pneumonia
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– Community Acquired Pneumonia (CAP) – Hospital Acquired Pneumonia (HAP) – Aspiration Pneumonia
Pathology of Pneumonia
Lobar pneumonia
– Involvement of an entire lobe
Pathogen identification
Sputum gram stain and culture
– Good specimen
PMN’s: WBC>25/LPF Few epithelial cells<10/LPF Single predominant organism
– Common organisms
Diagnosis Of CAP
History and physical examination Chest X-ray Blood WBC Blood culture Sputum gram stain and culture Pleural fluid Serology (Immunological testing) Molecular Techniques
CASE ANALYSIS
Chest X-ray:
Infiltration in the parenchyma of the lung, Consolidated patch in the left lower lobe of the lung.
Pneumonia and lung Abscess
Zhou Mingjuan Department of Respiratory, Guangdong Provincial Hospital of Traditional Chinese Medicine
Definition
Pneumonia is an acute inflammation or infection of the parenchyma of the lung.
Common pathogens
– Mixed flora – Mouth anaerobes
Peptostreptococcus spp, Actinomyces spp.
– Stomach contents
Chemical pneumonitis Enterobacterium
Typical pneumonia:
Bronchopneumonia
– Involvement of parts of the lobe only
Interstitial pneumonia Miliary pneumonia
1. 2. Bronchopneumonia 3. 4. Interstitial pneumonia 5. Lobar pneumonia
Community - Acquired Pneumonia (CAP)
Epidemiology Incidence of CAP is 5%-12%
Pathogenesis--CAP
Common pathogens
– Viruses ( most common type) – Bacteria:
– Productive cough, – Mucopurulent sputum
Fever for 2 days
– Fever with chills,
Pleuritic chest pain
CASE ANALYSIS
PE:
T: 39 ℃, HR:102 times/min, R: 28 times/min. Lung auscultation: Rales over all the lung. WBC: 13.2*109/L, N: 83%.
Depend on the virulence and host susceptibility.
May also be caused by other factors, including X-ray, chemical, allergen.
Pneumonia
The lungs' air sacs fill with pus, mucus, and other liquid and can not function properly.
Clinical presentation
Usual bacteria – Sudden onset – Fever with chills, rigors – Productive cough, Mucopurulent sputum – Tachypnea and tachycardia – Pleuritic chest pain – Breath sound: crackles and rales – CXR: infiltrate, consolidation
Lobar pnБайду номын сангаасumonia
Pathology：1.Congestion 2.Red hepatization 3.Gray hepatization 4.Resolution
Interstitial pneumonia
Clinical Presentation
– Fever – Breath sound: rales/ronchi – Productive cough – Increased respiratory rate – Increased WBC – Chest X-ray: infiltrate / consolidation
GROUP IIIA
GROUP IIIB
GROUP IVA
GROUP IVB
Prevention
Release aspiration Washing hands Vaccination
CASE ANALYSIS
32 years old, male A long history of smoking Cough for 1 wk after cold
S. pneumoniae(Streptococcus) H. influenzae
– Mycoplasma – Chlamydia – Legionella – Mycobacterium
Aspiration Pneumonia
Organism resident: from nasopharynx /patient /animal /environment
Chest X-ray pneumonia
Pneumonia Pathogens
Microorganisms
– Viruses – Bact Pneumonia
Streptococcus
– Mycoplasma, Chlamydia, Legionella – M. tuberculosis – Fungi – parasites
CAP Treatment
GROUP I
GROUP II
GROUP IVA
CAP Antibiotic Therapy
Antibiotics:
– Bacteria – Atypical pathogens
Empiric therapy (4-8h) Combined empiric therapy to target therapy Period of treatment: 10-14d
Pathogenesis--HAP
Common pathogens
– Bacteria: Colonization of the pharynx and possibly the stomach.
S. pneumoniae K. pneumoniae H. influenzae Staphylococcal pneumoniae Peptostreptococcus spp Actinomyces spp
Diagnosis Of HAP
It is difficult to find the cause of HAP Blood cultures can identify 20% Chest X-ray is important
HAP Treatment
Antimicrobial therapy begin promptly because delays in administration of antibiotics have been associated with worse outcomes.
Oxygen can’t reach the blood-insufficient oxygen in the blood--body cells can not function properly --die.
Classification of Pneumonia
Typical vs. Atypical Practical classification
Pulmonary tuberculosis Lung cancer Acute lung abscess Pulmonary embolism Noninfectious pulmonary infiltration
CAP Treatment
Keep vital signs: Airway, Breathing, Circulation
Period of treatment: 14-21d
Empirical therapy
The initial selection of an antimicrobial agent is almost always made on an empiric basis and is based on factors such as severity of infection, patientspecific risk factors, and total number of days in hospital before onset.
Symptom treatment The therapy should always follow
confirmation of the diagnosis of pneumonia and should always be accompanied by a diligent effort to identify an etiologic agent.
Gram positive: diplococcus (pairs and chains) Gram positive: clusters, ie staphylococcal Gram negative: coccobacillary Gram negative: rods
Differential diagnosis
Lung abscess is a cavitated and localized area of suppuration within lung tissue that leads to parenchymal destruction.
Etiology
Pneumonia caused by bacteria, fungi, virus, parasite etc.
