PNEUMONIA

Introduction:
Pneumonia is defined as inflammation in the air sacs of lungs, which are called alveoli.It is
characterized by consolidation which is a pathological process in which alveoli fill with fluid or pus,
making it difficult to breathe.

Pathophysiology:
The normal function of alveoli is to exchange O2 and CO2 between the blood and external environment.
Bacteria or viruses usually cause pneumonia when they are breathe into lungs. The invading organisms
provoke an overly excited immune response in lungs. Due to inflammation of parenchyma & small blood
capillaries in lungs become leaky which drains inflammatory fluids into the alveoli .This results in a less
functional area for O2 and CO2 exchange. The patient becomes relatively oxygen deprived, while
retaining dangerous level of carbon dioxide. The patient breathes faster and faster, in an effort to bring
in more oxygen and blow off more carbon dioxide. Mucus production is increased, and the leaky
capillaries may tinge the mucus with blood. Mucus plugs actually further decrease the efficiency of gas
exchange in the lung. The alveoli fill further with fluid and debris from the large number of white blood
cells being produced to fight the infection.

Clinical features:
 Viral pneumonia may start with flu-like symptoms, such as wheezing. A high fever may occur
after 12–36 hours.
 Bacterial pneumonia may cause a fever as high as 105°F along with profuse sweating, bluish lips
and nails, and confusion.
 Difficulty in breath because the air sacs are filled with inflammatory mixture.
 Cough reflex with purulent sputum which is the normal response of lungs to clear up the lungs
from mucus.
 Chest Pain. pleural cavity normally contains lubricating fluid that allows the two layers to slide
over each other when the pleura becomes inflamed, the layers rub together causing chest pain.
 Confusion,mostly in elderly patients they may cough whole night but not bring up the mucus.
 Fever & Sweating i.e 39.5-40°c which is the sign of an infection in body.
 Chills ( called rigors).
Etiology:
A large number of organisms causes pneumonia such as;
1. Bacteria: most pneumonias are caused by pneumococcus spp commonest cause overall
ie. Streptococcus pneumoniae, Staphylococcus pneumoniae, Chlamydial pneumoniae,
Legionella spp.
2. Viruses: i.e Rhinovirus,Influenza virus,Varicella zoster virus.
3. Fungi: Candida species, Aspergilus species, mucur species.
 4. Parasites: rare cases ie protozoa , toxoplasma.
5. In some cases of pneumonia there is an unknown cause.

Types of pneumonia:
The major types of pneumonia are classified by the cause of the infection.
1.Types by germs example bacteria,viral,fungal pneumonia
2.Types by Location example community acquired pneumonia ,hospital acquired pneumonia.
3.Types by how they are acquired example aspiration pneumonia , VAP pneumonia

Community Acquired Pneumonia (CAP): Community-acquired pneumonia refers to pneumonia acquired

outside of hospitals or extended-care facilities. Acute Infection is acquired in community.it is most
commonest type of pneumonia.
Hospital Acquired Pneumonia (HAP): hospital-acquired pneumonia describe infections acquired by a
patient in the hospital setting at least 48–72 hours after being admitted & did not appear to be
incubating at the time of admission.it is more severe and has sufficient mortality risk.
Aspiration pneumonia: Aspiration pneumonia is a complication of pulmonary aspiration when food
(may contain bacteria), stomach acid, or saliva is inhaled into your lungs. Aspirate food that travels back
up from your stomach to your esophagus such as in People with GERD. Some substance is aspirated i.e.
instead of going down along esophagus into the stomach it is gone down to trachea and into the lungs
and it is toxic to the lungs and cause pneumonitis .Aspiration pneumonitis are caused by inhaling toxic
substances, usually gastric contents, into the lungs. Gastric acid is very destructive to lungs tissues and
lead to severe tissue necrosis. Damaged tissues are then exposed to secondary infection.
Ventilator-associated pneumonia (VAP): When people who are using a ventilator get pneumonia, it’s
called VAP.

General Management of Pneumonia:

The Aim of Treatment is to cure the infection & prevent further complications.
o Antibiotics: The choice of agents is based on severity of illness, comorbidities, age & causative
agents i.e bacteria spp.For outpatients generally these includes beta-lactams such as
amoxicillin,cefuroxime,cefdinir. Macrolides such as
 Azithromycin,Clarithromycin,Erythromycin,Doxythromycin, however patients with comorbidities
( Diabties,COPD,CHF,Renal Failure) include Respiratory Fluroquinones i.e
Moxifloxacin,Levofloxacin,Beta-Lactams i.e amoxicillin.
o Analgesics: simple analgesia such as paracetamol,Ibuprofen, NSAIDS help treat chest pain &
fever.
o Cough Suppressants: not effective.
o For inpatients include Inpatients Management include Respiratory
fluroquinones,Macrolides+Beta lactams
o Physiotherapy: Chest physiotherapy is need when sputum retention is an issue.
o Oxygen: oxygen should be administered to maintain saturation between 94% and 98% provided
the patient is not at risk of carbon dioxide retention.
o Bronchoscopy: Aspiration pneumonia: if inhaled a substance causing pneumonia it is located &
removed by bronchoscopy.