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Investigations for pneumonia

Mostly, the clinical and radiologic assessments are usually all that has to be done!!

Chest radiography:

• An absolute necessity in patients with suspected pneumonias

• Confirming diagnosis

• Differentiate from other conditions

• Etiologic diagnosis (sometimes)

Findings:

• Opacities

• Air bronchograms

• Silhouette sign

• Complications of pneumonia:

Parapneumonic effusions, lung abscesses, atelectasis

Three radiological patterns :

• Lobar pneumonia

• Bronchopneumonia

• Interstitial pneumonia

S pneumoniae pneumonia

• Lobar or segmental pattern

• Patchy bronchopneumonic pattern involving the lower lobes in the elderly

• Parapneumonic effusions are common

S aureus pneumonia

• Patchy bronchopneumonia is more common and often bilateral

• Lobar consolidation may be seen

• Pneumatoceles

• Empyema

• Abssesses

Interstitial pneumonia:

Viral

Atypical

• Multilobar involvement

• Nodular or reticular infiltrates

• May have lobar pattern

Klebsiella pneumoniae pneumonia

• Patchy bronchopneumonia and dense lobar consolidations.

• Bulging of the interlobar fissures; rare and characteristic

Pseudomonas aeruginosa pneumonia

• Characteristic predilection for the lower lobes

• Patchy bronchopneumonia or extensive consolidation may be present

• Parenchymal abscesses

CT:

• Limited role

• Suspected post obstructive pneumonia caused by :

Tumor

Foreign body

Gram’s stain and Culture of sputum:

• Gram’s staining may identify certain pathogens

• To be adequate for culture, a sputum sample must have >25 neutrophils and <10 squamous epithelial cells per low-power field

• Patients may already have started a course of antibiotics that can interfere with culture results at the time a sample is obtained

Deep-suction aspirate or bronchoalveolar lavage sample

• ICU and intubated

• High yield on culture

Blood Cultures

• Yield from blood cultures, even when samples are collected before antibiotic therapy, is disappointingly low

• No longer considered for most patients

ZN (acid fast bacilli- AFB) stain and culture

Pleural fluid studies

Aspiration for microscopy, biochemistry and culture (+/- AFB examination)

• TLC/DLC

• ESR/CRP

• Urea

• ABG

Polymerase chain reaction (PCR) tests

Urinary antigen tests

Serology

Respiratory virus screen

Roshan 11/2/2015 [email protected]

THANK YOU!!

Subedi