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Pneumonia

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Pneumonia

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  1. Pneumonia Dr. Meg-angela Christi Amores

  2. Definition • infection of the pulmonary parenchyma • often misdiagnosed, mistreated, and underestimated • community-acquired pneumonia (CAP) or health care–associated pneumonia (HCAP) • hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)

  3. Pathophysiology • proliferation of microbial pathogens at the alveolar level and the host's response • aspiration from the oropharynx • inhaled as contaminated droplets • hematogenous spread

  4. Pathophysiology • Host defense: • hairs and turbinates of the nares • branching architecture of the tracheobronchial tree traps particles on the airway lining • gag reflex and the cough mechanism • normal flora adhering to mucosal cells of the oropharynx • resident alveolar macrophages

  5. host inflammatory response, rather than the proliferation of microorganisms, triggers the clinical syndrome of pneumonia • inflammatory mediators, such as interleukin (IL) 1 and tumor necrosis factor (TNF), results in fever

  6. Pathology • Edema • presence of a proteinaceousexudate • Red hepatization • erythrocytes in the cellular intraalveolarexudate • Gray hepatization • neutrophil is the predominant cell, fibrin deposition is abundant, and bacteria have disappeared • Resolution

  7. Etiology • Typical: • S. pneumoniae, Haemophilusinfluenzae, S. aureusand gram-negative bacilli such as Klebsiellapneumoniaeand Pseudomonas aeruginosa • Atypical: • Mycoplasmapneumoniae, Chlamydophilapneumoniae, and Legionella spp. as well as respiratory viruses such as influenza viruses, adenoviruses, and respiratory syncytial viruses (RSVs

  8. Risk factors • CAP:alcoholism, asthma, immunosuppression, institutionalization, and an age of 70 years versus 60–69 years

  9. Clinical Manifestations • frequently febrile, with a tachycardic response, and may have chills and/or sweats and cough • pleura is involved, the patient may experience pleuritic chest pain • fatigue, headache, myalgias, and arthralgias • Crackles, bronchial breath sounds

  10. Management • Diagnosis • CLINICAL • XRAY – suggests etiology • pneumatoceles suggest infection with S. Aureus • upper-lobe cavitating lesion suggests tuberculosis • Sputum Gram stain and culture • Blood culture

  11. Management • Treatment : CAP • Site of Care • Home • Hospital • Antibiotics • Empiric • Previously healthy and no antibiotics in past 3 months • A macrolide [clarithromycin (500 mg PO bid) or azithromycin (500 mg PO once, then 250 mg od)] orDoxycycline (100 mg PO bid)