Pneumonia and its causes sign symptome treatment

It is best for care of pneumonia patient

1. PNEUMONIA

2. OVERVIEW
1.Definition and Classification
2.Epidemiology
3.Etiology
4.Pathophysiology
5.Sign and Symptoms
6.Diagnosis
7.Management
8.Prevention
9.Complication
10.Prognosis

3. DEFINITION
Pneumoniaisalunginfectionthatcanbecaused
bydifferenttypesofinfectiousagentsuchas
bacteria,viruses,fungi,andparasites.

4. CLASSIFICATION
a.CAP:community-acquiredpneumonia
Anindividualwhohasnotrecentlybeen
hospitalizeddeveloppneumonia.
b.HAP:hospital-acquiredpneumonia
Apatientcontractedpneumoniainahospital,at
least48–72hoursafterbeingadmitted.Itis
usuallycausedbyabacterialinfection,rather
thanavirus.Itiscallednosocomialinfection

5. CLASSIFICATION
c.HCAP:healthcare-associatedpneumonia
•isacategoryofpneumoniainpatientswith
recentclosecontactwiththehealthcaresystem.
•HCAPisaconditioninpatientswhoarenot
hospitalised(similartoCAP)butitscauses,
prognosis,preventionandtreatmentaremore
similartoHAP.
•Thecategorywasintroducedbecause
healthcarehasincreasinglyshiftedfrom
hospital-basedtohomecare,andmorepeople
areresidinginnursinghomesorextendedcare
facilities.

6. CLASSIFICATION
d.VAP:ventilator-associatedpneumonia
•VAPisdefinedaspneumoniaoccurring>48
hourspostendotrachealintubation.
•Theriskfordevelopingpneumoniainthe
hospitalincreasesby6to21timesaftera
patientisintubatedbecauseitbypassesthe
naturalairwaydefencesagainstthemigrationof
upperrespiratorytractorganismsintothelower
tract.

7. EPIDEMIOLOGY
•Pneumoniaisacommon illnessaffecting
approximately450millionpeopleayearand
occurringinallpartsoftheworld.
•Itisamajorcauseofdeathamongallagegroups
resultingin4milliondeaths.
•Ratesaregreatestinchildrenlessthan5years
old,andadultsolderthan75yearsofage.
•Itoccursaboutfivetimesmorefrequentlyinthe
developingworldversusthedevelopedworld.
•Pakistanranksthirdforpneumoniaintheworld,
Accordingtothelatestreport,71,000childrendie
ofpneumoniaeveryyearinPakistan.

8. EPIDEMIOLOGY

9. ETIOLOGY
•Pneumoniaiscausedbyanumberofinfectious
agents,i.e.:viruses,bacteria,fungi,parasites.
•Pneumoniacanbespreadinanumberofways.
Thevirusesandbacteriathatarecommonly
foundinachild'snoseorthroat,caninfectthe
lungsiftheyareinhaled.
•Theymayalsospreadviaair-bornedropletsfrom
acoughorsneeze.
•Inaddition,pneumoniamayspreadthrough
blood,especiallyduringandshortlyafterbirth.

10. ETIOLOGY
1. Viralpneumonia
a. Influenza
b. Para-influenza
c. Adenovirus
d. Respiratory syncytial virus (RSV)
appears mostly in children
e. Cytomegalovirus
in imuno-compromised host

11. ETIOLOGY
2.Bacterialpneumonia
a.GramPositive:
Streptococcuspneumoniae(mostcommon
causeofpneumoniainallagegroups,except
newborninfants).
b.Gramnegative:
Haemophilus influenzae, Klebsiella
pneumoniae,Escherichiacoli,Pseudomonas
aeruginosa,andMoraxellacatarrhalis.
c.Atypical(donotstainbygram-stain):
Coxiellaburnetii,Chlamydophilapneumoniae,
Mycoplasmapneumoniae,andLegionella
pneumophila.

12. ETIOLOGY
3.Fungalpneumonia
•MostoftencausedbyHistoplasma
capsulatum,blastomyces,Cryptococcus
neoformans,Pneumocystisjiroveci(most
commoncauseofpneumoniaininfants
infectedwithHIV),andCoccidioidesimmitis.

13. Etiology of severe pneumonia in children in developing countries.

14. PATHOPHYSIOLOGY
Pneumoniafrequentlystartsasanupper
respiratorytractinfectionthatmovesintothe
lowerrespiratorytract.

15. •Virusesinvadecellsinordertoreproduce.
•Typically,avirusreachesthelungswhen
airbornedropletsareinhaledthrough
themouthornose.
•Onceinthelungs,thevirusinvadesthecells
liningtheairwaysandalveoli.Thisinvasion
oftenleadstocelldeath,eitherfromdamageto
thecellbythevirusorfromaprotective
processcalledapoptosisinwhichtheinfected
celldestroysitselfbeforeitcanbeusedasa
conduitforvirusreproduction.
VIRAL

16. •Whentheimmunesystemrespondstotheviral
infection,evenmorelungdamageoccurs.White
bloodcells,mainlylymphocytes,activatecertain
chemicalcytokinesthatallowfluidtoleakintothe
alveoli.Thiscombinationofcelldestructionand
fluid-filledalveoliinterruptsthenormal
transportationofoxygenintothebloodstream.
•Aswellasdamagingthelungs,manyvirusesaffect
otherorgansandthusdisruptmanybodyfunctions.
•Virusescanalsomakethebodymoresusceptible
tootherbacterialinfections;inthiswaybacterial
pneumoniacanariseasacomorbidcondition.
VIRAL

