Pneumonia

1.

PNEUMONIA
• LOWER RESPIRATORY TRACT INFECTIONS
– BRONCHITIS
– BRONCHIOLITIS
– PNEUMONIA
PNEUMONITIS: GENERAL TERM FOR LUNG INFLAMMATION THAT MAY
OR MAY NOT BE ASSOCIATED WITH CONSOLIDATION
PNEUMONIA: INFLAMMATION OF THE PARENCHYMA OF THE LUNG
LOBAR PNEUMONIA: “TYPICAL” PNEUMONIA LOCALIZED TO ONE OR
MORE LOBES OF THE LUNG IN WHICH THE AFFECTED LOBE OR LOBES
ARE COMPLETELY CONSOLIDATED

2.

ATYPICAL PNEUMONIA:
BRONCHOPNEUMONIA: INFLAMMATION OF THE LUNG THAT
IS CENTERED IN THE BRONCHIOLES AND LEADS TO THE
PRODUCTION OF A MUCOPURULENT EXUDATE THAT
OBSTRUCTS SOME OF THESE SMALL AIRWAYS AND CAUSES
PATCHY CONSOLIDATION OF THE ADJACENT LOBULES
INTERSTITIAL PNEUMONITIS: INFLAMMATION OF
INTERSTITIUM – WALLS OF THE ALVEOLI, THE ALVEOLAR SACS
AND DUCTS AND THE BRONCHIOLES

3.

ETIOLOGIC AGENTS AND EMPIRICAL ANTIBIOTIC THERAPY
FOR COMMUNITY ACQUIRED PNEUMONIA
NEONATES: GBS, GR (-), STREP. PNEUMONIAE, HAEMOPHILUS
TREATMENT: AMPICILLIN + GENTAMYCIN (OR CEFOTAXIME) +
ANTISTAPHYLOCOCCAL AGENT IF STAPH AUREUS IS SUSPECTED
1-3 MONTH: RSV, OTHER RESPIRATORY VIRUSES, S. PNEUMONIAE,
H. INFLUENZAE
TREATMENT: CEFUROXIME OF CEFOTAXIME OR CEFTRIAXONE +
OXACILLIN
AFEBRILE PNEUMONIA: CHLAMIDYA TRACHOMATIS, MYCOPLASMA
HOMINIS, UREAPLASMA UREALYTICUM, CMV
TREATMENT: ERYTHROMYCIN, AZITROMYCIN OR CLARITHROMYCIN

4.

3-12 MONTH: RSV, OTHER RESPIRATORY VIRUSES, S.PNEUMONIAE,
H. INFLUENZAE, CHLAMYDIA TRACHOMATIS, MYCOPLASMA
PNEUMONIAE, STREP GR A
TREATMENT:
OUTPATIENT: AMOXICILLIN, ERYTHROMYCIN, AZITHROMYCIN
HOSPITAL: AMPICILLIN OR CEFUROXIME
SEVERELY ILL: CEFTRIAXONE + ERYTHROMYCIN
2-5 YEARS: RESPIRATORY VIRUSES, S. PNEUMONIAE, H. INFLUENZAE,
M. PNEUMONIAE, CHLAMYDIA PNEUMONIAE, S. AUREUS,
GR A STREP
TREATMENT:
OUTPATIENT: AMOXICILLIN, ERYTHROMYCIN, AZITHROMYCIN
HOSPITAL: AMPICILLIN OR CEFUROXIME
SEVERELY ILL: CEFTRIAXONE + ERYTHRO

5.

5-18 YEARS: M. PNEUMONIAE, S. PNEUMONIAE, CHLAMYDIA
PNEUMONIAE, H. INFLUENZA, RESPIRATORY VIRUSES
TREATMENT:
OUTPATIENT: MACROLIDES
HOSPITAL: MACROLIDES WITH AMPICILLIN
SEVERELY ILL: CEFTRIAXON + MACROLIDES

6.

CLINICAL PATTERN OF PNEUMONIA

7.

LABORATORY AND IMAGING
WBC
BLOOD CULTURE- POSITIVE IN 10-20% OF PATIENTS
SEVERELY ILL PATIENTS WITH RECCURENT PNEUMONIA, OR
PNEUMONIA UNRESPONSIVE TO EMPIRICAL THERAPY- BRONCHOSCOPY
WITH BRONCHOALVEOLAR LAVAGE FOR MICROBIOLOGICAL DIAGNOSES
EMPYEMA- THORACOCENTESIS
X- RAY
US
CT

8.

