Nikola Bla ž evi ć Mentor: A. Ž mega č Horvat

- inflammation of the lungs caused by infection - many different causes: bacteria, viruses, fungi, idiopathic - damages ALVEOLI > exudate (fluid) > consolidates > lack of oxygen

NORMAL ALVEOLI  PNEUMONIA 

DIAGNOSIS 1. Symptoms (dyspnea, cough) 2. Physical examination 3. X-ray (not always reliable) 4. Blood test (high white cell count > inflammation) 5. Sputum cultures 6. CT (most reliable)

COMBINED FINDINGS Prediction rule for the frequency of inflammation: Temperature > 100 degrees F (37.8 degrees C) Pulse > 100 beats/min Crepitations Decreased breath sounds Absence of asthma Probability of inflammation based on the number of findings: 5 findings - 84% to 91% probability 4 findings - 58% to 85% 3 findings - 35% to 51% 2 findings - 14% to 24% 1 finding - 5% to 9% 0 findings - 2% to 3%

Classification Early classification schemes: Anatomical : 1. lobar pneumonia(streptoccocus or klebsiella pneumoniae) 2. multilobar pneumonia 3. interstitial pneumonia(viruses or atypical bacteria) Radiological Microbiological Combined clinical classification: 1. ACUTE (less than three weeks duration) - classic bacterial bronchopneumonia - atypical(interstitial pneumonitis) - aspiration pneumonia syndromes 2. CHRONIC - non-infectious - mycobacterial Streptococcus pneumoniae - fungal - bacterial infections caused by airway obstructi on

Community-acquired pneumonia (CAP) - in a person who has not recently been hospitalized! - most common type of pneumonia - home care, oral antibiotics Most common cause of CAP  H. influenzae Streptococcus pneumoniae  most common cause of CAP worldwide viruses atypical bacteria Fourth most common cause of death in UK and sixth in US Hospital-acquired pneumonia (nosocomial) - acquired during or after hospitalization for another illness or procedure, 72h latency time after admission - 5% patients develop HAP - more deadly

Microorganisms (more resistant): MRSA ( methicillin-resistant Staphylococcus aureus) Pseudomonas Enterobacter Serratia Risk factors : mechanical ventilation decreased amounts of stomach acid immune disturbances heart and lung diseases

Severe acute respiratory syndrome (SARS) Bronchiolitis obliterans organizing pneumonia (BOOP) Eosinophilic pneumonia Aspiration pneumonia Dust pneumonia SARS

- oral antibiotics, rest, lots of fluid! - h ome care  no hospitalization needed - people with other medical problems and elderly  hospitalization if pneumonia persists Bacterial pneumonia  treated with antibiotics: - amoxicillin - fluoroquinolones - cephalosporins - aminoglycosides Viral pneumonia  influenza A  rimantadine, amantadine

Bacterial pn.  resolves within 2 to 4 weeks - 1/20 people with pneumococcal pneumonia die - half of the people who develop MRSA on ventilator die Viral pn.  lasts longer than bacterial Mycoplasmal pn.  4 to 6 weeks to resolve - low mortality

Vaccination  H. influenzae and S. pneumoniae in the 1st year - repeat after 5-10 years Abtibiotics  Group B Streptococcus and Chlamydia trachomatis positive pregnant women Treating underlying illnesses (e.g. AIDS) can decrease the risk of pneumonia Smoking  cigarette smoke interferes with many of the body's natural defenses against pneumonia

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