PNEUMONIA A CLINICAL APPROACH AND MANAGEMENT

PNEMONIA A DIAGNOSTIC APPROACH WITH MANAGEMENT

1. DR SUBHAYAN BATABYAL 3 rd YEAR PG RESIDENT DEPARTMENT OF MEDICINE DIAGNOSTIC APPROACH TO PNEUMONIA

2. PRESENTATIONS PULMONARY SYMPTOMS : Cough which is initially dry and painful, later associated with expectoration of mucopurulent sputum . SYSTEMIC SYMPTOMS : Fever usually high grade associatedvwith chills rigor malaise headache .

3. COMMUNITY ACQUIRED PNEUMONIA Community acquired pneumonia is a syndrome in which acute infection of lung developes in person who have not been hospitalized recently or exposed to health care system . CAP comprises of 70% of out patients and 30% of in patients. Mortality is 12-20% of hospitalized patients.

4. DIAGNOSTIC APPROACH CLINICAL DIAGNOSIS ETIOLOGICAL DIAGNOSIS

5. CLINICAL DIAGNOSIS

6. ETIOLOGICAL DIAGNOSIS GRAM STAIN AND SPUTUM CULTURE BLOOD INVESTIGATIONS(CBC ,LFT, RFT ,ELECTROLYTES ) BLOOD CULTURE URINARY ANTIGEN TEST POLYMERSE CHAIN REACTION SEROLOGY BIOMARKERS

7. GRAM STAIN AND SPUTUM CULTURE : Mainly to assess susceptibilty by culure For ICU admitted patients ET aspirate or BAL may be used. BLOOD CULTURE: Only 5-14% are positive .most common pathogen is S.PNEUMONIAE. URINE ANTIGEN TEST: Most common antigen associated are pneumococcal & leigonella , PCR : Mainly to detect DNA or RNA of leigonella , pneumococcal BIOMARKERS: CRP & PROCALCITONIN ,IL-6(COVID )

8. RADIOLOGICAL INVESTIGATIONS MAINLY CHEST XRAY AND HRCT

9. CURB 65 APPROACH

10. CRITERIA FOR SEVERE CAP

11. TREATMENT PROTOCOLS

12. ADJUVANT MEASURES OXYGEN THERAPY : HIGH FLOW O2 TO MAINTAIN SATURATION >94% FEVER : INJ PCM AND TEMPERATURE CHARTING FLUID INFUSION ACCORDING TO ECF VOLUME STATUS AND OTHER COMORBIDITIES SYMPTOMATIC MANAGEMENT OF COUGH ,RHIRORRHEA , DIARRHEA

13. COMPLICATIONS METASTATIC INFECTIONS LUNG ABSCESS COMPLICATED PLEURAL EFFUSION ANTIBIOTIC RESISTANCE

14. PROGNOSIS FACTORS DETERMINING PROGNOSIS : AGE COMORBIDITIES SITE OF TREATMENT(OPD /IPD)

15. PREVENTION Main prevention is by vaccination PNEMOCOCCAL POLYSACCHARIDE VAACCINE (PPSV23) AND PROTEIN CONJUGATE PNEMOCOCCAL VACCINE (PCV13). PCV13 MOST IMPORTANT AND COMMON;LY USED AS IT PRODUCE T CELL DEPENDENT ANTIGEN –LONG TERM MEMORY. INFLUENZA VCCINE ALSO AVAILABLE USED DURING OUTBREAKS .

16. VENTILATOR ASSOCIATED PNEUMONIA A nosocomial pneumonia associated with mechanical ventilation that developes with in 48 hrs or more of hospital admission which was not present during admission . 2 nd most common hospital infection 90% in ICU setting.

17. HOSPITAL ACQUIRED PNEUMONIA A nosocomial pneumonia NOT associated with mechanical ventilation that developes with in 48 hrs or more of hospital admission which was not present during admission. LESSER INCIDENCE OF MRSA lead to good prognosis Main pathogen involve ANAEROBES and polymicrobial nature.