Lobar pneumonia

Question 1

What is the definition of lobar pneumonia?

Answer 1

Inflammation of a lobe of the lung, usually caused by bacteria

Question 2

How common is lobar pneumonia?

Answer 2

0.5%-1% of people develop community-acquired pneumonia (CAP) in the UK every year.

Question 3

What is the pathology of lobar pneumonia?

Answer 3

• Anatomical classification of pneumonia – the other is bronchopneumonia
• Streptococcus pneumonia, Mycoplasma pneumonia, Influenza A and Haemophilus influenza common
• 4 stages in lobar pneumonia (if untreated):
• 1) Consolidation and exudate
• 2) Appears red/brown/firm/dry, alveolar walls thick
• 3) Grey hepatization, capillary congestion, alveolar walls thick
• 4) exudate drains with gradual aeration of the affected segments

Question 4

What are the risk factors/aetiology of lobar pneumonia?

Answer 4

• Aspiration of vomit
• Radiotherapy
• Pre-existing lung disease e.g. COPD
• Contact with birds
• Contact with other animals
• IV drug users
• CF
• Immunosuppressed
• Use of cytotoxic drugs

Question 5

What are the signs/symptoms of lobar pneumonia?

Answer 5

• Pyrexia
• Cough
• Sputum production
• Pleurisy
• Pleural rub
• Dyspnoea
• Late inspiratory crackles
• Dullness of percussion

Question 6

What diseases present similarly to lobar pneumonia?

Answer 6

• Bronchial carcinoma
• PE
• Pulmonary oedema
• Pulmonary haemorrhage
• Hypersensitivity pneumonitis

Question 7

What investigations are conduced for suspected lobar pneumonia?

Answer 7

• CXR – done at time of diagnosis and 6 weeks later to rule out bronchial carcinoma
• Bloods
• ↓ albumin
• Abnormal WCC
• Blood culture
• ABG
• Sputum
• CURB-65 – assesses severity of community acquired pneumonia
• Confusion
• Urea >7mmol/L
• Resp rate >30/min
• BP <60/90
• Age > 65

Question 8

What are the pharmacological treatments for lobar pneumonia?

Answer 8

• Analgesia – for pleuritic pain
• Humidified oxygen
• Fluids
• Abx
• Hospital acquired = co-amoxiclav/cephalosporin
• Community acquired = amoxicillin

Question 9

What are the non pharmacological treatments for lobar pneumonia?

Answer 9

• Physiotherapy – encourages patient to cough