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Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine
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Epidemiology 6th leading cause of death in U.S. Number one Among the infectious diseases 4 million patients annually in US Incidence 12/1,000/year Mortality in OPD patients 1-5 %, but Inpatients 25%, ICU 50-60%
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Definition Pneumonia is the inflammation of lower respiratory tracts including alveoli, interstitial tissues, and broncioles by the microorganisms, chemical irritations or by an immunological process
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Classifications & Terminology Community Acquired Pneumonia Nosocomial Pneumonia Ventilator Associated Pneumionia Mild, moderate, severe Bacterial, viral, fungal, parasitic Primary vs. Secondary Immune compromised vs. Normal immunity Lobar vs interstitial Typical vs. Atypical
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Severe Community Acquired Pneumonia Respiratory rate > 30/min PaO2/FiO2 ratio < 250mmHg Need for Mechanical Ventilation Diffuse bilateral involvement or multiple lobes, incresing infiltration > 50% within 48 hours B.P. < 90systolic or 60 mmHg diastolic Need for vasopressors Renal failure
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Mycoplasma Pneumonia
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Streptococcal Pneumonia
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Streptococcus pneumoniae Gram + Diplococci
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Streptococcal Pneumonia
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Staphylococcus aureus BAL Fluid
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Staphylococcal Pneumonia Pneumatocele
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Staphylococcal Pneumonia
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Osler’s Node
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Pseudomonas Pneumonia
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Ecthyma gangrenosum
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Immunofluorescent Ab Test RSV Antigen Detection
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Legionella Pneumonia
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Legionella pneumophila by Silver impregnation Stain
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Pneumonia in COPD
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CMV Inclusion in BAL
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Sputum Gram Stain
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Treatment of CAP <60yrs/OPD/no Comorbid conditions Pathogens : S. pneumoniae, Mycoplasma& Chlamydia pneumoniae, H. indfluenzae, RSV, Legionella, S. aureus Treatment : 2 nd Generation Cephalosporin + Macrolide or Quinolone monotherapy
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Treatment of CAP >60yrs/OPD/with Comorbid conditions Pathogens : S. pneumoniae, RSV, H. indfluenzae, Gram (-) rod, S. aureus, Morexella catarrhalis, Legionella spp. Treatment : 2 nd Generation Cephalosporin + TMX/SFX, or beta lactam/betalactam inhibitor + Macrolide
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Treatment of Severe CAP Pathogens : S. pneumoniae, Legionella spp. Gram (-) rod, Mycoplasma,H. indfluenzae,S. aureus Treatment : 3 rd Generation Cephalosporin with anti- Pseudomonal activity or + other anti Pseudomonal agent (Imipenem/quinolone) + Macrolide
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Aspiration Pneumonia
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Lipoid Pneumonia
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