Pneumococcal pneumonia

pneumococcal pneumonia

1. PNEUMOCOCCAL PNEUMONIA Dr Narendra

2. Microbiology S pneumoniae is an encapsulated, gram-positive, catalase-negative cocci that grows as a facultative anaerobe. These organisms often appear on Gram stain as lancet-shaped diplococci that grow in chains (see image below). Other identifying properties include sensitivity to optochin and bile solubility.

3. RISK FACTORS Adults 65 years or older are at increased risk for pneumococcal disease. Adults of all ages are also at increased risk for pneumococcal disease if they have: Sickle cell disease, no spleen, hiv infection, cancer, or another condition that weakens the immune system Diabetes

4. Nephrotic syndrome Chronic heart, lung, kidney, or liver disease Cochlear implants Alcoholism Adults who smoke cigarettes are also at increased risk for pneumococcal disease. Chronic lung illnesses that increase an adult’s risk of pneumococcal disease include chronic obstructive lung disease, emphysema, and asthma.

5. Transmission Direct person-to-person contact via respiratory droplets Autoinoculation in persons carrying the bacteria in their upper respiratory tract

6. PATHOPHYSIOLOGY Infection typically occurs after the colonization of the oropharynx and nasopharynx of healthy individuals. Inhalation of these colonies causes the infection of the lower airways. Infection.

7. CLINICAL MENIFESTATIONS Conditions that may develop by direct extension of  S pneumoniae  from the nasopharynx include the following : Conjunctivitis Otitis media Sinusitis Acute exacerbations of chronic bronchitis (AECB) Pneumonia (which may be complicated by purulent pericarditis )

8. Conditions that may result from vascular invasion and hematogenous spread of  S pneumoniae  include the following : Meningitis Bacteremia (most common manifestation of invasive pneumococcal disease) Joint and bone infections ( osteomyelitis and septic arthritis) Soft tissue infections ( eg , myositis , periorbital cellulitis , abscess) Peritonitis Cardiac infections ( eg , endocarditis )

9. PNEUMONIA Pts often present with fever, abrupt-onset cough and dyspnea , and sputum production. Pts may also have pleuritic chest pain, shaking chills, or myalgias . Among the elderly, presenting signs and symptoms may be less specific, with confusion and malaise but without fever or cough.

10. PHYSICAL EXAMINATION Adults may have tachypnea (>30 breaths/min) and tachycardia, crackles on chest auscultation, and dullness to percussion of the chest in areas of consolidation. In some cases, hypotension, bronchial breathing, a pleural rub, or cyanosis may be present. Upper abdominal pain may be present if the diaphragmatic pleura is involved.

11. DIAGNOSIS  Blood culture Gram staining Sputum cultures Urinary antigens

12. Chest radiography has been considered to be the mainstay in diagnosing pneumonia. Classically lobar pneumonia has been taught to be caused by  S. pneumonia . Computed tomography (CT) has shown to have better sensitivity and accuracy as compared to plain chest radiography.

13. ( a ,  b ,  c ) Lobar pneumonia. ( a ) Posteroanterior and lateral ( b ) chest radiographs in this patient with fever and cough demonstrate lateral segment right middle lobe consolidation (arrows). ( c ) Axial contrast-enhanced CT image shows a mixed opacity of consolidation (arrow) and ground-glass opacity (small arrows) consistent with lobar pneumonia

14. DIFFERENTIAL DIAGNOSIS There are no specific signs and symptoms for pneumococcal pneumonia so whenever the diagnosis of pneumococcal pneumonia is considered following differentials should be kept in mind. Viral pneumonia PCP Influenza Klebsiella pneumonia Legionella pneumonia Pleural effusion

15. Treatment Outpatient treatment: Amoxicillin (1 g po q8h) is effective for virtually all cases of pneumococcal pneumonia. Fluoroquinolones (e.g., levofloxacin , 500–750 mg/d; or moxifloxacin , 400 mg/d) are also highly likely to be effective. Clindamycin and azithromycin are effective in 90% and 80% of cases, respectively.

16. Inpatient treatment: For pts with noncritical illness, β- lactam antibiotics are recommended—e.g., Penicillin (3–4 mu IV q4h) or ceftriaxone (1 g IV q12– 24h). For pts with critical illness, vancomycin may be added, with its use reviewed once susceptibility data are available.

17. Treatment duration: The optimal duration of treatment is uncertain, but continuation of antibiotics for at least 5 days after the pt becomes afebrile seems prudent

18. COMPLICATIONS Necrotizing pneumonia Lung abscess Parapneumonic effusion Empyema Septicemia, Septic shock Respiratory failure

19. PNEUMOCOCCAL VACCINATION 1. Pneumococcal conjugate vaccine or PCV13 All babies and children younger than 2 years old People 2 years or older with certain medical conditions 2. Pneumococcal polysaccharide vaccine or PPSV23 All adults 65 years or older People 2 through 64 years old with certain medical conditions Adults 19 through 64 years old who smoke cigarettes

20. Thank you