PNEUMONIASri Lestari SAYunita Fediani

Definition Acute inflammation of lung

parenchyma

Inflammatory infiltrate in alveoli (=consolidation)

Disease Pattern

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

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

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

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

Classification Morphological:

BronchopneumoniaLobar pneumonia

Location:Community-acquired pneumoniaHospital acquired pneumonia (nosocomial

infection)

Clinical ManifestationVaries with agePathogens: Group B Streptoccus, E coli,

PneumococcusStaphylococcus aureus and rarely Group A

Strep are severeAtypical bacteria mycoplasma tends to be

mild

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

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

Management Appropriate AntibioticsOxygen SupportBronchodilatorHumidityPostural DrainageHydration/Fever Control/Nutritional Support

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)

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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