Pneumonia Flashcards
An infection in the lung tissue caused by microbes and the result is an inflammation
Inflamation brings water to the site of infection in the lung thus it’s make it hard to breathe
How the lungs protect it self from microbes and foreign orgasms ?
1- coughing
2- mucociliary escalator
3- macrophages
What’s happen if those microbes colonizes tge bronchioles or alveoli?
We will have pneumonia 🌚
What is the inflammatory response in pneumonia?
1- white blood cells
2- red blood cells
3- proteins
4-fluid
Pneumonia causes?
Microbes like : 1-viruses 2-bacteria 3-fungal 4-parasitic
Give examples of microbes that cause pneumonia?
1- viral- influenza and parainfluenza
2- bacterial- staphylococcus aureus, staphylococcus pyogenes ,streptococcus pneumonia , mycobacterium tuberculosis
3- fungi + parasites 🦠- candida albicans , histoplasm, aspergillus
Classifications of pneumonia :
1 - depending on the etiological agent * bacterial, viral , fungal, parasitic 2- depending on the status of the lung : *primary pneumonia-in a healthy lung *secondary pneumonia-previously affected lung 🫁 3- depending on the environment form where the infection was contracted * community pneumonia *Nosocomial pneumonia
The difference between community acquired pneumonia and nosocomial pneumonia?
One gets it from the hospital which’s more serious and more resistant to drugs so we need stronger medication 💊
And one we get it from the outside of the hospital 🏥
Pathophysiology of pneumonic process ?
Pneumonia activation depends on 3 major factors:
1-microbial virulence
2-microbial inoculum size
3- host response
The respiratory defense mechanisms :
1- mechanical ⚙️: removal of the microbes 🦠 with cough 😷, and muco-ciliary clearance . To the microbes that come from the nasal cavity.
2- biological ( hormones، enzymes and cells) :
* humoral- immunoglobulin (igA,igG) ,antioxidant, lysosomes
*cellular -lymphocytes, neutrophils, macrophages
Lower respiratory tract contamination mechanisms تكمله للباثوفيزيولوجي ؟
1-aspiration, inhalation (micro aspiration at the level of oro-nasopharynx is the most frequent mechanism in pneumonia pathogenesis
2- hematological dissemination (نشر) : occurs from remote infections sites تناقل العدوى البعيده الي الرئتين )endocarditis,septic phlebitis
3-direct inoculation: during trauma )rare
Pneumococcal community-aquired pneumonia: morphopathology :?
Alveolar labor pneumonia characterized by :
1-damage to peripheral air spaces due to the presence of an inflammatory exudate containing germs 🦠
2-homogeneous condensation ( condensation) opacities
3- condensation with out the bronchi (non-opacified bronchus
4 pneumococcal pneumonia-typical example of labor pneumonia
Symptoms of
pneumococcal community-Acquired
pneumonia
1-dyspnea
2-general sings: fever 🥵,chills,asthenia,sweats
3-chest pain due to pleural inflammation, thoracic discomfort
4-cough - dry then productive with blood 🩸 sputum
5-myalgias الم بالعضلات
6-arthralgias - الم بالمفاصل
7-inappetence and wight loss
Pneumococcal community acquired pneumonia
Physical exam:
1-Continuous fever 🥵 2-Tachycardia 3-Tachypnea 4-Cyanosis in sever cases 5-Pulmonary condensation syndrome: limitations of respiratory movements and amplitude, local dullness, crackels, bronchial breath sound
Paraclinical diagnosis 🫁 in pneumococcal community acquired pneumonia
1-inflammatory syndrome presence 2-arterial gasometry reveals 3- bacteriologic suptum exam 4- hemocultures 5-thoracic-xray
Hospitalization criteria
All the symptoms but more severe
More intense pain , sever lung 🫁 damage , very high values PMN ,failure of first antibiotic therapy, risk factor presence
Differential diagnosis
Collapse Sarcoidosis Pleural effusion Pulmonary edema Pulmonary embolism Other cases of acute fever 🥵
Complications:
General :
toxic- nephritis , hepatitis , myocarditis
Septic- pericarditis endocarditis ,otitis septicemia with sepsis metastasis
Acute renal failure 😞
Local:parapneumonic pleural effusion
Metapneumonic pleular effusion
Abscedation :pus formation
Chronicization: bronchiectasis
Which score can evaluate the severity of a patient ?
Curb-65 C- confusion - 1point U- urea-1p R-respiratory rate-1p B-blood pressure -1p 65- age above 65 years old -1p 0-1 -safely treated at home 🏠 2- shortly period admission 3-require hospital admission 4–5 hospital ICU
Nosocomial pneumonia
is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization
Pneumonia with klebsielia
Klebsiella pneumoniae (K. pneumoniae) are bacteria that normally live in your intestines and feces.
These bacteria are harmless when they’re in your intestines. But if they spread to another part of your body, they can cause severe infections. The risk is higher if you’re sick.
Treatment for community acquired pneumonia pharmacological :
Symptomatic treatment
Symptomatic treatment:
Fever- antipyretic
Thoracic pain-pain killers
Dry cough 😷- anti cough medications-codeine15mg
Productive cough-mucolytic and expectorants
Pharmacological treatment
Antibiotics:
After sampling (sputum/blood)
At home 🏠:
- Ampicillin/amoxicillin for7-10days
- Patient with high severity score: amoxicillin\ Augmentin 2tb
Patient with severity score and chronic respiratory pathologis and multiple previous antibiotherapy :levofloxacin500mg + augmentin
M
Hospital 🏥 treatment :
Two Hemoculture from 2 different sites and 10 min interval
Augmentin 1 vial or cephalosporin 1g vial or ceftriaxone 1-2 g
