1 / 43

Pneumonia

Pneumonia. Lina Chen MD West China Second University Hospital, Sichuan Universtiy. Pneumonia. A potentially serious respiratory infection Diagnosis requires both clinical presentation and diagnostic studies. Objectives. Know etiologic agents and pathogenesis of pneumonia

Jims
Download Presentation

Pneumonia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pneumonia Lina Chen MD West China Second University Hospital, Sichuan Universtiy

  2. Pneumonia • A potentially serious respiratory infection • Diagnosis requires both clinical presentation and diagnostic studies

  3. Objectives • Know etiologic agents and pathogenesis of pneumonia • Recognize clinical presentation and know possible complications • Know how to diagnose and treat pediatric patients with pneumonia

  4. Introduction • The most frequent diagnosis in pediatric inpatient department :1/3-1/2 • The most important cause of death in children from developing country • Incidence peaks :between 1 and 5 years of age • The most important one of four common pediatric diseases in China : pneumonia, diarrhea, anemia and ricket

  5. Introduction • Definition • Pneumonia is an inflammation of the lungs. • Causes • Microorganisms: viral,bacterial and atypical organisms • Non-infectious causes: aspiration of food or gastric acid, foreign bodies, hydrocarbons and lipoid substances, hypersensivity reactions, drug-or-radiation-induced pneumonitis

  6. Introduction • Risk factors for the development of pneumonia • Lung disease: asthma, cystic fibrosis, respiratory anormaly • Anatomical problems: tracheoesophageal fistula • Gastroesophageal reflux • Neurologic disorders • Diseases which alter immune system: immunodeficiency, hemoglobinopathies

  7. Classification 1. based on pathological features • Parenchymal pneumonia • Brochopneumonia • Lobarpneumonia • Interstitial pneumonia • Mixed type of pneumonia

  8. Classification 2. based onetiology

  9. Etiology ---pathogen Atypical organisms Bacteria Viruses • In developed countries, virus is the most common cause • in developing countries, bacteria are the most common causes • Streptococci is the most common bacterial cause • aspiration or the hematogenous route

  10. Classification 3. based oncourse of disease • Acute Pneumonia • within one month, most in 2-3 weeks • Most common • Prolonged Pneumonia • 1 month to 3 months • Chronic Pneumonia • over 3 months • hard to treat , must search reason

  11. Classification 4. based onclinical manifestations • Mild pneumonia: Mainly involves respiratory system, no generalized toxic symptoms • Severe pneumonia:Besides respiratory system, other systems might be severely involved • Respiratory failure • Circulatory system: congestive heart failure • Digestive system: abdominal distention , toxic intestinal paralysis • CNS: toxic encephalopathy • Other: body fluid derangement ,disseminated intravascular coagulation (DIC)

  12. Classification 5. based ononset time • Community acquired pneumonia, CAP • Hospital Acquired Pneumonia, HAP

  13. Pathophysiology • Edema and accumulation of mucus→bronchiolar obstruction • Walls of alveoli →thicken • Alveoli are filled with inflammatory exudates→impairs the normal exchange of gases in the lungs • Diminished ventilation of the alveoli →hypoxemia and carbon dioxide retention →interfere normal metabolic process and normal function of the chief organs

  14. Pathophysiology

  15. Clinical manifestations • Prodromal symptoms • Upper respiratory tract infection: rhinitis, cough • General condition • diminished appetite, restless, • gastrointestinal disturbance: vomiting, anorexia, diarrhea,

  16. Clinical manifestations • Fever • Temperatures are generally lower in viral pneumonia than in bacterial pneumonia. • Infants may have hypothemia. • Cough • dry cough →wet cough • Neonates and infants may present with choking cough, groan.

  17. Clinical manifestations • Tachypnea • The most consistent clinical manifestation of pneumonia • Increased respiratory rate: >60 breaths/min in neonate, >50 in infants 11 months of age or less, >40 in children over 11 months • Increased work of breathing accompanied by supraclavicular, intercostal, and subcostal retractions, nasal flaring, and use of accessory muscles • Cyanosis • Cyanosis will appear when SaO2 <85% and unoxygenated Hb>5g/dl • location: face, finger nails.

  18. Clinical manifestation • Physical findings depend on the stage of pneumonia • Early course: • diminished breath sounds, scattered crackles, rhonchi, wheezing • difficult to localize the source of these adventitious sounds in very young children • Development of increasing consolidation or complications: • cyanosis: • dullness on percussion • abdominal distention: gastric dilation from swallowed air • liver enlargement: downward displacement of the diaphragm

  19. Severe pneumonia • Circulatory system: congestive heart failure • Central nervous system: toxic encephalopathy • Digestive system: toxic intestinal paralysis • Disseminated intravascular coagulation (DIC)

  20. Severe pneumonia ---Circulatory system • Myocarditis: pallor, tachypnea, and arrhythmia, low and dull heart sound • Heart failure • tachypnea, breath rate more than 60/min • tachycardia, heart rate is quicker than 160 -180 beats/min • suddenly extreme restless, obvious cyanosis, pallor or grey complexion • heart sound decrease, gallop rhythm, high distention of jugular vein occurs • liver enlarged rapidly, liver can be palpable 3cm at right subcostal region • oliguria, facial edema and edema of lower extremity • shock:gram negative bacillus , microcirculation dysfunction