17. BACTERIAL
•Bacteriatypicallyenterthelungwhenairborne
dropletsareinhaled,butcanalsoreachthelung
throughthebloodstreamwhenthereisaninfectionin
anotherpartofthebody.
•Manybacterialiveinpartsoftheupperrespiratory
tract,suchasthenose,mouth,andsinuses,andcan
easilybeinhaledintothealveoli.
•Onceinside,bacteriamayinvadethespaces
betweencellsandbetweenalveolithrough
connectingpores.
•Thisinvasiontriggerstheimmunesystemtosend
neutrophils,atypeofdefensivewhitebloodcell,to
thelungs.

18. BACTERIAL
•Theneutrophilsengulfandkilltheoffending
organisms,andalsoreleasecytokines,
causingageneralactivationoftheimmune
system.
•Thisleadstothefever,chills,andfatigue
commoninbacterialandfungalpneumonia.
Theneutrophils,bacteria,andfluidfrom
surroundingbloodvesselsfillthealveoliand
interruptnormaloxygentransportation.

19. SIGN AND SYMPTOMS
•Fever
•Lower-than-normal body temperature in older people
•Cough
•Shortness of breath
•Sweating
•Shaking chills
•Chest pain that fluctuates with breathing (pleurisy)
•Headache
•Muscle pain
•Fatigue

21. DIAGNOSIS
•Pneumoniacanbehardtodiagnose
becauseitmayseemlikeacoldorflu.
•Diagnosisofpneumoniaisbasedon
medicalhistory,aphysicalexamination,
andtestresults.

22. MEDICAL HISTORY
•Doctorwillaskaboutpatientssignsand
symptomsandhowandwhentheybegan.
•Tofindoutwhattypeofgermiscausingthe
pneumonia,he/shealsomayaskpatientabout
the:
I.Involvementinanyrecenttravelling
II.Hobbies
III.Exposuretoanimals
IV.Exposuretosickpeopleathome,school,or
work
V.Pastandcurrentmedicalconditions,and
whetheranyhavegottenworserecently
VI.Intakeofanymedicines
VII.Whethersmoking
VIII.Whetherhadfluorpneumoniavaccinations

23. If patient has pneumonia:
Doctors will listen
a. Lungs may
make
crackling,
bubbling, and
rumbling
sounds when
inhale
b. Wheezing
c. Find hard
to hear
sounds of
breathing in
some areas of
chest
PHYSICAL EXAMINATION

24. TESTS
1.ChestX-ray
2.BloodTests
3.Chestcomputedtomography(CT)scan
4.Sputumtest
5.Pulseoximetry
−Asmallsensorisattachedtopatient’sfingeror
ear.Thesensoruseslighttoestimatehow
muchoxygenisintheblood.
6.Bronchoscopy

25. MANAGEMENT
1.Firstprioritytoassessingthepatientwith
pneumoniais
–Toevaluatetheadequacyofrespiratory
function
–Todeterminewhethertherearesignsof
systemicillness,specificallydehydrationor
sepsiswithresultingcirculatorycollapse.
2.Primaryobjectivesofthetreatmentare
eradicationoftheoffendingorganismand
completeclinicalcure.

26. MANAGEMENT
3.Treatmentofbacterialpneumoniainitially
involvestheempiricaltherapybyusingbroad-
spectrumantibiotics.Itshouldbenarrowedto
killthespecificpathogensoncetheresultsofthe
culturesandsensitivity(C&S)testareknown.
4.Appropriateempiricchoicesfortreatmentof
bacterialpneumoniasrelatedtopatient’s
underlyingdiseaseareshowninTable1for
AdultsandTable2forChildren.

27. Table 1: Empirical Antimicrobial Therapy for Pneumonia in Adults

28. Table 2: Empirical Antimicrobial Therapy for Pneumonia in Pediatrics

29. Antibiotic Doses for the Treatment of Bacterial Pneumonia

30. 1.Vaccination
•Effectiveforpreventingpneumoniainbothchildren
andadults.
•CenterforDiseaseControlandPrevention
recommendsthateveryone≥6monthsshouldget
yearlyvaccination.
•E.g.,vaccinationagainstHaemophilusinfluenzae
andStreptococcuspneumoniae.
2.Environmentalmeaures
Reducingindoorairpollution
Smokingcessation
3. Appropriately treating other diseases
-Appropriately treating underlying illnesses such as
AIDS can decrease the risk of pneumonia
PREVENTION

31. 1.Acute Respiratory Distress Syndrome (ARDS)
2.Fluid around the lung (pleural effusion)
3.Lung abscesses
4.Respiratory failure (which requires a breathing
machine or ventilator)
5.Sepsis, which may lead to organ failure
9. COMPLICATIONS

32. •With appropriate treatment, most patients will improve
within 2 weeks. Elderly or very sick patients may need
longer treatment.
•Those who may be more likely to have complicated
pneumonia include:
a.Older adults or very young children
b.People whose immune system does not work well
c.People with other, serious medical problems such
as diabetes or cirrhosis of the liver
PROGNOSIS