Investigations for pneumonia

learn investigations for pneumonia

1. Investigations for pneumonia



Mostly, the clinical and radiologic assessments are usually all that has
to be done!!

2. Chest radiography:
•An absolute necessity in patients with suspected pneumonias
•Confirming diagnosis
•Differentiate from other conditions
•Etiologic diagnosis (sometimes)

3. Findings:
•Opacities
•Air bronchograms
•Silhouette sign
•Complications of pneumonia:
Parapneumonic effusions, lung abscesses, atelectasis

4. Three radiological patterns :

• Lobar pneumonia
• Bronchopneumonia
• Interstitial pneumonia

5. S pneumoniae pneumonia
•Lobar or segmental pattern
•Patchy bronchopneumonic pattern involving the lower lobes in the
elderly
•Parapneumonic effusions are common

8. S aureus pneumonia
•Patchy bronchopneumonia is more common and often bilateral
•Lobar consolidation may be seen
•Pneumatoceles
•Empyema
•Abssesses

10. Interstitial pneumonia:
Viral
Atypical

•Multilobar involvement
•Nodular or reticular infiltrates
•May have lobar pattern

14. Klebsiella pneumoniae pneumonia
•Patchy bronchopneumonia and dense lobar consolidations.
•Bulging of the interlobar fissures; rare and characteristic

16. Pseudomonas aeruginosa pneumonia
•Characteristic predilection for the lower lobes
•Patchy bronchopneumonia or extensive consolidation may be present
•Parenchymal abscesses

17. CT:
•Limited role
•Suspected post obstructive pneumonia caused by :
Tumor
Foreign body

19. Gram’s stain and Culture of sputum:
•Gram’s staining may identify certain pathogens
•To be adequate for culture, a sputum sample must have >25
neutrophils and <10 squamous epithelial cells per low-power field
•Patients may already have started a course of antibiotics that can
interfere with culture results at the time a sample is obtained

20. Deep-suction aspirate or bronchoalveolar lavage sample
•ICU and intubated
•High yield on culture

21. Blood Cultures
•Yield from blood cultures, even when samples are collected before
antibiotic therapy, is disappointingly low
•No longer considered for most patients

22. ZN (acid fast bacilli- AFB) stain and culture

Pleural fluid studies
Aspiration for microscopy, biochemistry and culture (+/- AFB
examination)

23. •TLC/DLC

•ESR/CRP

•Urea

•ABG

24. Polymerase chain reaction (PCR) tests
Urinary antigen tests
Serology
Respiratory virus screen Roshan
11/2/2015
[email protected]
THANK YOU!!
Subedi