community aquired pnemonia _ احمد عبيد Flashcards
what’s the “Pneumonia” ?
Pneumonia is an acute respiratory illness +
recently developed radiological pulmonary shadowing,
what’re the type of “Pneumonia”or the radiological shadowing ?
may be
1-segmental
2- lobar
3-or multilobar
classification of “Pneumonia” ?
1-Community- Or
2- Hospital-acquired
3-Pneumonia in immuno-compromised hosts.
‘Lobar pneumonia is
radiological and pathological term referring
to **homogeneous consolidation **
***one or more lung lobes,
*** often with associated pleural inflammation.
‘Bronchopneumonia’ refer to
more ***patchy alveolar consolidation
**often affecting both lower lobes
**associated with bronchial and bronchiolar inflammation, .
inflammatory response in lobar pneumonia ?
the alveolar units are flooded by a proteinaceous exudate & by neutrophils, red blood cells, & numerous pneumococci may be observed.
As fibrin forms, on the cut surface of the affected lobe, it resembles liver
3rd stage,(‘grey hepatisation’)
As congestion resolves, the lung tissue becomes grey
4th stage (resolution ) ------------------ , clearance and repair mechanisms restore the normal architecture of the lung. (resolution )
Community-acquired pneumonia Accounting for in LRTI?
around 5–12%
Community-acquired pneumonia affect which age group ?
Affects all age groups but is common at the extremes of age it’s called old man
Community-acquired pneumonia spread by ?
droplet infection, in most cases
Community-acquired pneumonia most common agent ?
Streptococcus pneumoniae
which factor point on the organism ?
Age & the clinical context, point to that other organisms
Adult CAP increasingly recognized caused by
by viral infection
Factors that predispose to Pneumonia ?
1-Old age
2-Cigarette smoking
3-Alcohol
4-Corticosteroid therapy
5-Pre-existing lung disease
6-Upper respiratory tract infections
7-Recent influenza infection
8-HIV
9-Indoor air pollution
Organisms causing CAP bacterial?
.Streptococcus pneumoniae • Mycoplasma pneumoniae • Legionella pneumophila • Chlamydia pneumoniae • Haemophilus influenzae • Staphylococcus aureus • Chlamydia psittaci • Coxiella burnetii (Q fever,) • Klebsiella pneumoniae
Organisms causing CAP viral ?
- Influenza, parainfluenza
- Measles
- Herpes simplex
- Varicella
- Adenovirus
- Cytomegalovirus (CMV)
- Coronavirus
what’s the Clinical Context means ?
means ‘best guess’ as to the likely organism may be made from the context in which pneumonia develops,
but not from the clinical & radiological picture, which does not differ sufficiently from one organism to another
Mycoplasma pneumoniae is more common in
young & rare in the elderly.
Haemophilus influenzae is more common in
in the elderly, when underlying lung disease is present.
Legionella pneumophila
occurs in local outbreaks centred on contaminated cooling system.
Staphylococcus aureus is more common
following an episode of influenza
Foreign Travel
facilitates the spread of illnesses such as severe acute respiratory syndrome (SARS), caused by coronavirus
lobar pneumonia, usually presents as
lobar pneumonia, usually presents as an acute illness.
1-Systemic features: fever, rigors, shivering and malaise and delirium, appetite is invariably lost & headache frequently reported.
2-Pulmonary symptoms: cough, which at first is short, painful & dry, but later accompanied by the expectoration of muco-purulent sputum.
2-Rust-coloured sputum: Strep. Pneumoniae & occasional haemoptysis.
3-Pleuritic chest pain may be a presenting feature , referred to shoulder or anterior abdominal wall, in lober penu.
4-Upper abdominal tenderness lower lobe pneumonia or if there is associated hepatitis.
4-Less typical presentations may be seen in very young & elderly.
rust colored – usually caused by pneumococcal bacteria (in pneumonia), pulmonary embolism, lung cancer or pulmonary tuberculosis. Brownish – chronic bronchitis (greenish/yellowish/brown); chronic pneumonia (whitish-brown); tuberculosis; lung cancer. Yellow, yellowish purulent – containing pus
Rust-coloured sputum caused by
Strep. Pneumoniae
Less typical presentations may be seen in
in very young & elderly.
examination
1-R. Rate & P. Rate raised
2- Blood pressure decrease
3- Mental state reveal delirium.
4-Pyrexia is clue if present.
5-. Cyanosed & Distressed
Oxygen saturation low
1-Chest signs vary, depending on the phase
2-consolidated, the lung is: dull to percussion , as conduction of sound is enhanced
3- Auscultation
-bronchial breathing
-whispering pectoriloquy
refers to an increased loudness of whispering noted during auscultation
-crackles are heard throughout.
But, in many patients, signs are more subtle with reduced air entry only, but crackles are usually present
ولكن ، في العديد من المرضى ، تكون العلامات أكثر دقة مع
انخفاض دخول الهواء فقط ، ولكن عادة ما تكون الطقطقة
