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SECONDARY LOBULE
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Normal lung histologyNormal lung histology Inflammatory Cells Inflammatory Cells lsPneumonialsPneumonia
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WHAT IS PNEUMONIA ? WHAT IS PNEUMONIA ?
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Pneumonia: DefinitionPneumonia: Definition
Syndrome Syndrome
caused by acute infection, usually bacterial (may be caused by acute infection, usually bacterial (may be
non bacterial)non bacterial)
Involving lung parenchyma distal to terminal Involving lung parenchyma distal to terminal
bronchioles bronchioles
Characterized by Characterized by clinicalclinical and/or and/or radiographic radiographic
signs signs of consolidation of a part or parts of one or of consolidation of a part or parts of one or
both lungs. both lungs.
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What are symptoms of What are symptoms of Pneumonia ?Pneumonia ?
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Symptoms in PneumoniaSymptoms in Pneumonia
CoughCoughFeverFeverShortness of BreathShortness of BreathRapid Breathing Rapid Breathing ConfusionConfusionRestlessnessRestlessness
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What are signs of Pneumonia
General InspectionGeneral InspectionRespiratory InspectionRespiratory InspectionPalpationPalpationPercussionPercussionAuscultationAuscultation
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Clinical Signs in PneumoniaClinical Signs in Pneumonia
FeverFever TachycardiaTachycardia Rapid Respiratory Rapid Respiratory Cyanosis in Severe casesCyanosis in Severe cases Signs of consolidationSigns of consolidation
Reduced movementReduced movement Dull Percussion sound Dull Percussion sound Bronchial Breathing and CracklesBronchial Breathing and Crackles
My be signs of Pleurisy/ Pleural EffusionMy be signs of Pleurisy/ Pleural Effusion
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Radiological Signs of Radiological Signs of PneumoniaPneumonia
What is the Hall Mark ?What is the Hall Mark ?
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Radiological Signs of Radiological Signs of PneumoniaPneumonia
What is the Hall Mark ?What is the Hall Mark ?
CONSOLIDATION CONSOLIDATION AIRBRONCHOGRAMAIRBRONCHOGRAM
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What is this ?What is this ?
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Pneumonia of RULPneumonia of RUL
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Classification of Classification of PneumoniasPneumonias
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Classification of PneumoniaClassification of Pneumonia
According to Etiology According to Etiology
According to anatomical siteAccording to anatomical site
According to Clinical Settings According to Clinical Settings
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Classification of Pneumonia Classification of Pneumonia
According to Etiological agent According to Etiological agent
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Classification of Pneumonia Classification of Pneumonia
According to Aetiological agent According to Aetiological agent Bacterial PneumoniaBacterial Pneumonia Viral PneumoniaViral Pneumonia Bacteria like & Ricketsial PneumoniaBacteria like & Ricketsial Pneumonia Fungal PneumoniasFungal Pneumonias Parasitic PneumoniaParasitic Pneumonia Chemical Pneumonia (lipoid pneumonia)Chemical Pneumonia (lipoid pneumonia) Physical Pneumonia (ionizing radiation)Physical Pneumonia (ionizing radiation)
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Classification of PneumoniaClassification of Pneumonia
According to anatomical siteAccording to anatomical site LobarLobar SegmentalSegmental Sub-segmentalSub-segmental Lobular/ Bronchopneumonia/ Diffuse Lobular/ Bronchopneumonia/ Diffuse
PneumoniaPneumonia
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Lobar Pneumonia of RULLobar Pneumonia of RUL
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Segmental Pneumonia Right Upper Segmental Pneumonia Right Upper lobelobe
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Bronchopneumonia/ Diffuse Bronchopneumonia/ Diffuse PneumoniaPneumonia
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Classification of PneumoniaClassification of Pneumonia
According to Clinical Setting According to Clinical Setting Community acquired Pneumonia ( CAP)Community acquired Pneumonia ( CAP) Hospital acquired/Health care associated Hospital acquired/Health care associated
PneumoniaPneumonia Ventilator Associated Pneumonia (VAP)Ventilator Associated Pneumonia (VAP) Aspiration PneumoniaAspiration Pneumonia Hypostatic PneumoniaHypostatic Pneumonia Pneumonia in immunocompromised hostPneumonia in immunocompromised host
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““Community Acquired Community Acquired Pneumonia”Pneumonia”
Can U define ? Can U define ?
