Pneumonia
Prof. Dr. Bilun Gemicioğlu
Definition
Pneumonia is a lung parenchyma
infection caused by bacteria, a virus
or fungi, with a consolidation on
radiological examination.
Pneumonitis is an inflammation of
the lungs caused by chemical or
radiation therapy but not with
infectious agents.
Spread of lung infections
– Inhalation
– Aspiration of oropharingeal secretion
– Hematogenic spread
– Direct spread (thorax wall, mediastinum)
Predisposing factors of pneumonia
• Airways mechanical barrier damage
• Specific and/or nonspecific immune defense
mechanisms injury
• Bronchial obstruction
• Micro aspiration of upper respiratory truck
secretion.
• Lung edema
• Viral infections.
Diagnostic Methods
• History, physical examination
• Chest X-Ray
• Sputum examination (gram stained)
• Sputum , blood cultures
• Serological tests
• Peripheral blood analysis
Diagnosis
Symptoms
fever, shaking chills,
cough, sputum (expectoration),
pleuritic pain.
Others: (dispnea, fatigue, sweating, loss of appetite...)
Physical signs:
increased vibration thoracic
impaired percussion (matity),
end inspiratory rales (crepitations) and
bronchial breathing (tuber soufle)
Others (cyanosis, tachipnea, tachicardia...)
Diagnosis
Radiology:
lobar opacities,
interstitial images,
bronchopneumonic (patchy) opacities,
Others (absea, pneumatocele, pleurisy...)
Chest X-Ray
• Gold standart test for pneumonia
• For differencial diagnosis
• For grading pneumonia severity
• For examining complications
Normal Chest X Ray in Pneumonia
-First 24 hours
-Dehydration
-Elderly
-Neutropenia
-Pneumocystis carinii
Classification with anatomical
localization
• Lobar consolidation
• Bronchopneumonia
• Interstitial pneumonia
Classification with ethiology
•Bacterial
•Viral
•Fungal
•Parazites
Classification with targeting
therapy
• Community acquired pneumonia
• Hospital acquired pneumonia
(Nosocomial)
• Immunosuppresed
(immunocompromised) patients
pneumonia
Community acquired pneumonia
Pneumonia acquired outside
hospital frequently in healthy
persons
Caracteristics of community acquired
pneumonia (CAP)
Typical pneumonia
acute
fever,chills
productive cough
pleural pain
physical signs ( + )
lobar consolidation
Agents
S. pneumoniae
H. Influenzae
Gr(-)aerop bacillus
Aneorobes
Atypical pneumonia
subacute,
subfebril fever
non productive cough
nonrespiratory symptoms
physical signs ( - )
non-lobar infiltration
M.pneumonia
C.pneumoniae
L. Pneumophila
Virus
Lobar pneumonia
Lobar pneumonia
Bronchopneumonia
Interstitial pneumonia
CAP THERAPY
GROUP 1
GROUP 2
GROUP 3
OUTPATIENTCLINIC
HOSPITAL
INTENSIVE
CARE
Mild pneumonia,
Moderate
pneumonia
Severe
pneumonia
CAP Therapy: Group I
No antibiotic usage
No comorbidity
With comorbidities
Pneumococci resistant to penicillin
Gram (–) agents
Usage of antibiotic last three months
Usage of corticosteroid
Penicillin,
Macrolide,
Floroquinolone,
ß laktame +
Macrolide
Therapy: Group
2 II
CAPCAP
Therapy:
Group
•
S.pneumoniae
•
H.influenzae
•
M.pneumoniae
•
C.pneumoniae
•
Mix infection)
•
Enteric Gram
negatives !
•
Virus
First choise
Alternatif
________________________________________
Penicillin G ± makrolide
Levofloksasin
Aminopenicillin ± makrolide
Moksifloksasin
Aminopenicillin / β-laktamase
inhibitor ± macrolide
Non- antipseudomonal cefalosporin II-III
± macrolide
CAP Therapy: Group III
No risk of P. aeruginosa
• Non pseudomonal cefalosporin III+ macrolide
or
• Non pseudomonal cefalosporin III + (moksifloksasin or
levofloksasin)
With risk of P. aeruginosa
• Anti-pseudomonal cefalosporin (sefepim-seftazidim)
or
• Ureidopenicillin/beta-laktamase inhibitor (piperasilin..
or
• Karbapenem + siprofloksasin
Duration of the therapy
After fever drop
1 week
- Pneumococcic pneumonia
7-10 days
- Legionella pneumonia
- Mycoplasma ve C. pneumoniae
14-21 days
10-14 days
Severe pneumonia
2-3 weeks