Diseases of the respiratory system(1). Pneumonia - PowerPoint Presentation

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Diseases of the respiratory system(1). Pneumonia

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Causes

Many germs can cause pneumonia.

The most common are bacteria and viruses in the air we breathe.

Human body usually prevents these germs from infecting lungs.

But sometimes these germs can overpower the immune system, even if the health is generally good.

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Pneumonia classification

Community-acquired pneumonia

Hospital-acquired pneumonia

Health care-acquired pneumonia

Aspiration pneumonia

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Pneumonia classification

Community-acquired pneumonia

Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. It may be caused by:

Bacteria.

The most common cause of bacterial pneumonia is Streptococcus pneumoniae. This type of pneumonia can occur on its own or after

smb

’s had a cold or the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia.

Bacteria-like organisms.

Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms than do other types of pneumonia. Walking pneumonia is an informal name given to this type of pneumonia, which typically isn't severe enough to require bed rest.

Fungi.

This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and vary depending upon geographic location.

Viruses.

Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of pneumonia in children younger than 5 years. Viral pneumonia in some cases can become very serious.

Hospital-acquired pneumonia

Some people catch pneumonia during a hospital stay for another illness. Hospital-acquired pneumonia can be serious because the bacteria causing it may be more resistant to antibiotics and because the people who get it are already sick. People who are on breathing machines (ventilators), often used in intensive care units, are at higher risk of this type of pneumonia.

Health care-acquired pneumoniaHealth care-acquired pneumonia is a bacterial infection that occurs in people who live in long-term care facilities or who receive care in outpatient clinics, including kidney dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia can be caused by bacteria that are more resistant to antibiotics.

Aspiration pneumonia

Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. Aspiration is more likely if something disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drugs.

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Risk factors

Pneumonia can affect anyone. But the two age groups at highest risk are:

Children who are 2 years old or younger

People who are age 65 or older

Other

risk

factors

include

:

Being

hospitalized

.

You're

at

greater

risk

of

pneumonia

if

you're

in

a

hospital

intensive

care

unit

,

especially

if

you're

on

a

machine

that

helps

you

breathe

(a

ventilator

).

Chronic

disease

.

You're

more

likely

to

get

pneumonia

if

you

have

asthma

,

chronic

obstructive

pulmonary

disease

(COPD)

or

heart

disease

.

Smoking

.

Smoking

damages

your

body's

natural

defenses

against

the

bacteria

and

viruses

that

cause

pneumonia

.

Weakened

or

suppressed

immune

system

.

People

who

have

HIV/AIDS,

who've

had

an

organ

transplant

,

or

who

receive

chemotherapy

or

long-term

steroids

are

at

risk

.

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Symptoms

The signs and symptoms of pneumonia vary from mild to severe,

depending on factors such as the type of germ causing the infection, and your age and overall health.

Mild signs and symptoms often are similar to those of a cold or flu, but they last longer.

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Signs and symptoms of pneumonia may include:

Chest pain

when you breathe or cough

Confusion or changes in mental awareness

(in adults age 65 and older)

Cough

, which may produce phlegm

Fatigue

Fever

, sweating and

shaking chills

Lower than normal body temperature (in adults older than age 65 and people with weak immune systems)

Nausea, vomiting or diarrhea

Shortness of breath

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Diagnosis of pneumonia

tests

comments

Blood tests

are used to confirm an infection and to try to identify the type of organism causing the infection. However, precise identification isn't always possible.

C-reactive protein

-

pneumonia marker

.

Sputum test

A sample of fluid from lungs (sputum) is taken after a deep cough and analyzed to help pinpoint the cause of the infection.

Pulse oximetry

This measures the oxygen level in blood. Pneumonia can prevent lungs from moving enough oxygen into bloodstream.

Chest X-ray

This helps to diagnose pneumonia and determine the extent and location of the infection. However, it can't tell a doctor what kind of germ is causing the pneumonia.

If pneumonia isn't clearing as quickly as expected, a doctor may recommend a chest CT scan to obtain a more detailed image of your lungs.

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Chest X-ray showing pneumonia

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Complete airspace consolidation with

air bronchograms

of the right upper lobe, with further consolidation within the medial right middle lobe. Small right parapneumonic effusion.

Left lung and pleural space are clear. Cardiomediastinal contour is unremarkable.

Frontal Lateral

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CT scan showing the consolidation in the lower lobe of the right lung.

https://www.oatext.com/Frank-s-sign-in-a-patient-with-pneumococcal-pneumonia.php

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Double (bilateral) pneumonia

https://www.ehealthstar.com/conditions/pneumonia/double-bilateral

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Posterior-anterior CXR in an emphysematous patient. It is possible to observe multiple bronco-pneumonic bilateral outbreaks, confluent in the right region. Left lateral

costo

-phrenic sinus is totally filled b

y pleural effusion.

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ARDS in H1N1 virus pneumonia. Supine CXR showing bilateral, predominantly peripheral, asymmetrical patchy consolidation with air bronchograms. Septal lines and pleural effusions, are absent.

