Pneumonia, lung abscess, bronchiectasis
- 1. MUC. Ilkin Bakirli SLOVAK MEDICAL UNIVERSITY
- 3. Introduction • Inflammation of the lower respiratory tract that involves the airways and the lung parenchyma with consolidation of the alveolar space • Pneumonia can be caused by an infectious organism, aspiration, radiation, allergy (hypersensitivity) or by certain drugs
- 5. Clinical classification • Community acquired (typical, atypical, aspiration) • Nosocomial (>48h after admission) Hospital acquired, ventilator associated, health care associated • Pneumonia in elderly (gradual onset, less fever, less cough) • Pneumonia in Immunocompromised
- 6. Pathophysiology • Reduced host defence against bacteria (reduced cough, reduced immunity, reduced mucous clearance) • Aspiration of nasopharyngeal or gastric content (NGT, dysphagia) • Bacteria introduced into lower respiratory tract (tracheostomy, ventilators) • Bacteraemia • Abdominal sepsis
- 7. Etiology Community acquired Nosocomial Immunocompromised Typical: Strep. pneumoniae Hemophilus influenza Moraxella catarhallis Staph. aureus Enterobactericae: E. coli Klebsiella pneumoniae Proteus mirabilis Enterobacter Pseudomonas aueroginosa MRSA Fungi: Pneumocyctis jirovecii Histoplasma capsulatum Cryptococcus neoformans Coccidiodes immitis Atypical: Mycoplasma pneumoniae Chlamydia pneumonophila Legionella pneumonophilla Coxiella burnetii RSV, adenovirus, coronavirus, influenza
- 8. Risk factors • Cigarette smoking • Upper respiratory tract infections • Alcohol • Corticosteroid therapy • Old age • Recent influenza infection • Pre-existing lung disease
- 9. Clinical manifestations Symptoms Low grade fever Rigor Shivering Headache Decreased appetite Myalgia Abdominal pain Pleuritic chest pain Dyspnea
- 10. Diagnosis • Pulse oximetry, ABGs • Physical exam: increased vocal fremitus, dull on percussion, decreased breathing sounds on auscultation, bronchial breathing, crackles • Laboratory: CBC (leucocytosis: bacterial neutrophilia; viral lymphocytosis) Increased CRP and ESR • Culture: blood, throat swab, bronchoalveolar fluid lavage • CXR: typical lobar pneumonia / increased interstitial markings / peribronchial thickening • USG: to differentiate from pleural effusion and empyema • CT: evaluate serious disease / pleural abscess / bronchiectasis
- 11. Management • Hospitalise if score >2 1. Confusion 2. BUN >7mmol/L 3. Respiratory rate >30/min 4. SBP <90 mmHg and/or DBP <60 mmHg 5. Age > 65 years • 02 supplementation, I.V fluids • NSAIDs, paracetamol (anti-pyretics) • Empiric ATBs therapy: aminopenicillin + macrolide / fluoroquinolone(mono) / cephalosporin + macrolide • SpecialATB: vancomycin for MRSA, piperacillin + tazobactam / imipenem + fluoroquinolone for Pseudomonas
- 13. Introduction • Severe localised suppuration caused by an infection, associated with >2cm cavitations and parenchymal pulmonary liquefactive necrosis • Lung gangrene (necrotising pneumonia) formation of multiple small lung abscesses • Primary abscess in previously healthy lungs • Secondary abscess complication of another lung disease
- 14. Etiology • Pathophysiology: aspiration, preceding infection, bronchial obstruction, septic emboli, necrotising pneumonia • Causes Anaerobes: Actinomycosis, Fusobacterium, Peptostreptococcus Microaerophilics: Steptococcus milleri Aerobic: Staph, Klebsiella, E. coli, Hemophillus Fungi: Candidan spp, Aspergillus spp Parasites: entamobea spp
- 15. Symptoms and diagnosis • Gradual onset, but acute in necrotising pneumonia • Cough, fever, shivering, night sweats, dyspnea, lethargy, chest pain, purulent, hemoptysis, anorexia, • CXR/CT/MRI: unilateral, usually at the posterior of the upper lobe or apex of the lower lobe, air-fluid level visible • Laboratory: increased ESR and CRP • Microbiology: sputum reveals mixed flora
- 16. Management • Broad spectrum antibiotics (empiric: I.V clindamycin/ co-amoxiclav) • Pulmonary physiotherapy • Anaerobic: metronidazole or clindamycin • Aerobic: B-lactams / cephalosporins / vancomycin / linezolid • Bronchoscopy to remove aspirate • Surgical drainage if needed
- 18. Introduction • Irreversible airway dilatation that involves the alveoli in either a focal (due to an obstruction) or a diffuse (due to a systemic inflammation or infectious process) manner • Can be acquired or congenital
- 19. Etiology Congenital Acquired CF Pneumonia Ciliary dyskinesia Pertussis Kartagener syndrome Aspiration of foreign body Primary hypogammaglobulinemia PulmonaryTBC Aspergillosis Bronchial tumours
- 20. Clinical manifestations and diagnosis • Chronic productive cough, malaise, headache, hemoptysis, anorexia • Acute: fever, pronounced cough, increased mucous production, pleurisy • Signs crackles, decreased breath sounds (lobar collapse) • Culture: sputum • CXR: normal in mild illness, thickened airway, consolidation or collapse in severe disease • CT: dilated bronchi with thickened bronchial walls and multiple cysts containing, fluid at the end of bronchioles • Ciliary test assessment: saccharin test or nasal biopsy
- 22. Management • Bronchodilators, corticosteroids • Physiotherapy (postural drainage) • ATBs: according to etiology (macrolides / cephalosporins most common) • Mucolytic • Surgery: resection of focal disease, uncommon • Lung transplantation • Prognosis: may lead to respiratory failure after CF, otherwise good prognosis