-
Empyema
- pus in pleural cavity
Management
-
ABCDE
-may need to give oxygen
Conservative
-Stop underlying cause
-Analgesia
-Physiotherapy
-Pulmonary Rehab
Medical
-Antibiotics- start ASAP on broad spectrum and tailor after culture
CAP:
CURB-65
Score 0-1= Mild. Oral Amoxicillin (or erythromycin)
Score 2= Admission. i.v. amoxicillin+erythromycin
Score 3+= ICU. i.v. co-amoxiclav+erythromycin

HAP:
Gram -ve antibiotics e.g. co-amoxiclav or ciprofloxacin
Prognosis
(if CURB-65 >3, 50% chance of death).
Depends!!
CAP-
5%
mortality
Full transcript