pneumonia Flashcards
definition
acute disease - pathogen released - alveolar exudation
Pneumonia is acute inflammatory process of infectious origin affecting the pulmonary acinus.
classification - international, pathogenesis, localization, clinico-morphological signs, severity, morphological stage, etiology
- International
- Community acquired pneumonia / typical
- Hospital acquired (nosocomial) pneumonia
- Aspiration pneumonia
- Pneumonia in immunocompromised host(including AIDS)
- Atypical pneumonia - according to pathogenesis:
- primary- due to primary etiology such as bacteria & virus. (typical , atypical)
- secondary- at height of chronic bronchitis. after operations & ventilation. complication of other disease CVS , disease of blood , metabolic , superimpose chronic disease of respiratory system - According to localization:
- 1 sided- can be total, lobal, segemental, sublobular & central.
- 2 sided.
- localized (whole of one or more lobes)
- diffuse ( lobules) - according clinico morphological signs
- parenchymatous ( lobe, lobular)
- interstitial
- mixed - According to severity:
- mild.
- moderate.
- severe. - According to morphological stage:
- congestion.
- hepatization.
- resolution. - According to etiology:
- typical : pneumococcal
- atypical : mycoplasma, legionella, chlamydiae, coxiella burnetti, ricketsia
- viral and Q fever
- parasitic.
- fungal.
- atypical microbes.
- aspiration.
- Immune deficiency.
- Radiotherapy
- Allergic mechanism
- chemical and physical factors - According to course
- acute
- prolonged
main syndromes
- Syndrome of infiltration of lung tissue.
- Lung tissue is infiltrated by cells & exudates.
- Percussion- dull tympanic sound.
- X ray - white homogenous shadow. - Syndrome of intoxication.
- Fever. Weakness. Athralgia & myalgia. Headache, Dyspnea, Palpitation, Sleeplessness - Consolidation syndrome
- dullness percussion
- cough with sputum - initial period can be dry
- pleural pain - dry pleurisy - short inhalation, pain inhalation, affected side
- dyspnea
- hemoptysis
objective signs
- unsymmetrical when inhalation - lagging one side
percussion
- unsymmetrical dullness
auscultation
- stages of pneumonia
early - diminished vesicular breathing - crepitation
late (consolidation stage) - bronchial and laryngotracheal breathing
additional sounds :- ( hear in local zone - affected zone )
- crepitation - inflammation in alveoli
- moist rales
- pleural friction rub
- General inflammation - Increase temperature, Chill, Leucocytosis
- Acute respiratory insufficiency
- Respiratory failure
– Dyspnea
- cyanosis - diffuse warm
- oxygen saturation - Affection of the other organs / In atypical causes
a. Liver Syndrome.
- Short duration of icterus.
- Pain in liver palpation.
- Increased ALT & ALT.
b. Kidney syndrome.
- toxic renal affection.
- proteins, RBC & leucocytes in urine.
other organs affected syndrome
c. GIT syndrome. - Diarrhea, nausea & vomiting.
d. Brain syndrome. - Encephalopathy. Psycosis.
e. Heart syndrome. - Myocardial dystrophy, myocarditis & pericarditis.
diagnostic criteria
- Blood
- Leukocytosis Shift to the left
- Increase neutrophil
- Disproteinemia
- Increase C protein
- Increase fibrinogen - Urine
- Hypovolemia
- Proteinuria
- Microerythrocyturia
- Increase specific gravity
- Indirect jaundice (3rd-4th days) - X-ray
- Infiltration of lung
- Decrease transparency on affected area
- Moderate consolidation
- Physiological emphysema - ECG
- Moderate cor pulmonale
- Tachycardia
- Enlargement of heart - Sputum
- Rusty with blood
Dx/dy
- Part of lung enlargement of volume
- Decrease perfusion
- X ray decrease transparency with 1 lobe or 2
- Sometimes homogenous but less patchy
- Border line of infiltration is cloudy
- Root of pneumonia is enlarge
primary pneumonia : epidemiology
- community acquired or hospital acquired
- Incidence: 1-3/1000 population
- Mortality: 10% (patients admitted to hospital)
- 10,000 people 7-14 cases
- 5 years – 10%
- AIDS over 50%
- Male > female 50-55%
- Age > 50-55%
- Season of the year and geographic location are other predictor of etiology
primary pneu : etiology
- bacteria & viruses.
- Bacteria: gram –ve & +ve.-. E. coli, S. pneumonia. Pneumococcus, Hemophilus influenza, Legionella, Klebsiella
- Viruses - influenza, parainfluenza & measles.
- Weather, occupational
primary pneu : pathogenesis
- pathogen reach lower respiratory tract in sufficient numbers or virulence.
- Possible routes - aspiration, microaspiration, aerosolization, hematogenous or direct spread
- Microaspiration - colonization bacteria at oropharyngeal, secretion aspirated into lungs. Aspiration - in postoperative or coma patients. Hematogenous spread by endocarditis & infections.
- virulent factors overcome the host defense causes pneumonia. common when the patient immune system is decreased.
