Andriy Lepyavko, MD, PhDDepartment of Internal Medicine

№ 2

Pneumonia – this is an inflammation in the lung parenchyma caused by bacteria, viruses or fungi which is characterized by intraalveolar exudation

I. Etiology (if it is known)II. Variants: Community-acquired pneumonia Nosocomial pneumonia – when patient

was hospitalized with any another diagnosis, and after 48 hours in the hospital (not earlier!) pneumonia was diagnosed, or pneumonia after artificial lung ventilation

Pneumonia due to aspiration. It results from the aspiration of gastric contents in addition to aspiration of upper respiratory flora in secretions.

Pneumonia in immunocompromised host – patients with AIDS or immunodeficit of other origin. Causes of pneumonia – viruses, fungi of saprofites (E.coli etc.)

III. Localization (side, lobe, segment)IV. Stages of severity: Mild stage –conciousness is clear, t less than 38,

heart rate less than 90, BP normal, dyspnea mild in case of physical activity, CXR – small infiltration

Moderate – conciousness is clear, sweating, general weakness, t 38-39, heart rate 90-100, moderate dccreased BP, dyspnea, large size of infiltration

Severe – t 39-40, conciousness is not clear, heart rate more than 100, low BP, severe dyspnea, cyanosis, large size of infiltration and presence of complications

V. Complications.

Route of entry - Inhalation - Aspiration - Bloodborne Host/ organism dynamics tipped by - Defect in host defences - Virulent organism - Overwhelming inoculum

Nasal hair Dynamics of airflow Cough Mucous Mucociliary apparatus Bacterial interference Immunoglobulin Surfactant Fibronectin Complement Cytokines Alveolar macrophages Polymorphonuclear leucocytes Cell-mediated immunity

Predisposition – CHF, diabetes, alcoholism, COPD

Classic symptoms – cough, fever, sputum production, dyspnea

Clinical syndrome – fever, pleuritic chest pain, productive cough with mucopurulent sputum

Focal pulmonary findings (rales, crapitation or signs of consolidation) – less sensitive than CXR

General blood analysis – increased ESR, leucocytosis, shift to the left

Sputum analysis – causative microorganism and its sencitivity to antibiotics may be found

CXR with infiltrates – diagnosis “pneumonia” is invalid without it

Most common pathogens: Streptococcus pneumoniae (9% to 75%; mean,

33%), Haemophilus influenzae (0 to 50%; mean, 10%), Legionella species (0 to 50%; mean, 7%), Chlamydia pneumoniae (0 to 20%; mean, 5%). Mycoplasma pneumoniae

Adeel A. Butt, MD

898

1071

83

1171 1207

684

0

200

400

600

800

1000

1200

1400

<5 5 to17

18-24 25-44 45-64 >65

# of cases

# in 1000s

Incidence

Adeel A. Butt, MD

25,7

74,9

0

10

20

30

40

50

60

70

80

<4 5 to 14 15-24 25-44 45-64 >65

# of deaths# in 1000s

Mortality

At least 5 days Until afebrile for 48-72 hours Stable vital signs Longer course needed if Initial antibiotic choice did not cover the

pathogen Extrapulmonary infection (meningitis) Lung abscess, cavitation or empyema Gram negative pathogen or S.aureus

Staphylococcus aureus Gram-negative microorganisms -

Pseudomonas, Klebsiella, Proteus, enterobacteria, E.coli

Fungi - Candida, Aspergillus, Rizopus.

Most effective are: Aminoglycozyde (tobramycin, sizomycin)

+ Metronidazol Cephalosporini III-IV

generation+Metronidazol