  21. Severe pneumonia --- Toxic encephalopathy • Change of degree of consciousness: - agitation and drowsiness • Cerebral edema • consciousness disturbance • Convulsion • irregular respiratory rhythm • hypertonia anterior fontanel

  22. Severe pneumonia ---Digestive system • Mild case : vomit, diarrhea, and abdominal distention • Abdominal distention • gastric distention • due to swallowed air or paralytic ileus • Enlarged liver • downward displacement of right diaphragm • superimposed congestive heart failure • Severe case • toxic paralysis of the intestine • bowel sounds disappear • hemorrhage : melena, hematemesis

  23. Severe pneumonia --- Disseminated intravascular coagulation (DIC) • Anemia • Bleeding tendency • bleeding at sites of vein puncture • scattered petechiae over the skin • gastric-intestinal bleeding • Activation of clotting - microvascular and macrovascular thrombosis

  24. Complications • Pleural effusions • Pneumatoceles • Empyema • Pneumothorax

  25. Laboratory finding---blood test • White blood cell count(leukocyte) • virus →normal or slightly elevated • bacterium ↑ WBC may be normal : when the pathogen is bacterium if the patient is malnutrition or in very severe condition • C reactive protein (CRP) • increase:in bacterial infection • normal: in viral infection

  26. Laboratory finding--- Etiologic agent • Isolation of an organism • nasopharygeal secretions (deep coughing, tracheal suction, or pleural fluid obtained at thoracentesis) • Blood culture: bacteria pneumonia • Sputum culture • Pleural fluid • Lung biopsy • Serologic testing:specific antibody to virus

  27. Radiologicalfinding • Methodology: • Chest X-ray • Chest CT • Findings: • Viral: hyperinflation, segmental atelectasis, interstitial infiltrates • Mycoplasma : usually lobar • Bacterial: Lobar consolidation, more common in the older child, diffuse infiltrates

  28. Radiologicalfinding bronchopneumonia normal lobar pneumonia

  29. Radiologicalfinding pleural effusion pneumatocele pneumothorax

  30. Diagnosis • Symptoms:fever, cough and tachypnea. • Signs:persistent moistralesin the lung • Chest X-ray:spotted-like or patchy shadows over the lung field • Severe case:Congestive heart failure, Toxic encephalopathy,Toxic intestinal paralysis, DIC • Complications:empyema,pyopneumothorax and pneumatocele

  31. Diagnostic Difficulties in Pediatric Pneumonia • Sputum samples are often unobtainable • Some common pathogens are not easily cultured: C. pneumoniae and M. pneumoniae • Nasopharyngeal samples are unreliable due to high asymptomatic carriage rates

  32. Differential diagnosis ---Acute bronchitis • Symptoms:mild • Breath sound:coarse,or a few rales(sputum) at the end of inspiration and early expiration. • Chest X-ray:lung markings↑,no spotted or patchy shadows

  33. Differential diagnosis ---Bronchial foreign body • History:foreign bodies aspiration, sudden onset of cough and wheezing • Physical signs:bronchial obstruction -complete obstruction :atelectasis -incomplete obstruction :emphysema.

  34. Differential diagnosis ---Pulmonary tuberculosis • History: recent contact with TB • Toxic symptoms of TB:fever,diminished appetite,weight loss, irritability, malaise,easy fatigability,night sweating • Laboratory test: -Radiogram -ESR↑ -Positive tuberculin test

  35. Treatment • Principles of treatment • Control infection • Improve ventilation • Prevent complications

  36. General treatment • Good and enough nutrition • Maintain good ventilation : • relieving hypoxia and CO2retention • when the secretion in airway is thick →intermittent ultrasonic inhalant therapy is recommended. • Sputum suction in time:the best way to keep normal ventilation of airway

  37. General treatment • Oxygen if indicated • oxygen inhalation can be administrated with nasal cannula, the flow is 0.5-1L/min. • If the hypoxia continues :Oxyhood may be used with a flow of 2-4L/min. • when respiratory failure occurs :intubation and ventilation needed • Analgesics and antipyretics • Expectorants

  38. Anti-microbial Therapy • Empiric therapy is justified as initial management as the specific bacteriological etiology is unknown and delaying therapy while trying to find a diagnosis may be injurious to the patient

  39. Choice of antibiotics • Factors to consider: • The age and any underlying illnesses • The degree of illness and the kinds of bacteria. (the best way →give the most sensitive antibiotic to the bacteria by medicine sensitive test) • Other: spectrum y of activity, pharmacokinetics, dosage, cost, frequency and route of administration, adverse effects, development of resistance • Palatability

  40. Choice of antibiotics • Chlamydia Macrolides azithromycin • Mycoplasm azithromycin • Staph aureus clindamycin vancomycin • S. pneumoniae penicillin • H. influenzae amoxicillin • E. coli amoxicillin

  41. Duration of Therapy • Total of 7 to 10 days of Antimicrobial therapy • Complications such as pleural effusion or empyema require 2 to 4 weeks of therapy • Staphylococcal empyema is 3 to 4 weeks

  42. Other treatment • Treatment of complication: • Pleurocentesis • Surgery

  43. Thanks for listening!

More Related