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

2. 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.

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

6. 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.

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

8. 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...)

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

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

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

12. Classification with anatomical localization
Lobar consolidation
Bronchopneumonia
Interstitial pneumonia

13. Classification with ethiology
Bacterial
Viral
Fungal
Parazites

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

15. Community acquired pneumonia
Pneumonia acquired outside hospital frequently in healthy persons

16. 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

17. Lobar pneumonia

18. Lobar pneumonia

19. Bronchopneumonia

20. Interstitial pneumonia

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

22. 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

23. 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

24. 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

25. Duration of the therapy
After fever drop week
- Pneumococcic pneumonia days
- Legionella pneumonia days
- Mycoplasma ve C. pneumoniae days
Severe pneumonia weeks