PNEUMONIA Flashcards
Pneumonia
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Etiology
🤦🏻♀️85% of CAP are bacterial: S.pneumonia, H.influenza,
15%are atypical:
M.pneumonia, legionella,C.pneumonia.
Viruses: influenza, CMV, RSV,measles,varicella.COVID-19
- Oral anaerobes
- Fungi
- Mycobacterium tuberculosis
- C.psittacci
- Parasites, PCP.
Anatomic classification
- Lobar pneumonia: pneumonia of one or more lobes
- Bronchopneumonia: scattered bilateral inflammation both lungs
- Interstitial pneumonia: bilateral perihilar pulmonary inflammation
Clinical manifestations
👶🏻 Symptoms
Onset is variable from acute, sub-acute or gradual
- General Fever, malaise , toxemia (worst in bronchopneumonia)
- May be abdominal pain: Referred from lower lobe pneumonia
- Chest Cough (dry then productive)
- Dyspnea and grunting
👶🏻💔 signs
Respiratory distress
- Tachypnea is the most consistent clinical manifestation of pneumonia, nasal flaring, retractions and grunting
- Cyanosis and lethargy in severe infection specially in infants Signs
The liver may seem enlarged because of downward displacement of the right diaphragm or superimposed congestive heart failure.
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👩🏻⚕️👶🏻👶🏼 Chest examination
• Pneumonia ± effusion)
Pneumonia → Diminished breathing sound , bronchial breathing, Crepitations, Increased Bronchophony
Effusion→ trachea Shifted to opposite side, Stony dull, Markedly diminished vesicular
• Bronchopneumonia→ Bilateral wheezes , Crepitations, Normal vesicular
• Interstitial pneumonia
🛑🛑
Older children →lobarpneumonia→pleurisy
Babies→bronchopneumonia → respiratory distress
Viral or bacterial pneumonia?
- Clinical Large pleural effusion, lobar consolidation, and a high fever at the onset of the illness are suggestive of a bacterial etiology
- Investigations
An underlying disorder should be considered if a child experiences recurrent bacterial pneumonias
abnormalities of antibody production cystic fibrosis cleft palate congenital bronchiectasis ciliary dyskinesia, tracheoesophageal fistula , increased pulmonary blood flow deficient gag reflex Cerebral palsy
Pneumococcal Pneumonia
S. pneumoniae is still the most common cause of bacterial infection of the lungs.
one or more lobes, lobar pneumonia
diffuse disease that follows a bronchial distribution and that is characterized by many limited areas of consolidation around the smaller airways
Permanent injury is rare.
Preceded by viral infection
Laboratory 🧫 🧪
1- WBC count
- In viral pneumonia usually not higher than 20,000/mm3 , with a lymphocyte predominance
- In bacterial pneumonia, in the range of 15,000-40,000/mm3 , and a predominance of granulocytes
- Mild eosinophilia is characteristic of infant C. trachomatis pneumonia
2- Acute phase reactants: High ESR, positive C-reactive protein and Procalcitonin usually suggest bacterial rather than viral pneumonia
3- Isolation of an organism
Radiological findings
- Chest X-ray findings:
A. 🤓Lobar pneumonia
- Homogenous opacity in one or more lobes
- Usually bacterial
B. 🤓Bronchopneumonia
- Scattered opacities in both lungs
- Viral or bacterial
C. 🤓Interstitial pneumonia
- Scattered bilateral interstitial infiltrates and peribronchial cuffing
- Hyperinflation, and atelectasis
- Seen in viral bronchopneumonia and atypical pneumonia
D. 🤓Complications Effusion, abscess, or pneumatoceles (single or multiple, thin-walled, air-filled, cystlike cavities) may indicate S. aureus, gram-negative, or complicated pneumococcal pneumonia.
Meningitis, suppurative arthritis, and osteomyelitis are rare complications of hematologic spread of pneumococcal or H. influenzae type b infection
- Ultrasonography:
- Highly sensitive and specific in diagnosing pneumonia by determining lung consolidations and air bronchograms or effusions
- Differentiate simple effusion and empyema
- Guide thoracentesis of a loculated effusion
- Contrast CT scan, CT or ultrasonography guided lung biopsy:
Reserved for complicated cases/ COVID-19
Complications of pneumonia 🙊
🙊respiratory
Pleural effusion Empyema with or without bronchopleural fistula and pyopneumothorax Lung abscess Pneumatoceles Unresolved pneumonia
🙊systematic
Meningismus especially with right upper lobe pneumococcal pneumonia Heart failure Distant infections e.g. Septicemia, meningitis, pericarditis Paralytic ileus
Tx
Supportive
- Bed rest, humidified O 2 inhalation ± restricted I.V. fluids
- Symptomatic treatment e.g. antipyretics for fever
- Treatment of complications e.g. Heart failure.
- Aspiration /drainage for effusion or empyema
- Oral zinc (10- 20 mg/day) is recommended add-on in developing countries
ii. Specific treatment
1. Suspected bacterial pneumonia: Antibiotics
Antibiotics
1-Milder cases
• Amoxicillin (50–90 mg/kg/dose) or Cefuroxime or Amoxicillin clavulanate
Hospitalized cases
- Children less than 4 weeks ➡️ IV Ampicillin and an Aminoglycoside
- Infants 4–12 weeks of age➡️ IV Ampicillin for 7–10 days
- older child 🧒 ➡️ Parenteral cefotaxime or ceftriaxone
- Suspected Staph➡️ vancomycin
- Suspected Klebsiella➡️ Add aminoglycoside
- Mycoplasma pneumonia➡️ Erythromycin or azithromycin or clarithromycin
Staph pneumonia
- caused by S. aureus may be primary or secondary after a viral infection such as influenza
- Hematogenous pneumonia may be secondary to septic emboli from right-sided endocarditis or septic thrombophlebitis, with or without intravascular devices.
- Inhalation pneumonia is caused by alteration of mucociliary clearance, leukocyte dysfunction, or bacterial adherence initiated by a viral infection.
Staph pneumonia sx
- Common symptoms and signs include high fever, abdominal pain, tachypnea, dyspnea,
- localized or diffuse bronchopneumonia or lobar disease.
- S. aureus often causes a necrotizing pneumonitis that may be associated with early development of empyema, 😱pneumatoceles, pyopneumothorax, and bronchopleural fistulas.
- Chronic pulmonary infection with S. aureus contributes to progressive pulmonary dysfunction in children with cystic fibrosis
Staph pneumonia tx
-vancomycin
