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Pneumonia and its causes sign symptome treatment
- 1. PNEUMONIA
- 2. OVERVIEW 1. Definition and Classification 2. Epidemiology 3. Etiology 4. Pathophysiology 5. Sign and Symptoms 6. Diagnosis 7. Management 8. Prevention 9. Complication 10.Prognosis
- 3. DEFINITION Pneumonia is a lung infection that can be caused by different types of infectious agent such as bacteria, viruses, fungi, and parasites.
- 4. CLASSIFICATION a. CAP: community-acquired pneumonia An individual who has not recently been hospitalized develop pneumonia. b. HAP: hospital-acquired pneumonia A patient contracted pneumonia in a hospital, at least 48–72 hours after being admitted. It is usually caused by a bacterial infection, rather than a virus. It is called nosocomial infection
- 5. CLASSIFICATION c. HCAP: healthcare-associated pneumonia • is a category of pneumonia in patients with recent close contact with the health care system. • HCAP is a condition in patients who are not hospitalised (similar to CAP) but its causes, prognosis, prevention and treatment are more similar to HAP. • The category was introduced because healthcare has increasingly shifted from hospital-based to home care, and more people are residing in nursing homes or extended care facilities.
- 6. CLASSIFICATION d. VAP: ventilator-associated pneumonia • VAP is defined as pneumonia occurring >48 hours post endotracheal intubation. • The risk for developing pneumonia in the hospital increases by 6 to 21 times after a patient is intubated because it bypasses the natural airway defences against the migration of upper respiratory tract organisms into the lower tract.
- 7. EPIDEMIOLOGY • Pneumonia is a common illness affecting approximately 450 million people a year and occurring in all parts of the world. • It is a major cause of death among all age groups resulting in 4 million deaths. • Rates are greatest in children less than 5 years old, and adults older than 75 years of age. • It occurs about five times more frequently in the developing world versus the developed world. • Pakistan ranks third for pneumonia in the world, According to the latest report, 71,000 children die of pneumonia every year in Pakistan.
- 8. EPIDEMIOLOGY
- 9. ETIOLOGY • Pneumonia is caused by a number of infectious agents, i.e.: viruses, bacteria, fungi, parasites. • Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. • They may also spread via air-borne droplets from a cough or sneeze. • In addition, pneumonia may spread through blood, especially during and shortly after birth.
- 10. ETIOLOGY 1. Viral pneumonia a. Influenza b. Para-influenza c. Adenovirus d. Respiratory syncytial virus (RSV) appears mostly in children e. Cytomegalovirus in imuno-compromised host
- 11. ETIOLOGY 2. Bacterial pneumonia a. Gram Positive: Streptococcus pneumoniae (most common cause of pneumonia in all age groups, except newborn infants). b. Gram negative: Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Moraxella catarrhalis. c. Atypical (do not stain by gram-stain): Coxiella burnetii, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila.
- 12. ETIOLOGY 3. Fungal pneumonia • Most often caused by Histoplasma capsulatum, blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci (most common cause of pneumonia in infants infected with HIV), and Coccidioides immitis.
- 13. Etiology of severe pneumonia in children in developing countries.
- 14. PATHOPHYSIOLOGY Pneumonia frequently starts as an upper respiratory tract infection that moves into the lower respiratory tract.
- 15. • Viruses invade cells in order to reproduce. • Typically, a virus reaches the lungs when airborne droplets are inhaled through the mouth or nose. • Once in the lungs, the virus invades the cells lining the airways and alveoli. This invasion often leads to cell death, either from damage to the cell by the virus or from a protective process called apoptosis in which the infected cell destroys itself before it can be used as a conduit for virus reproduction. VIRAL
- 16. • When the immune system responds to the viral infection, even more lung damage occurs. White blood cells, mainly lymphocytes, activate certain chemical cytokines that allow fluid to leak into the alveoli. This combination of cell destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream. • As well as damaging the lungs, many viruses affect other organs and thus disrupt many body functions. • Viruses can also make the body more susceptible to other bacterial infections; in this way bacterial pneumonia can arise as a comorbid condition. VIRAL
- 17. BACTERIAL • Bacteria typically enter the lung when airborne droplets are inhaled, but can also reach the lung through the bloodstream when there is an infection in another part of the body. • Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth, and sinuses, and can easily be inhaled into the alveoli. • Once inside, bacteria may invade the spaces between cells and between alveoli through connecting pores. • This invasion triggers the immune system to send neutrophils, a type of defensive white blood cell, to the lungs.
