Types of Pneumonia
Community Acquired
Hospital Acquired
Immunocompromised / Structurally Abnormal
Community Acquired Pneumonia
Clinical Features
Fever, rigor, chills, headache, malaise, cough, chest pain, dysponea, confusion
Pyrexia, tachycardia, tachypnoea, cyanosis
Pleural rub, bronchial breathing, impaired resonance, increased increased VF and VR creps
Investigations
CBC
Radiological
Bacteriological
Blood gas
S. PNEUMONIAE PNEUMONIA
Young to middle age
Acute onset
High fever, toxic, rigor
High TC, Europhilia,, toxic granules
X-ray : labar non homogr\enous opacity
Gram +ve diplococci in sputum
CHLAMYDIA PNEUMONIA
Young and middle age
Sporadic or epidemic
Onset mild may be self limiting
Associated URI
Small segmental infiltates
Normal WBC count + raised SGPT
+ve serology
MYCOPLASMA PNEUMONIA
Children and young
Insidious onset
More systemic features
Few respiratory findings
Assoc:EN, myo/pericarditis, meningoencephalitieis, heamolysis, rach
Patchy/lobar consolidation + / -hilar lymph node
UNCOMMON ORGANISMS
H. Influeza: pre-existing lung disease, bronchopneumonia in X-ray
S.Aureus: often seen in assoc: with viral pneumonia / Chronic debilitating illness or spread from abscess / osteomyelities and lobar/ segmental opacity, abscess, pneumatocoele
K.pneumoniae: very young and old age, marked systemic features, upper lobe predilication early abscess formation
VIRAL PNEUMONIAS
Caused by influenza – A / B
Chicken-pox
Avaian influenza
BAD PROGNOSTIC INDICATORS
Age> 60
H.R > 140
B.p – systolic <90 and diastolic <60
Altered mental status
More than one lobe affection
Coexistant disease
PO 2 < 60
WBC count >20000 0r <4000
Elevation of B. urea
MANAGEMENT
General measures
Antibiotics
Oxygen
Treatment of complications
GENERAL MEASURES
Rest
Antipyretics
Analgesics
Physiotherapy
ANTIBIOTICS
Started as early as possible
Sputum and blood culture
Should cover the most probable organism
Pattern in alocality
Resistance probability
Optimum dose
UNCOMPLICATED MILD CAP
Macrolide - Azithromycin , Clarithromycin
Fluroquinolones - gatifloxacin, levfloxacin, moxifloxacin
Doxcyclin
SEVERE CAP
Clarithromycin 500 mg I.V. Q12H or Azithromucin 500 mg I.V> OD
or Levofloxacin /gatifloxacin . I.V + Co-amoxiclav 1-2 gm I.V Q8H or ceftriaxone 1-2 gm Q12H + flucloxacillin 2 gm I.V Q6H
OXYGEN
In all cases with hypoxia
Ventillation in severe cases