1. PNEUMONIA DR. FAWAD AHMAD RANDHAWA M.B.B.S. ( KING EDWARD MEDICAL COLLEGE) M.C.P.S; F.C.P.S. ( MEDICINE) F.C.P.S. ( ENDOCRINOLOGY) ASSISTANT PROFESSOR OF ENDOCRINOLOGY KING EDWARD MEDICAL UNIVERSITY

2. A 55 year old female with rheumatoid arthritis presents to OPD with complaint of cough productive of rusty sputum, fever and generalized myalgia for 2 days. Temp 101.6, HR 110, Resp rate: 24, BP 125/80. On exam, she has crackles in her chest and dullness to percussion.

3. DEFINITION Pneumonia is the infection of lung parenchyma caused by  Bacteria  Viruses  Fungi

4. TYPES Lobar Pneumonia: Affects a section( Lobe) of a lung Caused by Streptococcus Pneumoniae, Haemopilus Influenza and Moraxella catarrhalis. Bronchopneumonia: Affects patches throughout the lung Mostly caused by Staph aureus, Klebsiella Pneumonia, E coli and Pseudomonas species.

6. Typical Pneumonia : sudden onset of fever, productive cough and chest pain. Atypical Pneumonia : gradual onset, dry cough with predominance of extra pulmonary symptoms. Caused by one of three bacteria 1.Mycoplasma Pneumonia 2.Legionella Pneumonia 3.Chlamydia Pneumonia

10. SEVERITY CRITERIA The morbidity and mortality in hospitalized patients is assessed through different scoring systems 1.CURB 65 2.Pneumonia Severity Index (PSI) (beyond the scope)

11. CURB 65

12. People with score  0 – 1 needs outpatient treatment  2 consider short term hospital stay  3 - 5 need hospitalization in ICU

13. 30 day mortality risk increases with increase in score  0 ---0.6 %  1 --- 2.7%  2 ---6.8%  3 ---14%  4 ---27.8%  5 ---27.8%

14. PNEUMONIA SEVERITY INDEX

15. DIAGNOSIS CBC ABGS Blood Culture Sputum Culture CXR HRCT ( rarely)

16. COMPLICATIONS Bacteremia Lung Abscess Pleural Effusion ARDS Shock

17. TREATMENT Outpatient: Oral Macrolides or Quinolones for 7 to 10 days. Inpatient : IV Macrolides and 3 rd generation Cephalosporins or IV Quinolones plus 3 rd generation Cephalosporins

18. PREVENTION Pneumococcal Vaccine Influenza Vaccine Stopping Smoking

19. TAKE HOME MESSAGE Pneumonia is an infection of lung parenchyma Can present with pulmonary or extrapulmonary manifestations Should be investigated as early as possible to avoid complications Choice of antibiotics depends upon the type of pneumonia.