Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Pneumonia PowerPoint PPT presentation
PNEUMONIA
Pneumonia is the inflammatory condition of lungs
primarily affecting the alveoli.
Pneumonia can be classified anatomically as
?Lobar pneumonia
?Bronchopneumonia
?Interstitial pneumonia
? Pathologically there is consolidation of alveoli or
infiltration of interstitial tissue with inflammatory
cells
ETIOLOGY
Viral
?RSV
?Influenza
?Parainfluenza
?Adenovirus
?Seen in 40% Cases
Bacterial
Common bacterial agents in first 2 months are gram
negative klebsiella ,E.coli and gram positive
pneumococci and staphylococci
Between 3month to 3 years ?Pneumococci,H.influenza
And staphylococci
? After 3 years-Pneumococci and staphylococci
? Chlamydia and Mycoplasma may cause community
acquired pneumonia in adolescents and children
RISK FACTORS
Low Birth weight
Malnutrition
Vitamin A deficiency
Lack of breast feeding
Passive smoking
Large Family size
Family history of bronchitis
Advanced birth order
Crowding
Young age
Clincal features
? Onset of pneumonia is insidious starting with
upper Respiratory tract infection or acute with
high fever , Tachypnea,dyspnea and grunting
respiration
? Flaring of ala nasi and retraction of lower chest
and intercoastal spaces
? Signs of consolidation are observed in lobar
pneumonia
Pneumococcal Pneumonia
Respiratory infection due to S.pneumonia
Transmitted by droplet
Common in winter
Incubation period in 1-3 days
Clinical Features
Onset is abrupt with headache,chills ,cough and
high fever
Cough-initaly dry and later with thick rusty sputum
? Chest pain radiating to shoulder or abdomen
? Severe Cases-Grunting,Chest indrawing, difficulty in
feeding and cyanosis
? Percussion note is impaired ,air entry is diminished
? Crepitations and bronchial breathing heard over
areas of consolidation
DIAGNOSIS
History
Examination
X-ray-finding of lobar consolidation
Leukocystosis
Sputum-Gram staining and culture
Blood culture
TREATMENT
Penicillin G 50000IU/kg/- IV or IM in
divided doses -7 days
Therapy with IV cefotaxime, ceftriaxone or
coamoxiclav
Staphylococcal Pneumonia
Infancy and childhood
Primary infection or secondary to staphylococcal
septicemia
Complication ? measles, influenza,cystic fibrosis
Empyema below 2 years of age is nearly always
staphylcoccal in etilogy
Pathology
Multiple micro abscesses are formed which erode the
Bronchial wall and discharge their content in bronchi
? Air enters the abscesses during inspiration
? Progressive inflation results in formation of
pneumatoceles ?pathognomonic
TREATMENT
Fever is controlled by antipyretics
Hydration maintained by IV fluids
Oxygen administered to relive the dyspnea and
cyanosis
Antibiotic therapy with penicillin G ,Coamoxiclav or
Ceftriaxone-2-6 weeks
Treatment of complications
Empyema and pyopneumothorax ?intercostal
drainage under water seal or low pressure aspiration
Metastatic abscess ?surgical drainage.
Significant pleural thickening-thoracotomy or
thoracoscopic surgery
Hemophilus pneumonia
? Occurs between age of 3 month-3 year
? Always associated with bacteremia
? Presents with moderate fever, dyspnea, grunting and
Retraction of lower intercoastal space
Complications-Bacteremia, pericarditis, empyema,
meningitis and polyarthritis.
Treatment- parental ampicillin 100mg/kg/day and
coamoxiclav.
Streptococcal Pneumonia
Infection by group A beta-hemolytic
streptococci
Occurs following measles,varicella,influenza
or petrusis
Most important cause of respiratory distress
in Newborns
Clinical features
onset is abrupt with fever ,chills, dyspnea, rapid
respiration and blood streaked sputum
Signs of bronchopneumonia is less pronounced as
pathology is usually interstitial
Diagnosis
Radiograph- shows interstitial pneumonia with
segmental involvement, diffuse peribronchial
densities or a effusion
Blood count shows neutrophilic leucocystosis.