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Community Acquired Community Acquired Pneumonia Pneumonia
(CAP)(CAP)Pneumonia Pneumonia
that begins outside hospital that begins outside hospital or is or is diagnosed diagnosed within 48 hours of admission within 48 hours of admission in hospitalin hospital
in a patient who has not been in a patient who has not been hospitalized hospitalized
or residing in a long- term care facility or residing in a long- term care facility for 14 days or more before the onset of for 14 days or more before the onset of
symptomssymptoms
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AETIOLOGYAETIOLOGY No cause found in 40-60% of casesNo cause found in 40-60% of cases In more than 20% cases, more than one organismIn more than 20% cases, more than one organism Bacteria are more commonly identified than virusesBacteria are more commonly identified than viruses Commonest OrganismsCommonest Organisms
Strept pneumonaie Strept pneumonaie MycoplasmaMycoplasma H influenzaH influenza Chlamydophilla pneumonaie Chlamydophilla pneumonaie MRSAMRSA Respiratory VirusesRespiratory Viruses
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Which lobe is involvedWhich lobe is involved What is the organismWhat is the organism
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60 years old woman is brought to 60 years old woman is brought to hospital in confusional state. She is hospital in confusional state. She is febrile and short of breath. On febrile and short of breath. On auscultation there are few crackles in auscultation there are few crackles in the mid zone bilaterally.the mid zone bilaterally.
She is anaemic. WBC count is 6X10She is anaemic. WBC count is 6X109. 9.
Her chest x-ray is : Her chest x-ray is :
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What is the diagnosis ?What is the diagnosis ?
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Mycoplasma Pneumonia)Mycoplasma Pneumonia)
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Legionella PneumoniaLegionella Pneumonia
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RISK FACTORS FOR PNEUMONIARISK FACTORS FOR PNEUMONIA
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RISK FACTORS FOR PNEUMONIARISK FACTORS FOR PNEUMONIA
COPDCOPD Pulmonary OedemaPulmonary Oedema Altered consciousnessAltered consciousness Recent Viral respiratory Recent Viral respiratory
tract infectiontract infection Cigarette smokingCigarette smoking AlcoholAlcohol BronchiectasisBronchiectasis Bronchial obstructionBronchial obstruction ImmunosupressionImmunosupression Intravenous drug abuseIntravenous drug abuse
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How the organism reaches Lung ?How the organism reaches Lung ?
Inhalation of micro-organism Inhalation of micro-organism
Aspiration of gastric contentAspiration of gastric content
Spread from contagious siteSpread from contagious site
Hematological spread from distant Hematological spread from distant
sitesite
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AspirationAspiration
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What investigations will What investigations will you carry out ?you carry out ?
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INVESTIGATIONSINVESTIGATIONS Blood Complete picture Blood Complete picture Chest X Ray Chest X Ray Sputum Gram stain ?Sputum Gram stain ? Sputum CultureSputum Culture Blood culturesBlood cultures Urea, creatinine, electrolytesUrea, creatinine, electrolytes Serological studiesSerological studies Arterial blood gases (ABGs) in severe Arterial blood gases (ABGs) in severe
casescases Thoracocentesis if effusion is presentThoracocentesis if effusion is present
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Serological testsSerological tests
Pneumococcal antigenPneumococcal antigen Latex test on urine, sputum & serumLatex test on urine, sputum & serum
Mycoplasma antibodies (IgM & IgG)Mycoplasma antibodies (IgM & IgG) Cold agglutinin in 50% casesCold agglutinin in 50% cases
Legionella antibodiesLegionella antibodies Immunoflorescence testImmunoflorescence test
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MANAGEMENT OF PNEUMONIA
Doctor should assess severity of the Pneumonia and should decide whether patient can be treated at
home or in hospital
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When to admit ?When to admit ?
