Pneumonia

PNEUMONIA
acute lower respiratory tract illness associated with fever , signs ans symptoms in the chest , abnormalities in the chest xray .

incidence - 1-3 per 1000 population
mortality - 10%

classification

• community acquired pneumonia(CAP)
• hospital acquired peumonia(HAP)@nosocomial
• aspiration pneumonia (AP)
• pneumonia in immunocompromised(PI)

aetiology

CAP- Streptococcus pneumoniae , Haem.influenzae , Mycoplasma Pneumoniae , Staph aureus , Legionella spp
HAP- Gram neg. enterobacteria , Staph aureus , Pseudomonas , Klebsiella , Bacteroides , Clostridia
AP - those with stroke , myasthenia , bulbar palsies , esophageal disease(achalasia , reflux) , poor dental hygiene
PI - Streptococcus pneumonia , H.influenzae , Staph aureus , Moraxella catarrhalis , Mycoplasma pneumoniae

Clinical features

Symptoms - high grade fever with chills and rigor , malaise , anorexia , cough with/out purulent sputum , pleuritic chest pain , coughing out blood(haemoptysis)
Signs - Fever , cyanosis , confusion(sign in elderly) , tachypnoea , tachycardia , hypotension , signs of consolidation - diminished expansion , dull percussion note , increased tactile vocal fremitus/vocal resonance , bronchial breathing) , pleural rub.

Tests and investigations

• CXR(chest x ray)
• ABG(arterial blood gas)
• Blood tests - FBC , CRP , LFT , blood cultures ,
• Sputum - C&S(culture and sensitivity)
• Pleural fluid aspiration for culture.
• Bronchoscopy

Management

• Antibiotics therapy - orally if not severe , i.v. if severe
• Oxygen therapy
• IV fluids
• Analgesics

Complications of pneumonia

1. Pleural effusion
2. empyema
3. lung abscess
4. respiratory failure
5. pericarditis
6. myocarditis
7. cholestatic jaundice
8. brain abscess

Prevention
offer pneumococcal vaccine(23-valent pneumovax) tp those with:

• chronic heart or lung condition
• cirrhosis
• nephrosis
• Diabetes mellitus
• Immunosuppression state - splenectomy , AIDS , chemotherapy

C/I - pregnancy , lactation , fever