TREATMENT
Penicillin G -50000-100000IU/kg/day -7 to 10 days
Second generation or third generation
Cephalosporins
Like cefaclor, cefuroxime,ceftriaxone
THANK YOU
Primary Atypical Pneumonia
Etiological agents-Mycoplasma pneumonia
Chlamydia
Legionella spp
Transmitted-droplet infection
Incubation period-12-14 days
Common in winter among children in overcrowding
living
Clinical features
Symptoms
Malaise, headache, fever, sore throat, myalgia and
Cough.
Cough is dry at first later with mucoid expectoration
With blood streaked
Signs
Mild pharyngeal congestion, cervical
lymphadenopathy
Crepitations
Diagnosis
X-ray finding show infiltrates involving one lobe,
usually lower
Poorly defined fluffy or hazy exudates radiates from
the hilar region with enlarged hilar lymphnodes and
pleural effusion
IgM antibody by ELISA during acute stage
IgG antibody after 1 week
Confirmed by PCR
TREATMENT
Macrolide antibiotics-erythromycin,azithromycin
Clarithromycin for 7-10 days
Pneumonia due to Gram negative
organisms
Etiology-E.coli , klebsiella, pseudomonas
Affects small children with malnutrition and
immunity
Gradual onset
Constitutional symptoms are more prominent than
respiratory distress
Radiograph shows multiple areas of consolidation
Treatment-IV Cefotaxime or ceftriaxone 75-
100mg/kg/day with or with out aminoglycoside of 10-
14 days
Pseudomonas ? treated with Ceftazadine
VIRAL PNEUMONIA
Etiology- Respiratory syncytial Virus is chief cause
under 6 months of age
Others-para influenza, influenza and adenovirus
Presents with extensive interstitial pneumonia
Clinical signs of consolidation are absent
Radiological signs consist of perihilar and
peribronchial infiltrates
ALIPHATIC HYDROCARBON
ASSOCIATED PNEUMONIA
Kerosene exerts toxic effects on lungs and CNS
Milk and alcohol promotes absorption
Since kerosene has low viscosity and low surface
tension ,it diffuses quickly from pharynx to lungs.
Clinical features-Cough, dyspnea, high fever,
Vomiting, drowsiness and coma
Physical signs are minimal
X-ray chest-ill-defined homogenous or patchy
opacities
Treatment
Vomiting is not induced
Gastric lavage is avoided to prevent inadvertent
aspiration.
The patient is kept on oxygen
Routine antibiotics are not indicated
Loefflers Syndrome
Larvae of many nematodes enter portal circulation
and pass through the hepatic vein and inferior vein
cava into heart and lungs.
In lungs it enters capillaries, enter alveoli and block
Bronchi with mucus and eosinophilic material
Clinical features include cough,low fever scattered
crepitations
Eosinophilia
Treatment is symptomatic
ACUTE RESPIRATORY TRACT
INFECTION CONTROL PROGRAM
Acute lower respiratory tract infection is chief cause of
mortality in children below 5 years of age
Common bacteria causing LRTI in preschool children
like H influenza,S.pneumonia are sensitive to
antibacterial agents like cotrimoxazole and
amoxicillin
To control death due to LRTI,WHO has
recommended a criteria for diagnosis of pnumonia
where IMR is >40/1000 live births.
Criteria for diagnosis include rapid respiration
Rapid respiration is rate more than 60,50,40/min in
Children below 2 months,2-12 months and 1-5 years of age
? WHO recommends that in primary setting,children with
cough(2months-5years of age) should be examined for
rapid respiration and difficulty in breathing,cyanosis or
difficulty in feeding.
? If respiratory rate is normal ,there is no chestindrawing
and feeding is well, the child is assessed to be suffering
from URT infection and treated symptomatically
If the child has rapid respiration and chest indrawing,
But no hypoxia, feeding well and does not have danger
signs,child may be treated with amoxicillin 40mg/kg
twice daily for 5 days
? Chest indrawing, evidence of hypoxia or danger
signs(lethargy,cyanosis, poor feeding, seizures),it is
severe pnumonia
? Patient require admission, and treatment with iv
penicillin or ampicillin and gentamycin for least
5days.
IV ceftriaxone can be used as 2nd line drug
For Children below 2 months old,the presence of any
of following indicate pneumonia:fever>38
degree,seizures,abnormally sleepy or difficult to
wake,stridor ,wheezing,not feeding,tachypnea,chest
indrawing, altered sensorium, central
cyanosis,grunting
apneic spells or distended abdomen
THANK YOU
This post was last modified on 12 August 2021