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PNEUMONIASri Lestari SAYunita Fediani
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Definition Acute inflammation of lung
parenchyma
Inflammatory infiltrate in alveoli (=consolidation)
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Disease Pattern
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PathophysiologyNormally, Lungs Are Well Protected (columnar
epithelial cells, each cell contains about 200 cilia, coordinated waves about 1000x/minute)
Infection Due To:Failure or Defect in Host DefensesExposure to Very Virulent
PathogensExposure to an Overwhelming
Load of Pathogens
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Pathophysiology (cont’)Host defenses:
natural barriers of the bodyantibodies or immunoglobulins productioncellular immunity by phagocytosis
Failure of host defenses:absence of cough or epiglottic reflexdysfunctional muco-ciliary blanket local production of secretory iga is reduced immune response stunted: defective neutrophil function,
decreased immunoglobulin productionprior viral infection (common cold) compromises overall immunitysystemic sepsis weakens immune response
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Pathophysiology (cont’)Microbial pathogens enter the lung by:Aspiration of organisms from oropharynx
Gram positive and anaerobes: Strep. pneumonia, Haemophyllus influenzae, Mycoplasma, Moraxella, Actinomyces
Gram negatives: E.colli, Pseudomonas sp., Klebsiella sp.
Inhalation of Infectious AerosolsInfluenza, Legionella, Psittacosis, Histoplasmosis,
TBHematogenous Dissemination
Staph aureusFusobacterium infections of the retropharyngeal
tissues: Lemierre’s syndromeDirect inoculation and Contiguous Spread
Tracheal intubation, stab wounds
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Etiologic PathogensLess than half of all cases with identified
pathogensStreptococcus pneumoniae: most common
cause of uncomplicated pneumonia in all age groups (except newborns)
Atypical bacteria:mycoplasmachlamydia
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Classification Morphological:
BronchopneumoniaLobar pneumonia
Location:Community-acquired pneumoniaHospital acquired pneumonia (nosocomial
infection)
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Clinical ManifestationVaries with agePathogens: Group B Streptoccus, E coli,
PneumococcusStaphylococcus aureus and rarely Group A
Strep are severeAtypical bacteria mycoplasma tends to be
mild
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Symptoms and signsNon-specific: fever, malaise, headache, GI
complaints, restlessness, apprehensionRespiratory: tachypnea, dyspnea, shallow
or grunting respiration, cough, nasal flaring, intercostals retraction
Pleuritic: referred pain to neck and back, abdominal pain if diaphragmatic involvement
Extra-pulmonary: disseminated disease, skin and soft tissue involvement arising from bacteremia, meningitis
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DiagnosisClinical history and examinationLaboratory:
CBC: leukositosisCRP: ↑
Serologic: ASTO, antiDnase BSputum analysis: gram stain, cultureChest x-ray:
Infiltrate: interstitiel, alveolar (consolidation), diffuseProminent marking of bronchovascular patternPeribronchial cuffing, hyperaeration
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Management Appropriate AntibioticsOxygen SupportBronchodilatorHumidityPostural DrainageHydration/Fever Control/Nutritional Support
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Prevention HIB conjugate vaccine virtual eliminated
of disease in infants and childrenConjugate polysaccharide pneumococcal
vaccine approved (for children upper 2 years old)
Pneumococcal vaccine strain 23 (for children under 2 years old)
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Complication Rupture into pleural space ⇒ empyema or
broncho-pleural fistula (⇒ pyopneumothorax).Rupture into pericardium ⇒ pericarditis.Septicemia ⇒ sepsis in other organs e.g.
osteomyelitis, brain abscess.Erosion of blood vessels ⇒ haemoptysis.Organisation ⇒ fibrosis
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Thank you