Atypical pneumonia:
Clinical presentation
– Gradual onset – Afebrile – Dry cough – Breath sound: Rales – Uni/bilateral patchy, infiltrates – WBC: usual normal or slight high – Sore throat, myalgia, fatigue, diarrhea
Hospital Acquired Pneumonia (HAP)
– Hospital Acquired Pneumonia
(Nosocomial Pneumonia) Ventilator Associated Pneumonia (VAP) Health Care Associate Pneumonia (HCAP)
Pathology of Pneumonia
Lobar pneumonia
– Involvement of an entire lobe
Pathogen identification
Sputum gram stain and culture
– Good specimen
PMN’s: WBC>25/LPF Few epithelial cells<10/LPF Single predominant organism
– Common organisms
Diagnosis Of CAP
History and physical examination Chest X-ray Blood WBC Blood culture Sputum gram stain and culture Pleural fluid Serology (Immunological testing) Molecular Techniques
CASE ANALYSIS
Chest X-ray:
Infiltration in the parenchyma of the lung, Consolidated patch in the left lower lobe of the lung.
Pneumonia and lung Abscess
Zhou Mingjuan Department of Respiratory, Guangdong Provincial Hospital of Traditional Chinese Medicine
Definition
Pneumonia is an acute inflammation or infection of the parenchyma of the lung.
Common pathogens
– Mixed flora – Mouth anaerobes
Peptostreptococcus spp, Actinomyces spp.
– Stomach contents
Chemical pneumonitis Enterobacterium
Typical pneumonia:
Bronchopneumonia
– Involvement of parts of the lobe only
Interstitial pneumonia Miliary pneumonia
1. 2. Bronchopneumonia 3. 4. Interstitial pneumonia 5. Lobar pneumonia
Community - Acquired Pneumonia (CAP)
Epidemiology Incidence of CAP is 5%-12%
Pathogenesis--CAP
Common pathogens
– Viruses ( most common type) – Bacteria:
– Productive cough, – Mucopurulent sputum
Fever for 2 days
– Fever with chills,
Pleuritic chest pain
CASE ANALYSIS
PE:
T: 39 ℃, HR:102 times/min, R: 28 times/min. Lung auscultation: Rales over all the lung. WBC: 13.2*109/L, N: 83%.
Depend on the virulence and host susceptibility.
May also be caused by other factors, including X-ray, chemical, allergen.
Pneumonia
The lungs' air sacs fill with pus, mucus, and other liquid and can not function properly.
Clinical presentation
Usual bacteria – Sudden onset – Fever with chills, rigors – Productive cough, Mucopurulent sputum – Tachypnea and tachycardia – Pleuritic chest pain – Breath sound: crackles and rales – CXR: infiltrate, consolidation
Lobar pnБайду номын сангаасumonia
Pathology：1.Congestion 2.Red hepatization 3.Gray hepatization 4.Resolution
Interstitial pneumonia
Clinical Presentation
– Fever – Breath sound: rales/ronchi – Productive cough – Increased respiratory rate – Increased WBC – Chest X-ray: infiltrate / consolidation
GROUP IIIA
GROUP IIIB
GROUP IVA
GROUP IVB
Prevention
Release aspiration Washing hands Vaccination
CASE ANALYSIS
32 years old, male A long history of smoking Cough for 1 wk after cold
S. pneumoniae(Streptococcus) H. influenzae
– Mycoplasma – Chlamydia – Legionella – Mycobacterium
Aspiration Pneumonia
Organism resident: from nasopharynx /patient /animal /environment
Chest X-ray pneumonia
Pneumonia Pathogens
Microorganisms
– Viruses – Bact Pneumonia
Streptococcus
– Mycoplasma, Chlamydia, Legionella – M. tuberculosis – Fungi – parasites
CAP Treatment
GROUP I
GROUP II
GROUP IVA
CAP Antibiotic Therapy
Antibiotics:
– Bacteria – Atypical pathogens
Empiric therapy (4-8h) Combined empiric therapy to target therapy Period of treatment: 10-14d
Pathogenesis--HAP
Common pathogens
– Bacteria: Colonization of the pharynx and possibly the stomach.
S. pneumoniae K. pneumoniae H. influenzae Staphylococcal pneumoniae Peptostreptococcus spp Actinomyces spp
Diagnosis Of HAP
It is difficult to find the cause of HAP Blood cultures can identify 20% Chest X-ray is important
HAP Treatment
Antimicrobial therapy begin promptly because delays in administration of antibiotics have been associated with worse outcomes.
Oxygen can’t reach the blood-insufficient oxygen in the blood--body cells can not function properly --die.
Classification of Pneumonia
Typical vs. Atypical Practical classification
Pulmonary tuberculosis Lung cancer Acute lung abscess Pulmonary embolism Noninfectious pulmonary infiltration
CAP Treatment
Keep vital signs: Airway, Breathing, Circulation
Period of treatment: 14-21d
Empirical therapy
The initial selection of an antimicrobial agent is almost always made on an empiric basis and is based on factors such as severity of infection, patientspecific risk factors, and total number of days in hospital before onset.
Symptom treatment The therapy should always follow
confirmation of the diagnosis of pneumonia and should always be accompanied by a diligent effort to identify an etiologic agent.
Gram positive: diplococcus (pairs and chains) Gram positive: clusters, ie staphylococcal Gram negative: coccobacillary Gram negative: rods
Differential diagnosis
Lung abscess is a cavitated and localized area of suppuration within lung tissue that leads to parenchymal destruction.
Etiology
Pneumonia caused by bacteria, fungi, virus, parasite etc.
Atypical pneumonia:
Clinical presentation
– Gradual onset – Afebrile – Dry cough – Breath sound: Rales – Uni/bilateral patchy, infiltrates – WBC: usual normal or slight high – Sore throat, myalgia, fatigue, diarrhea
Hospital Acquired Pneumonia (HAP)
– Hospital Acquired Pneumonia
(Nosocomial Pneumonia) Ventilator Associated Pneumonia (VAP) Health Care Associate Pneumonia (HCAP)