Age > 65 yAge > 65 y Comorbid conditionComorbid condition Abnormal vital signsAbnormal vital signs
RR >30RR >30 BP < 90/60BP < 90/60 Temp > 101Temp > 101
Altered mental statusAltered mental status Sepsis/ multiorgan dysfunctionSepsis/ multiorgan dysfunction Abnormal Lab findingsAbnormal Lab findings
TLC < 4000 or > 30000TLC < 4000 or > 30000 Po2 ,60 PCO2 > 50Po2 ,60 PCO2 > 50 Multi-lobe involvement or pleural effusionMulti-lobe involvement or pleural effusion
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Confusion Urea level (>19 mmol/L) Respiratory rate (>30 b/m) Blood Pressure SBP<90 mmHg or DBP <60 mmHg Age >65 yrs
Excellent indicator for mortality
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General MeasuresGeneral Measures
Care of mouth and skinCare of mouth and skinFluidsFluidsCough Suppressants Cough Suppressants Analgesics for painAnalgesics for painAntipyretics for feverAntipyretics for feverOxygenOxygen
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DURATION OF TREATMENTDURATION OF TREATMENT
Influnced by severity of illness, the agent, Influnced by severity of illness, the agent, responsible, and other medical problemsresponsible, and other medical problems
For Strept Pneumonia: treat for 72 hours For Strept Pneumonia: treat for 72 hours after the patient is afebrileafter the patient is afebrile
For S aureus and Psudomonas, klebsiella, For S aureus and Psudomonas, klebsiella, anaerobes, mycoplasma, legionella: two anaerobes, mycoplasma, legionella: two weeks at leastweeks at least
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Lung AbcessLung Abcess EmpyemaEmpyema
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COMPLICATIONS OF PNEUMONIA COMPLICATIONS OF PNEUMONIA
Parapneumonic effusionParapneumonic effusionEmpyemaEmpyemaSepsisSepsisARDSARDSLung abcessLung abcessFocal BronchiectasisFocal Bronchiectasis
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PREVENTION OF PNEUMONIAPREVENTION OF PNEUMONIA Polyvalent pneumococcal vaccine Influenza vaccine Smoking Cessation Alcohol cassation
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ThanksThanks
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AETIOLOGYAETIOLOGY BACTERIAL
Streptococcus Pneumoniae
2/3rd of case > 30% Haemophilus influenzae Klebsiella Pneumoniae Staphylococcus aureus Moraxella catarrhalis
Atypical Bacterial Mycoplasma
pneumoniae (9%) Chlamydia pneumoniae
(10%) Legionella Pneumoniae Coxeilla burneti
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AETIOLOGYAETIOLOGY
ViralViral Influenza A & BInfluenza A & B AdenovirusAdenovirus VaricellaVaricella Respiratry syncytial Respiratry syncytial
virus virus MeaslesMeasles Parainfluenza VirusParainfluenza Virus CMVCMV Corona VirusCorona Virus Coxsackie virusCoxsackie virus Rhino virusRhino virus
BACTERIALBACTERIAL Streptococcus Streptococcus
PneumoniaePneumoniae 2/32/3rdrd of case of case
Haemophilus influenzaeHaemophilus influenzae Klebsiella PneumoniaeKlebsiella Pneumoniae Staphylococcus aureusStaphylococcus aureus Moraxella catarhalisMoraxella catarhalis
Atypical BacterialAtypical Bacterial Mycoplasma pneumoniaeMycoplasma pneumoniae Chlamydia pneumoniaeChlamydia pneumoniae Legionella PneumoniaeLegionella Pneumoniae Coxeilla burnetiCoxeilla burneti
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Hospital Acquired PneumoniaHospital Acquired Pneumonia
Two days after hospital admissionTwo days after hospital admission EtiologyEtiology
Gram negative bacteriaGram negative bacteria Staphylococcal aureusStaphylococcal aureus Anaerobic organismsAnaerobic organisms Lobar pneumonia causing organismsLobar pneumonia causing organisms
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Staphylococcal Staphylococcal
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Aetiological agents• Pneumocystis carinii• Pseudomonas aeroginosa• Aspergillus fumigatus• Cytomegalovirus• Herpesviruses• Mycobacterium
tuberculosis
Pneumonia in immunocompromised Pneumonia in immunocompromised hosthost