prof. dr. bilun gemicioğlu
DESCRIPTION
Pneumonia. Prof. Dr. Bilun Gemicioğlu. Pneumonia is a lung parenchyma infection caused by bacteria, a virus or fungi , with a consolidation on radiological examination. Pneumonitis is an inflammation of the lungs caused by chemical or radiation therapy but not with infectious agents. - PowerPoint PPT PresentationTRANSCRIPT
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Prof. Dr. Bilun Gemicioğlu
Pneumonia
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Pneumonia is a lung parenchyma infection caused by bacteria, a virus or fungi, with a consolidation on radiological examination.
Pneumonitis is an inflammation of the lungs caused by chemical or radiation therapy but not with infectious agents.
Definition
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– Inhalation
– Aspiration of oropharingeal secretion
– Hematogenic spread
– Direct spread (thorax wall,
mediastinum)
Spread of lung infections
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Predisposing factors of pneumonia
• Airways mechanical barrier damage
• Specific and/or nonspecific immune defense mechanisms injury
• Bronchial obstruction
• Micro aspiration of upper respiratory truck secretion.
• Lung edema
• Viral infections.
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Diagnostic Methods
• History, physical examination
• Chest X-Ray
• Sputum examination (gram stained)
• Sputum , blood cultures
• Serological tests
• Peripheral blood analysis
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Symptoms fever, shaking chills, cough, sputum (expectoration), pleuritic pain. Others: (dispnea, fatigue, sweating, loss of
appetite...)
Physical signs:increased vibration thoracic impaired percussion (matity), end inspiratory rales (crepitations) and
bronchial breathing (tuber soufle)Others (cyanosis, tachipnea, tachicardia...)
Diagnosis
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Radiology:
lobar opacities,
interstitial images,
bronchopneumonic (patchy) opacities,
Others (absea, pneumatocele, pleurisy...)
Diagnosis
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Chest X-Ray
• Gold standart test for pneumonia
• For differencial diagnosis
• For grading pneumonia severity
• For examining complications
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-First 24 hours
-Dehydration
-Elderly
-Neutropenia
-Pneumocystis carinii
Normal Chest X Ray in Pneumonia
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Classification with anatomical localization
• Lobar consolidation
• Bronchopneumonia
• Interstitial pneumonia
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•Bacterial
•Viral
•Fungal
•Parazites
Classification with ethiology
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Classification with targeting therapy
• Community acquired pneumonia
• Hospital acquired pneumonia (Nosocomial)
• Immunosuppresed (immunocompromised) patients pneumonia
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Community acquired pneumonia
Pneumonia acquired outside hospital frequently in
healthy persons
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Typical pneumonia Atypical pneumonia acute subacute, fever,chills subfebril fever productive cough non productive cough pleural pain nonrespiratory symptoms physical signs ( + ) physical signs ( - ) lobar consolidation non-lobar infiltration
Caracteristics of community acquired pneumonia (CAP)
Agents S. pneumoniae M.pneumonia H. Influenzae C.pneumoniae Gr(-)aerop bacillus L. Pneumophila Aneorobes Virus
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Lobar pneumonia
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Lobar pneumonia
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Bronchopneumonia
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Interstitial pneumonia
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CAP THERAPY
GRGROOUP UP 11
OUTPATIENT-OUTPATIENT-CLINICCLINIC
GRGROOUP UP 2 2
HOSPITALHOSPITAL
GRGROOUP UP 3 3
INTENSIVE INTENSIVE CARECARE
Mild pneumonia, Moderate pneumonia
Severe pneumonia
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No antibiotic usage No comorbidity
With comorbiditiesPneumococci resistant to penicillinGram (–) agentsUsage of antibiotic last three monthsUsage of corticosteroid
CAP Therapy: Group I
Penicillin,Macrolide,
Floroquinolone,ß laktame + Macrolide
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CAP Therapy: Group 2CAP Therapy: Group 2
• S.pneumoniae
• H.influenzae• M.pneumoniae
• C.pneumoniae
• Mix infection)
• Enteric Gram negatives !
• Virus
First choise Alternatif________________________________________
Penicillin G ± makrolide Levofloksasin
Aminopenicillin ± makrolide Moksifloksasin
Aminopenicillin / β-laktamase inhibitor ± macrolide
Non- antipseudomonal cefalosporin II-III ± macrolide
CAP Therapy: Group II
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No risk of P. aeruginosa• Non pseudomonal cefalosporin III+ macrolide or• Non pseudomonal cefalosporin III + (moksifloksasin or
levofloksasin)
With risk of P. aeruginosa• Anti-pseudomonal cefalosporin (sefepim-seftazidim) or• Ureidopenicillin/beta-laktamase inhibitor (piperasilin..
or• Karbapenem + siprofloksasin
CAP Therapy: Group III
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Duration of the therapy
After fever drop 1 week
- Pneumococcic pneumonia 7-10 days
- Legionella pneumonia 14-21 days- Mycoplasma ve C. pneumoniae 10-14 days
Severe pneumonia 2-3 weeks