DIFFERENTIAL DIAGNOSIS
PULMONARY EDEMA (CARDIOGENIC AND NONCARDIOGENIC)
ALLERGIC PNEUMONITIS
ASPIRATION
LUNG CONTUSION
HEMORRHAGE
FOREIGN BODY

9.

DIFFERENTIAL DIAGNOSIS OF RECCURENT
PNEUMONIA
HEREDITARY DISORDERS
CF
SICKLE CELL DISEASE
DISORDERS OF IMMUNITY
AIDS
BRUTON AGLOBULINEMIA
SELECTIVE IGG SUBCLASS DEFICIENCIES
COMMON VARIABLE IMMUNODEFICIENCY
SCID
DISORDERS OF LEUKOCYTES
CGD
HYPER IGE (JOB) SYNDROME
LAD

10.

DISORDERS OF CILIA
IMMOTILE CILIA SYNDROME
KARTAGENER SYNDROME
ANATOMIC DISORDERS
SEQUESTRATION
LOBAR EMPHYSEMA
GE REFLUX
FOREIGN BODY
T-E FISTULA
BRONCHIECTASIS
ASPIRATION (OROPHARYNGEAL INCOORDINATION)
ASTHMA

11.

TREATMENT
SUPPORTIVE TREATMENT
SPECIFIC TREATMENT
EMPIRICAL ANTIBIOTIC TREATMENT

12.

COMPLICATIONS
PARAPNEUMONIC EFFUSION
EMPYEMA
PNEUMATOCELE
BRONCHIECTASIS
LUNG ABSCESS

13.

STRIDOR
STRIDOR IS A HARSH, HIGH PITCHED RESPIRATORY SOUND
PRODUCED BY TURBULENT AIRFLOW THAT IS USUALLY
INSPIRATORY, BUT MAY BE BIPHASIC; IT IS A SIGN OF UPPER
AIRWAY OBSTRUCTION

14.

DIFFERENTIAL DIAGNOSIS OF STRIDOR
INFECTIONS
ACUTE (VIRAL) LARYNGOTRACHEOBRONCHITIS
PARAPHARYNGEAL ABSCESS
EPIGLOTTITIS
BACTERIAL TRACHEITIS
PHARYNGITIS
LARYNGOPHARYNGEAL DIPHTERIA
LARYNGEAL PAPILLOMATOSIS
EXTRINSIC INFLAMMATORY MASS COMPRESSING
THE TRACHEA (E.G. TUBERCULOSIS)

15.

NONINFECTION CONDITIONS
SPASMODIC CROUP
ANGIONEUROTIC EDEMA
FOREIGN BODY ASPIRATION
INGESTION OF CAUSTICS OR HOT FLUID
TRAUMA, SMOKE INHALATION
LARYNGOMALACIA
CONGENITAL SUBGLOTTIC STENOSIS
EXTRINSIC MASS COMPRESSING THE TRACHEA
(VASCULAR MALFORMATION, HEMANGIOMA,
CYSTIC HYGROMA)
VOCAL CORD PARALYSIS
HYPOCALCEMIA

16.

AGE RELATED DIFFERENTIAL DIAGNOSIS
INFANCY
LARYNGOMALACIA
SUBGLOTTIC STENOSIS (CONGENITAL, ACQUIRED
AFTER INTUBATION)
HEMANGIOMA
VASCULAR RING
TODDLERS
VIRAL CROUP
SPASMODIC (RECCURENT CROUP)
FOREIGN BODY
LARYNGEAL PAPILLOMATOSIS
BACTERIAL TRACHEITIS
DIPHTHERIA

17.

2-3 YEARS AND OLDER
VIRAL CROUP
SPASMODIC CROUP
INHALATION INJURY
FOREIN BODY
ANAPHYLAXIS
ANGIOEDEMA
TRAUMA

18.

CLINICAL MANIFESTATIONS
HARSH (BARKING) COUGH
LABORED BREATHING, SUPRASTERNAL,
INTERCOSTAL, SUBCOSTAL RETRACTIONS
± WHEEZING
± FEVER
± TOXICITY
± DROOLING

19.

TREATMENT
EPINEPHRIN
STEROIDS
COLD MIST