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

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

3. NORMAL ALVEOLI  PNEUMONIA 

4. 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)

5. 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%

6. 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

7. 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

8. 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

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

10. - 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

11. 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

12. 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

13.  http://en.wikipedia.org/wiki/Main_Page http://en.wikipedia.org/wiki/Main_Page  Med. English seminars