Pneumonia

Pneumonia is defined as inflammation with exudative solidification of lung parynchyma, generaly acute


Classification:-
Anatomically
  1) Lobar/Lobular
  2) Bronchopneumonia
  3) Interstitial

Aetiologically
  1) primary pneumonia
       Caused by specific pathogenic organism
       No pre-existing respiratory abnormality
       Common organisms r strepto, H. influenzae, staph, moraxella, legionella, mycoplasma

  2) secondary pneumonia
       Absence of specific pathogenic organism
       Presence of pre-existing abnormality of resp.
       E.g. Aspiration pneumonia-- aspiration of food, secretion etc

  3) suppurative pneumonia
       Destruction of lung tissue by inflamn, abscess formn

According to mode of acquiring:
 1) community-acquired
 2) nosocomial
 3) pneumonia in immunocompromised pts

Pathology
 Four stages:
   1) stage of congestion
   2) stage of red hepatisation
   3) stage of grey hepatisation
   4) stage of resolution/complication

clinicl features
  Onser of rigors followed by fever
  Pleuritic chest pain
  Productive cough with purulent sputum and
  haemoptysis
  Tachypnoea in elderly
  Tachycardia
  Crepitations over involved area
  Myalgia, arthralgia, headache, mental confusion

Investigations
 - DLC--leucocytosis
 - blood culture
 - respiratory secretions--culture, microscopy
 - serologial and antigen detecting tests
 - radiological studies--chest radiograph confirms diagnosis

Complications:
  Parapneumonic effusion
  Meningitis
  Arthritis
  Endocarditis
  Pericarditis
  Peritonitis
  Empyema
  ARDS
  Septicemia

Treatment:

General measures:
 - check airway, breathin, circulation
 - iv fluids
 - oxygen
 - mild analgesics

Antimicobial therapy:
- uncomplicated pneumonia:
     Erythromycin 250 mg 6 hrly alone or in combination with cefuroxime, fluroquinolones may b given
- moderate sick pts:
     Ceftriaxone 2 g once a dai IV and erythromycin 500 mg 6 hrly
- severly sick pts:
     Ceftriaxone 2 g once a dai IV and azithromycin 500 mg IV or levofloxacin 5000mg iv once a day