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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
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
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
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)
Polymerase chain reaction (PCR) tests
Urinary antigen tests
Serology
Respiratory virus screen
Roshan 11/2/2015 [email protected]
THANK YOU!!
Subedi