Pneumonia

1
Pneumonia

• Aming Chor-Ming Lin

2
Pneumonia

• Inflammation or infection of the lungs.
• The lungs' air sacs fill with pus, mucus, and
  other liquid and can not function properly.
• Oxygen cant reach the blood--insufficient oxygen
  in the blood--body cells can not function
  properly --die.

3
Classification of Pneumonia

• Typical vs. Atypical
• Practical classification
• Community Acquired Pneumonia (CAP)
• Hospital Acquired Pneumonia (HAP)
• Ventilator Associated Pneumonia (VAP)
• Health Care Associate Pneumonia (HCAP)
• Aspiration Pneumonia
• Pneumonia in the Immunocompromised Patients

4
Community Acquired Pneumonia

• ???????????48?????
• ?????????
• ??X??????

5
??CAP?????

• ???
• ???????
• COPD
• DM
• Renal insufficiency
• CHF
• CAD

• Malignancy
• Chronic neurological disease
• Chronic liver disease

6
Pneumonia

• Clinical Presentation
• Fever
• Increased WBC
• Productive cough
• Increased respiratory rate
• Breath sound rales/ronchi
• Chest X-ray infiltrate / consolidation

7
?????

• A Airway
• B Bone
• C Cardiac, mediastinum and hilar
• D Diaphragm
• E Else (soft tissue, pleura, breast)
• F Lung Field

8
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• ???????????

9
????

• ??
• ?????????1-1.5??(vertebral body)
• ????
• ???(C-P angle) ?????
• ??
• ??????0.75-3??
• ???????lt1.6cm
• ???????lt1.8cm

10
????Air-Bronchogram

• ?????,????????????
• ????????????????????????????????,??????????,??????
  ???????,???
• ???

11
Pneumonia

• ???????????????????
• ??air-bronchogram?
• ????volume reduction,????volume expansion(?K.P.
  pneumonia)?
• ???????????
• ?????????????(?????)???????

12

• 32 Y/O male
• Cough for 1 wk
• Fever for 2 days
• Rales over LLL

13
Pneumonia Pathogens

• Microorganisms
• Viruses
• Bact Pneumonia
• Mycoplasma, Chlamydia, Legionella
• M. tuberculosis
• Fungi
• Protozans and parasites

• Age Etiologic agents
• lt6months C. trachomatis, RSV,
• 6months-5Yr H. influenza
• Adol/Adult Mycoplasma, Chlamydia
• gt65Yr H. influenzae,
• L. pneumoniae
• except Streptococcus pneumoniae

14
PneumoniaCommunity Acquired

• Common pathogens
• Viruses ( most common type)
• Bacteria
• S. pneumoniae, H. influenzae
• M. pneumoniae
• C. pneumoniae
• Legionella pneumophila
• Mycobacterium

15
Aspiration Pneumonia

• Common pathogens
• Mixed flora
• Mouth anaerobes
• Peptostreptococcus spp, Actinomyces spp.
• Stomach contents
• Chemical pneumonitis
• Enterobacterium

16
Typical pneumonia Clinical presentation

• Usual bacteria
• Sudden onset
• Fever with chills, rigors
• Productive cough, Mucopurulent sputum
• Tachypnea and tachycardia
• Pleuritic chest pain
• Breath sound crackles and rales
• CXR air-bronchogram, consolidation

17
Atypical pneumoniaClinical presentation

• Atypical
• Gradual onset
• Afebrile
• Dry cough
• Breath sound Rales
• Uni/bilateral patchy, infiltrates
• WBC usual normal or slight high
• Sore throat, myalgia, fatigue, diarrhea
• Common etiology
• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Legionella pneumophilla
• Mycobactria
• Virus
• Others

18
Pneumonia

• Diagnosis
• Sputum gram stain and culture
• Good specimen
• PMNsgt25/LPF
• Few epithelial cellslt10/LPF
• Single predominant organism

19
Pneumonia

• Gram stain
• Organisms not visible on gram stain
• M. pneumonia, Chlamydia
• Legionella pneumophila
• Viruses
• Mycobacterium
• Common organisms
• Gram positive diplococci (pairs and chains)
• Gram positive clusters, ie staphylococcal
  pneumonia
• Gram negative coccobacillary, ie K.P.
• Gram negative rods

20
Pneumonia ? ??

• Keep vital signs Airway, Breathing, Circulation
• Symptom treatment
• Antibiotics
• Bacteria
• Atypical pathogens

21
????????

• ???,?????????,?????,???????
• The Pneumonia Patient Outcomes Research Team
  (PORT) risk factors (Wishwa N Kapoor Agency for
  Health Care Policy and Research, 1997)
• 65 ???
• ????????COPD?Bronchiectasis ?Malignancy ?DM ?CRF
  ?CHF ? Chronic liver disease ? Chronic alcohol
  abuse ?Malnutrition ?CVA ?Postsplenectomy.

22
????????

• ????????
• ????  ? 30/min
• ??? ? 60 mm Hg ???? lt 90 mm Hg
• ?? ? 125/min
• ?? lt 35 or ? 400C
• ????
• ???????
• ??????

23
????????

• ?????
• ??? lt 4000/?l ? gt 30000/ ?l
• PaO2 lt 60 mmHg ? PaCO2 gt 50 mmHg(room air)
• Serum creatinine gt 1.2 mg/dl or BUN gt 20 mg/dl
• ?? X ???,???????????????????(48 ????? 50)
• Hematocrit lt 30 or hemoglobin lt 9 mg/dl
• ???????????????,??????
• Arterial pH lt 7.35

24
??ICU?????

• ?????? Major criteria ? ?? Minor criteria
• The major criteria
• ????????
• ?? X ?????(48 ????? 50)
• ?????????????4??
• ?????(4???? lt 80 ml?serum creatinine gt 2
  mg/dl??????????)
• The minor criteria
• ??? ? 60 mm Hg ???? ? 90 mm Hg
• ????????
• ????  ? 30/min
• PaO2/FiO2 lt 250

25
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