1b PNEUMONIA Year 4 Internal Medicine Notes OmpathStudy

1b PNEUMONIA Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / IMED 4.3 / MOGERE -- Slide 1 PNEUMONIA Dr. Alex Mogere Consultant Physician,\nLecturer of Internal Medicine Slide 2 Objectives Define pneumonia. Classify and define each of the type of pneumonia. Describe the etiologic agents, risk factors for, clinical features, investigations, treatment, complications and preventive measures of the various types of pneumonias. Slide 3 Pneumonia DEFINITION Pneumonia is an acute respiratory illness associated with recently developed radiological pulmonary shadowing which is either segmental or affects more than one lobe. Pneumonia may be bacterial, viral, mycobacterial or fungal. Slide 4 Pathology Congestion- presence of proteinaceous exudate Red hepatization-extravastion of erythrocytes into intraalveolar space Grey hepatization- neutrophil is the predominant cell, fibrin deposition is abundant. No bacteria Resolution – mθ is the predominant cell, debris cleared Slide 5 Classification Anatomical classification 1)Lobar pneumonia 2)Bronchopneumonia 3)Interstitial pneumonia Clinical classification 1) Community-acquired pneumonia-typical/atypical/aspirational. 2) nosocomial/ HAP,VAP 3) Pneumonia in the immunocompromised host. 4) Pneumonia in elderly Slide 6 Community Acquired Pneumonia(CAP) DEFINITION Pneumonia acquired in the patient’s home or in the non-hospital environment such as a nursing home 14/7 prior. Mainly spread by inhalation. the most common type of pneumonia,\nis a leading cause of illness and death worldwide Slide 7 Ct. CAP Lobar pneumonia is a radiological and pathological term referring to homogeneous opacification (red hepatisation) of one or more lung lobes often associated with pleural inflammation. Bronchopneumonia refers to more patchy alveolar consolidation associated with bronchial and bronchiolar inflammation affecting both lower lobes. Slide 8 Ct.CAP ETIOLOGIC AGENTS (ORGANISMS) Streptococcus pneumoniae 30% Chlamydia pneumoniae 10% Mycoplasma pneumoniae 9% Legionella pneumophila 5% Haemophilus influenza 3% Others- Moraxella catarrhalis, streptococcus pyogenes Slide 9 Ct.CAP ETIOLOGIC AGENTS (ORGANISMS Others – Staphylococcus aureus, Chlamydia psittaci, Coxiella burnetti, Klebsiella pneumoniae, Actinomyces israeli all <1%. Viruses – Influenza virus 7-8% of CAP\n- Parainfluenza\n- Measles\n- Respiratory syncytial virus (RSV)\nin infancy\n- Varicella (chicken pox) Slide 10 Risk factors Cigarette smoking Alcohol intake Corticosteroid therapy Old age Recent influenza infection\nPreexisting lung disease Contact with sick birds (Chlamydia psittaci) Farm environments (Coxiella burnetti)\npollution Slide 11 Clinical features SYMPTOMS Cough – productive of rust coloured sputum. Fever Malaise Pleuritic chest pain Headache\nConfusion Nausea, Vomiting Diarrhoea Fatigue, muscle aches Slide 12 Clinical features SIGNS Fever Tachycardia Tachypnoea Hypoxemia Hypotension Confusion Pleural rub Signs of consolidation – dull percussion note and bronchial breath sounds Crepitations Cyanosis\nSigns of a pleural effusion – stony dullness and absent or reduced breath sounds. Slide 13 Invxs 1) Chest radiograph – may show a homogenous opacity localised to the affected lobe or segment. Is useful in identifying pleural effusion, intrapulmonary abscess formation or when empyema is suspected. Hilar lymphadenopathy is seen in Mycoplasma pneumonia. Slide 14 Invxs 2)Microbiological Investigations\n- sputum microscopy, culture and sensitivity\n- aspiration of tracheal/ bronchial secretions during bronchoscopy for M/C/S\n- Blood cultures and sensitivity patterns. 3) Arterial blood gas measurement for assessment of disease severity Slide 15 Invxs 4) Complete blood count \n- Neutrophil leucocytosis suggests bacterial pneumonia.\n- Leucopenia suggests viral etiology. Slide 16 Assessment of Disease severity Clinical parameters\n- Age of 60yrs or older\n- Respiratory rate 30/min\n- Diastolic blood pressure 60mmHg or less\n- Confusion\n- More than 1 lobe involved in CXR\n- Presence of underlying disease Slide 17 Assessment of disease severity Laboratory parameters\n- Hypoxemia (PaO2 <8kPa)\n- Leucopenia (<4000x109/L)\n- Leucocytosis ( 20000x109/L)\n- Raised serum urea ≥7mmol/L\n- Positive blood culture\n- Hypoalbuminemia Slide 18 Assessment of disease severity The 4 cardinal markers of severity are: - RR ≥30/ min\n- Diastolic BP ≤60mmHg\n- Serum BUN of ≥7mmol/L\n- Presence of confusion Patients with 2 or more of the 4 cardinal markers of severity have a 36-fold higher risk of dying compared with patients without these signs. Slide 19 CURB-65 Estimate prognosis and determine disposition in community-acquired pneumonia. Not yet validated in COVID-19 The CURB-65 score was derived and validated based on 1068 patients from three prospective studies in the UK, New Zealand, and the Netherlands Slide 20 CURB 65 Score – Pneumonia Clinical Prediction Tool Slide 21 Tx Supportive and specific treatment. Good response to antibi