Prof. Dr. Bilun Gemicioğlu Pneumonia Prof. Dr. Bilun Gemicioğlu

Definition Pneumonia is a lung parenchyma infection caused by bacteria, a virus or fungi, with a consolidation on radiological examination. Pneumonitis is an inflammation of the lungs caused by chemical or radiation therapy but not with infectious agents.

Spread of lung infections Inhalation Aspiration of oropharingeal secretion Hematogenic spread Direct spread (thorax wall, mediastinum)

Predisposing factors of pneumonia Airways mechanical barrier damage Specific and/or nonspecific immune defense mechanisms injury Bronchial obstruction Micro aspiration of upper respiratory truck secretion. Lung edema Viral infections.

Diagnostic Methods History, physical examination Chest X-Ray Sputum examination (gram stained) Sputum , blood cultures Serological tests Peripheral blood analysis

Diagnosis Symptoms fever, shaking chills, cough, sputum (expectoration), pleuritic pain. Others: (dispnea, fatigue, sweating, loss of appetite...) Physical signs: increased vibration thoracic impaired percussion (matity), end inspiratory rales (crepitations) and bronchial breathing (tuber soufle) Others (cyanosis, tachipnea, tachicardia...)

Diagnosis Radiology: lobar opacities, interstitial images, bronchopneumonic (patchy) opacities, Others (absea, pneumatocele, pleurisy...)

Chest X-Ray Gold standart test for pneumonia For differencial diagnosis For grading pneumonia severity For examining complications

Normal Chest X Ray in Pneumonia -First 24 hours -Dehydration -Elderly -Neutropenia -Pneumocystis carinii

Classification with anatomical localization Lobar consolidation Bronchopneumonia Interstitial pneumonia

Classification with ethiology Bacterial Viral Fungal Parazites

Classification with targeting therapy Community acquired pneumonia Hospital acquired pneumonia (Nosocomial) Immunosuppresed (immunocompromised) patients pneumonia

Community acquired pneumonia Pneumonia acquired outside hospital frequently in healthy persons

Caracteristics of community acquired pneumonia (CAP) Typical pneumonia Atypical pneumonia acute subacute, fever,chills subfebril fever productive cough non productive cough pleural pain nonrespiratory symptoms physical signs ( + ) physical signs ( - ) lobar consolidation non-lobar infiltration Agents S. pneumoniae M.pneumonia H. Influenzae C.pneumoniae Gr(-)aerop bacillus L. Pneumophila Aneorobes Virus

Lobar pneumonia

Lobar pneumonia

Bronchopneumonia

Interstitial pneumonia

CAP THERAPY GROUP 1 OUTPATIENT-CLINIC GROUP 2 HOSPITAL GROUP 3 INTENSIVE CARE Mild pneumonia, Moderate pneumonia Severe pneumonia

CAP Therapy: Group I No antibiotic usage Penicillin, No comorbidity With comorbidities Pneumococci resistant to penicillin Gram (–) agents Usage of antibiotic last three months Usage of corticosteroid Penicillin, Macrolide, Floroquinolone, ß laktame + Macrolide

CAP Therapy: Group II CAP Therapy: Group 2 H.influenzae S.pneumoniae H.influenzae M.pneumoniae C.pneumoniae Mix infection) Enteric Gram negatives ! Virus First choise Alternatif ________________________________________ Penicillin G ± makrolide Levofloksasin Aminopenicillin ± makrolide Moksifloksasin Aminopenicillin / β-laktamase inhibitor ± macrolide Non- antipseudomonal cefalosporin II-III ± macrolide

CAP Therapy: Group III No risk of P. aeruginosa Non pseudomonal cefalosporin III+ macrolide or Non pseudomonal cefalosporin III + (moksifloksasin or levofloksasin) With risk of P. aeruginosa Anti-pseudomonal cefalosporin (sefepim-seftazidim) Ureidopenicillin/beta-laktamase inhibitor (piperasilin.. Karbapenem + siprofloksasin

Duration of the therapy After fever drop 1 week - Pneumococcic pneumonia 7-10 days - Legionella pneumonia 14-21 days - Mycoplasma ve C. pneumoniae 10-14 days Severe pneumonia 2-3 weeks