- 18. BACTERIAL • The neutrophils engulf and kill the offending organisms, and also release cytokines, causing a general activation of the immune system. • This leads to the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation.
- 19. SIGN AND SYMPTOMS • Fever • Lower-than-normal body temperature in older people • Cough • Shortness of breath • Sweating • Shaking chills • Chest pain that fluctuates with breathing (pleurisy) • Headache • Muscle pain • Fatigue
- 21. DIAGNOSIS • Pneumonia can be hard to diagnose because it may seem like a cold or flu. • Diagnosis of pneumonia is based on medical history, a physical examination, and test results.
- 22. MEDICAL HISTORY • Doctor will ask about patients signs and symptoms and how and when they began. • To find out what type of germ is causing the pneumonia, he/she also may ask patient about the : I. Involvement in any recent travelling II.Hobbies III.Exposure to animals IV.Exposure to sick people at home, school, or work V.Past and current medical conditions, and whether any have gotten worse recently VI.Intake of any medicines VII.Whether smoking VIII.Whether had flu or pneumonia vaccinations
- 23. If patient has pneumonia: Doctors will listen a. Lungs may make crackling, bubbling, and rumbling sounds when inhale b. Wheezing c. Find hard to hear sounds of breathing in some areas of chest PHYSICAL EXAMINATION
- 24. TESTS 1. Chest X-ray 2. Blood Tests 3. Chest computed tomography (CT) scan 4. Sputum test 5. Pulse oximetry − A small sensor is attached to patient’s finger or ear. The sensor uses light to estimate how much oxygen is in the blood. 6. Bronchoscopy
- 25. MANAGEMENT 1. First priority to assessing the patient with pneumonia is – To evaluate the adequacy of respiratory function – To determine whether there are signs of systemic illness, specifically dehydration or sepsis with resulting circulatory collapse. 2. Primary objectives of the treatment are eradication of the offending organism and complete clinical cure.
- 26. MANAGEMENT 3. Treatment of bacterial pneumonia initially involves the empirical therapy by using broad- spectrum antibiotics. It should be narrowed to kill the specific pathogens once the results of the cultures and sensitivity (C & S) test are known. 4. Appropriate empiric choices for treatment of bacterial pneumonias related to patient’s underlying disease are shown in Table 1 for Adults and Table 2 for Children.
- 27. Table 1: Empirical Antimicrobial Therapy for Pneumonia in Adults
- 28. Table 2: Empirical Antimicrobial Therapy for Pneumonia in Pediatrics
- 29. Antibiotic Doses for the Treatment of Bacterial Pneumonia
- 30. 1. Vaccination • Effective for preventing pneumonia in both children and adults. • Center for Disease Control and Prevention recommends that everyone ≥ 6 months should get yearly vaccination. • E.g., vaccination against Haemophilus influenzae and Streptococcus pneumoniae. 2. Environmental meaures Reducing indoor air pollution Smoking cessation 3. Appropriately treating other diseases - Appropriately treating underlying illnesses such as AIDS can decrease the risk of pneumonia PREVENTION
- 31. 1. Acute Respiratory Distress Syndrome (ARDS) 2. Fluid around the lung (pleural effusion) 3. Lung abscesses 4. Respiratory failure (which requires a breathing machine or ventilator) 5. Sepsis, which may lead to organ failure 9. COMPLICATIONS
- 32. • With appropriate treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment. • Those who may be more likely to have complicated pneumonia include: a. Older adults or very young children b. People whose immune system does not work well c. People with other, serious medical problems such as diabetes or cirrhosis of the liver PROGNOSIS