Prof. Dr. Bilun Gemicioğlu

Pneumonia

Pneumonia is a lung parenchyma infection caused by bacteria, a virus or fungi, with a consolidation on radiological examination.

Pneumonitis is an inflammation of the lungs caused by chemical or radiation therapy but not with infectious agents.

Definition

– Inhalation

– Aspiration of oropharingeal secretion

– Hematogenic spread

– Direct spread (thorax wall,

mediastinum)

Spread of lung infections

Predisposing factors of pneumonia

• Airways mechanical barrier damage

• Specific and/or nonspecific immune defense mechanisms injury

• Bronchial obstruction

• Micro aspiration of upper respiratory truck secretion.

• Lung edema

• Viral infections.

Diagnostic Methods

• History, physical examination

• Chest X-Ray

• Sputum examination (gram stained)

• Sputum , blood cultures

• Serological tests

• Peripheral blood analysis

Symptoms fever, shaking chills, cough, sputum (expectoration), pleuritic pain. Others: (dispnea, fatigue, sweating, loss of

appetite...)

Physical signs:increased vibration thoracic impaired percussion (matity), end inspiratory rales (crepitations) and

bronchial breathing (tuber soufle)Others (cyanosis, tachipnea, tachicardia...)

Diagnosis

Radiology:

lobar opacities,

interstitial images,

bronchopneumonic (patchy) opacities,

Others (absea, pneumatocele, pleurisy...)

Diagnosis

Chest X-Ray

• Gold standart test for pneumonia

• For differencial diagnosis

• For grading pneumonia severity

• For examining complications

-First 24 hours

-Dehydration

-Elderly

-Neutropenia

-Pneumocystis carinii

Normal Chest X Ray in Pneumonia

Classification with anatomical localization

• Lobar consolidation

• Bronchopneumonia

• Interstitial pneumonia

•Bacterial

•Viral

•Fungal

•Parazites

Classification with ethiology

Classification with targeting therapy

• Community acquired pneumonia

• Hospital acquired pneumonia (Nosocomial)

• Immunosuppresed (immunocompromised) patients pneumonia

Community acquired pneumonia

Pneumonia acquired outside hospital frequently in

healthy persons

Typical pneumonia Atypical pneumonia acute subacute, fever,chills subfebril fever productive cough non productive cough pleural pain nonrespiratory symptoms physical signs ( + ) physical signs ( - ) lobar consolidation non-lobar infiltration

Caracteristics of community acquired pneumonia (CAP)

Agents S. pneumoniae M.pneumonia H. Influenzae C.pneumoniae Gr(-)aerop bacillus L. Pneumophila Aneorobes Virus

Lobar pneumonia

Lobar pneumonia

Bronchopneumonia

Interstitial pneumonia

CAP THERAPY

GRGROOUP UP 11

OUTPATIENT-OUTPATIENT-CLINICCLINIC

GRGROOUP UP 2 2

HOSPITALHOSPITAL

GRGROOUP UP 3 3

INTENSIVE INTENSIVE CARECARE

Mild pneumonia, Moderate pneumonia

Severe pneumonia

No antibiotic usage No comorbidity

With comorbiditiesPneumococci resistant to penicillinGram (–) agentsUsage of antibiotic last three monthsUsage of corticosteroid

CAP Therapy: Group I

Penicillin,Macrolide,

Floroquinolone,ß laktame + Macrolide

CAP Therapy: Group 2CAP Therapy: Group 2

• S.pneumoniae

• H.influenzae• M.pneumoniae

• C.pneumoniae

• Mix infection)

• Enteric Gram negatives !

• Virus

First choise Alternatif________________________________________

Penicillin G ± makrolide Levofloksasin

Aminopenicillin ± makrolide Moksifloksasin

Aminopenicillin / β-laktamase inhibitor ± macrolide

Non- antipseudomonal cefalosporin II-III ± macrolide

CAP Therapy: Group II

No risk of P. aeruginosa• Non pseudomonal cefalosporin III+ macrolide or• Non pseudomonal cefalosporin III + (moksifloksasin or

levofloksasin)

With risk of P. aeruginosa• Anti-pseudomonal cefalosporin (sefepim-seftazidim) or• Ureidopenicillin/beta-laktamase inhibitor (piperasilin..

or• Karbapenem + siprofloksasin

CAP Therapy: Group III

Duration of the therapy

After fever drop 1 week

- Pneumococcic pneumonia 7-10 days

- Legionella pneumonia 14-21 days- Mycoplasma ve C. pneumoniae 10-14 days

Severe pneumonia 2-3 weeks