MANATAD, Dione Kirk D.

January 22, 2020

MD- 2035638 CMED 221
CONCEPT MAP: PNEUMONIA

Fluid and
erythrocytes in Hypoxemia
Overcoming of alveoli space
Host defenses; Increased capillary
Alveolar
alveolar permeability Peripheral
macrophages are Macrophages leukocytosis; increase  Fever
initiate
overwhelmed IL-8 and GCSF
in purulent secretions  Tachycardia
inflammatory
response  tachypnea

Aspiration of
IL-1 and
fever
 Dyspnea
TNF
Microorganism;  Infiltrates on CXR
managed to  Consolidation on CXR
CLINICAL
reach alveolar  Hemoptysis
level MANIFESTATIONS
PATHO-  Crackles in auscultation
PHYSIOLOGY  Use of accessory
PNEUMONIA muscles
 Leukocytosis on CBC

ETIOLOGIC
 Streptococcus pneumoniae CAUSES
 Mycoplasma pneumoniae TREATMENT AND
 Haemophilus influenzae
 C. pneumoniae MANAGEMENT
 Respiratory virusesa

NON- PHARMACOLOGIC
PHARMACOLOGIC
 Antibiotics
 Adequate hydration  Bronchodilators
 oxygen therapy for
hypoxemia
 vasopressors
 assisted ventilation
 Non-Specific Upper
URTI Acute Rhinosinusitis Pharyngitis Laryngitis Epiglotitis
Respiratory Infection
Most rhinoviruses Viral (more common): Viral: Viral: H. influenzae type b
common *Rhinoviruses *rhinoviruses rhinovirus, influenza virus,
Etiologic *Parainfluenza virus *coronaviruses parainfluenza virus, adenovirus,
Agent *Influenza virus coxsackievirus, coronavirus,
Bacterial: and RSV
Bacteria: *S. pyogenes
(50-60% of bacterial cases) Bacterial:
*S. pneumonia Group A streptococcus
*Nontypable H. influenzae
Most *Principal nasal drainage and Acute pharyngitis due to Hoarseness of voice symptoms for <24 h,
Common signs and symptoms of congestion, facial respiratory viruses such as including
Clinical nonspecific URI include pain or pressure, and rhinovirus high fever, severe sore
Presentation rhinorrhea (with or headache or coronavirus usually is not throat, tachycardia,
without purulence), nasal severe and typically is systemic toxicity, and
congestion, cough, and sore associated (in many cases) drooling
throat. with a constellation of while sitting forward,
coryzal symptoms better stridor.
*Other characterized as nonspecific
manifestations, such as URI. fever is Rare.
fever, malaise, sneezing, acute pharyngitis from
lymphadenopathy, influenza virus can be
and hoarseness, are more severe, more likely to be
variable, with fever more associated with fever,
common among myalgias, headache, and
infants and young children. cough

*Similar to those clinical features of acute

of other URIs but lack a pharyngitis caused by
pronounced localization to streptococci of
one particular groups A, C, and G are
anatomic location similar, ranging from a
relatively mild illness
*Signs and symptoms are without many accompanying
diverse and frequently symptoms to clinically
variable severe cases with
profound pharyngeal pain,
fever, chills, and abdominal
pain.
Diagnostics History and Physical *Distinguishing viral from Throat swab culture- helps History and Physical History and Physical
Examination bacterial rhinosinusitis in to differentiate bacterial Examination of larynx (Direct examination
from viral origin laryngoscopy) Oropharyngeal
culture examination
 ambulatory setting is Rapid antigen-detection Culture and sensitivity
usually difficult due to tests- specific but not Lateral neck radiographs
relatively low sensitive CBC: mild leukocytosis
sensitivity and specificity of with predominance of
the common clinical neutrophils
features.

*diagnosing bacterial
sinusitis- symptoms lasting
> 10 days (adults)
accompanied by three
cardinal signs of purulent
nasal discharge, nasal
obstruction, and facial pain

* viral sinusitis- symptoms

not usually lasting more
than 10 days
Complications *May proceed to chronic Acute rheumatic fever,
sinusitis acute
glomerulonephritis and
*intracranial complications numerous suppurative
such as abscess conditions, such as
peritonsillar abscess
(quinsy), otitis media,
mastoiditis, sinusitis,
bacteremia,
and pneumonia—all of
which occur at low rates.
Management Symptom-based treatment *non-pharmacologic- *Treatment of viral *humidification and voice *Security of airway
and only Preferred initial approach pharyngitis is entirely rest alone.
Prevention Antibiotics have no role in in patients with mild to symptom-based * therapy with a β-
the treatment of moderate symptoms of *Antibiotics not indicated lactam/β-lactamase
uncomplicated nonspecific short duration is *pharyngitis due to S. except when group A strep is inhibitor
URI therapy aimed at symptom pyogenes- single dose of IM isolated in culture where combination or a third-
relief and facilitation of benzathine penicillin is the drug of choice generation
sinus drainage penicillin or a full 10-day cephalosporin is
course of oral penicillin Prevention: practice safe and recommended.
*Pharmacologic- Empirical Azithromycin can be used in healthy hygiene; avoid people Typically,
antibiotic therapy for place of penicillin showing symptoms; boost ampicillin/sulbactam,
community-acquired immune system of the body, cefotaxime, or
sinusitis in Prevention- hygienic vaccination ceftriaxone is given,
practices, avoidance of with clindamycin and
people who may show signs trimethoprim-
adults should consist of the and symptoms, healthy diet sulfamethoxazole
narrowest-spectrum agent and lifestyle in order to reserved for
active against boost immune system. patients allergic to β-
the most common bacterial lactams.
pathogens, including S.
pneumoniae If the household
and H. influenzae—e.g., contacts of a patient
amoxicillin/clavulanate with H. influenzae
(with the decision epiglottitis include an
guided by local rates of β- unvaccinated child aged
lactamase-producing H. <4 years, all members
influenzae). of the household
(including the patient)
Prevention: practice safe should receive
and healthy hygiene; avoid prophylactic
people showing symptoms; rifampin for 4 days to
boost immune system of eradicate carriage of H.
the body, vaccination influenzae.

Prevention: vaccination