PNEUMONIA

Dr. Manu Mohan KAssociate ProfessorPulmonary Medicine

Definition

Syndrome caused by acute infection, usually bacterial

Clinical and radiological signs of consolidation

Pneumonitis – chemical , radiation

Classification

Anatomist Lobar, segmental, subsegmental,

Bronchopneumonia Empiricist’s

Community – acquired, Hospital-acquired, Aspiration, Immunocompromised host

Behaviorist’s Easy, Difficult

Pathogenesis

Predisposed by conditions that Reduces or suppresses cough Impair mucociliary activity Reduces phagocytic activity Impair immunoglobulin production

Factors that predispose to pneumonia Cigarette smoking Upper respiratory tract infections Alcohol Corticosteroid therapy Old age Recent influenza infection Pre-existing lung disease HIV Indoor air pollution

Pathogenesis

Aspiration and micro aspiration Inhalation Colonization Blood spread

Pathology

Congestion Red Hepatization Grey Hepatization Resolution

Clinical features

Symptoms Constitutional Dyspnea Cough Hemoptysis Pleuritic chest pain

Signs

Investigations

Laboratory identification of infecting organisms Sputum Microscopy Sputum immunodetection Sputum culture Invasive methods for obtaining

respiratory secretions Blood culture

Investigations

Pneumococcal antigen detection Standard acute and convalescent

serological testing Newer microbiological technologies –

PCR Pleural fluid Chest radiography Arterial oxygen saturation and blood

gas analysis

Investigations

Other laboratory findings WBC counts Cold agglutinins – mycoplasma Biochemical abnormalities SIADH – hyponatremia Urine - serology

Differential diagnosis

Pulmonary infarction Pulmonary or pleural tuberculosis Pulmonary edema Pulmonary eosinophilia Malignancy: Bronchoalveolar cell

carcinoma Rare disorders – Bronchiolitis

obliterans organizing pneumonia (BOOP)

Assessing severity

Thank You