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Case Summary

A 50-year-old male presented to his primary care physician with

cough, fever, malaise, myalgias, and shortness of breath

that began 1 week before admission. He reported no recent travel, sick contacts, animal contacts, or environmental exposures.

His past medical history included hypertension and schizophrenia, well controlled on medication. His physician performed a chest x-ray in the office, which was abnormal, and the patient was referred to our institution for diagnostic work-up.

Vital signs revealed a

temperature of 37.9°C

, a

pulse 108 beats/min

, a blood pressure of 137/71 mm/Hg, and a breathing frequency of 18 breaths/min.

His physical examination was unremarkable except for tachycardia and right upper lobe rales.

Complete blood count

revealed a

white blood cell count of 14.4 ×10

3/mL, a hemoglobin of 9.9 g/dL, a hematocrit of 28.9%, and a platelet count of 406 ×103/mL. The erythrocyte sedimentation rate was 104 mm/h. His serum ferritin level was 407 ng/mL (normal 14–235 ng/mL), alanine aminotransferase was 22 IU/L (normal 4–36 IU/L), aspartate aminotransferase 22 IU/L (normal 13–39 IU/L), and alkaline phosphatase 55 IU/L (normal 25–100 IU/L). Procalcitonin level was 0.11 mg/mL (normal 0–0.5 mg/mL). Figure 1 shows his admission chest x-ray.

Urine legionella antigen, legionella species titer, and Mycoplasma pneumoniae and Chlamydia pneumoniae immunoglobulin-M (IgM) and IgG titers were negative. Cold and febrile agglutinins were negative, Anti-smooth muscle antibody titers were negative. Q fever phase I and II antigens were negative. Blood, urine, and sputum cultures were negative. He was treated empirically for 6 weeks with Antibiotics - doxycycline, which has activity against all of the infectious causes of round pneumonias. A specific etiology was not identified. Repeat chest x-ray taken 8 weeks later demonstrated near resolution of the round pneumonia (

Fig. 2

).

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Admission chest x-rays in a 50-year-old man with round pneumonia.

Figure 1

http://rc.rcjournal.com/content/58/7/e80

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Chest x-rays 8 weeks later show near complete resolution of round pneumonia.

Fig. 2

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Please,

compare again the dynamics of radiological changes as a result of treatment

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Treatment

Treatment for pneumonia involves curing the infection and preventing complications.

People who have community-acquired pneumonia usually can be treated at home with medication.

Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more.

Specific treatments depend on the type and severity of pneumonia, age and patient’s overall health.

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Treatment of pneumonia

Antibiotics

These medicines are used to treat bacterial pneumonia.

It may take time to identify the type of bacteria causing pneumonia and to choose the best antibiotic to treat it.

If patient’s symptoms don't improve, a different antibiotic may be recommended.

Cough medicine

This medicine may be used to calm a cough so that patient can rest.

Because coughing helps loosen and move fluid from the lungs, it's a good idea not to eliminate patient’s cough completely.

In addition, a patient should know that very few studies have looked at whether over-the-counter cough medicines lessen coughing caused by pneumonia.

If a patient wants to try a cough suppressant, he can use the lowest dose that helps him rest.

Fever reducers/pain relievers

T

hey are assigned to control

fever and discomfort.

These include drugs such as paracetamol or ibuprofen

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Hospitalization

Patient is

older than age 65

Patient is

confused

about time, people or places

Patient’s

kidney function has declined

Patient’s

systolic blood pressure

is below 90 millimeters of mercury (mm Hg) or

diastolic blood pressure

is 60 mm Hg or below

Patient’s breathing is rapid (30 breaths or more a minute)Patient needs breathing assistancePatient’s temperature is below normalPatient’s heart rate is below 50 or above 100

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Complications

Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications, including:

Bacteria in the bloodstream (bacteremia).

Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure.

Difficulty breathing.

If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a breathing machine (ventilator) while your lung heals.

Fluid accumulation around the lungs (pleural effusion).

Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery.

Lung abscess.

An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus.

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Prevention

To help prevent pneumonia:

Get vaccinated.

Vaccines are available to prevent some types of pneumonia and the flu. Recommended for patients with chronic obstructive pulmonary disease, bronchiectasis, other chronic diseases of the lungs, lower respiratory tract

Make sure children get vaccinated.

Doctors recommend a different pneumonia vaccine for children younger than age 2 and for children ages 2 to 5 years who are at particular risk of pneumococcal disease. Children who attend a group child care center should also get the vaccine. Doctors also recommend flu shots for children older than 6 months.

Practice good hygiene.

To protect yourself against respiratory infections that sometimes lead to pneumonia, wash your hands regularly or use an alcohol-based hand sanitizer.

Don't smoke.

Smoking damages your lungs' natural defenses against respiratory infections.

Keep your immune system strong.

Get enough sleep, exercise regularly and eat a healthy diet.