Clinical picture of lobular pneumonia
Clinical picture of lobular pneumonia
- Lobular pneumonia same as bronchopneumonia.
- Cough with sputum
- Pain in the chest
- Fever remittent, irregular (subfebrile).
- Dyspnoea
- Moderate hyperemia of the face; cyanosis of the lips.
- Tachypnoea (25-30 per min).
- vocal fremitus – increased
- dull percussion sound
- decrease vesicular breathing
- vesiculobronchial or bronchial breathing
- dry / consonating moist rales, crepitation
- More patchy alveolar consolidation associated with bronchial and bronchiolar inflammation
primary pneu : investigations
- Blood test: mild leucocytosis, moderately increased ESR.
- Sputum: mucopurulent; leucocytes, macrophages and columnar epithelium. Bacterial flora
- X-ray: focal consolidations at least 1-2 cm in diameter
lobar pneumonia : definition
Homogeneous consolidation of one ore more lobes, associated with pleural inflammation
lobar pneu : Symptoms according to different pathomorphological periods
Symptoms according to different pathomorphological periods
1. Congestion.
- hyperaemia of lung tissue, exudation, obstruction of capillary & stasis of blood.
- shaking chills or rigor with fever ( 39-40 C ).
- Pleuritic pain on the affected side.
- Dyspnoea. Cough is dry.
- Severe headache & pain in limbs in atypical form.
- condition is grave, confused or delirious in alcoholics, convulsions.
- fascies pneumonica- hyperaemea of cheeks on affected side, nostrils breathing, herpes nasalis & labialis & cyanosis.
- lagging of affected side, Vocal fremitus is increased. dull tympanic sound, weak vesicular breathing, crepitation indux & increased bronchophony.
- It lasts from 12 hours to 3 days
- Hepatization. - Height of the disease
- Gen inspection - lagging of affected side, tachypnoea. tachycardia
- Cough & a rusty sputum in the beginning of red hepatization stage.
- In palpation there‘s increased vocal fremitus. In percussion absolute dull sound.
In auscultation - bronchiol breathing & in pleuritis - pleural friction rub. There‘s increased bronchophony, egophony.
a. Red hepatization
- Massive confluent exudation with RBC, neutrophils & fibrin filling the alveolar spaces. Lobe appears red, firm & airless with liver like consistency
- The lobe now appears distinctly red, firm, and airless with a liver like consistency.
- Continues from 1 to 3 days
b. Gray hepatization
- progressive disintegration of RBC. Alveoli containing fibrin becomes filled with leucocytes.
- persistence of fibrosupurative exudates giving gross appearance of grayish brown & dry surface.
- Lasts from 2 to 6 days
- Resolution
- Consolidated exudates within alveolar spaces undergoes enzymic digestion produce granular semifluid debris that is resorbed, ingested by macrophages or coughed up.
- Cough with mucopurulent sputum, dyspnoea decreased & condition improves.
- Palpation decreased vocal fremitus. Percussion gives dulled tympanic sound.
- Auscultation weak vesicular breathing, crepitation redux & small moist bubbling rales.
lobar pneumonia : complications
- Lung type
- Obstruction
- Pleuritis
- Acute respiratory insufficiency
- acute respiratory distress syndrome
- Pleurisy
- Parapneumonia or metapneumonic effusion
- Post pneumonia
- Emphysema of pleura
- empyema,
- lobar collapse,
pneumothorax
- lung abscess - extrapulmonary complication
- Infectional intoxicational shock
- Bacterial endocarditis
- Infection endocarditis
- Cor pulmonale
- Cardiodystrophy
- Meningitis
- Toxic hepatitis
- Meningoencephalopathy
- septicemia,
- renal failure, nephritis
- multi organ failure,
- ectopic abscess,
- pericarditis, myocarditis
- intoxication psychosis
Etiological & pathogenetic treatment of primary pneumonia
- etiology treatment
- antibiotic combined w sulpha drug eg: sulphadimethoxine
- penicillin.
- Groups of cephalosporins. combination with alcohol is not good.
- Aminoglycosides. Contraindication in pregnancy.
- Macrolides
- Tetracycline.
- Metronidazole.
- Florquinolone. Contraindication in young children & pregnancy.
- Chloramphenical..
- nitrofuran, furazolin.
- In resolution stage use physiotherapy. - pathogenic treatment
- immunomodulation preparation (interferon, levamisol, zymosan)
- patient with viral pneumonia give anti influenza n globuli
- passive immunization w hyperimmune anti-staphylococcal plasma/staphylococcal antitoxin to patient of staphylococcal pneumonia
- Vit C,E,B n biogenic stimulant to restore nonspecific body resistance
- Broncholytic (euphyline, ephedrine)
Principles of antibiotic therapy
- Give antibiotics in the 1st hour.
- By the 3rd day must have positive effect. decreased intoxication, condition improves, decreased fever & normalization of peripheral blood otherwise change antibiotics.
- If successful, duration of antibiotics given for 2 weeks.
- Unknown etiology:
penicillin + aminoglycoside aminoglycoside + cephalosporin
