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Prof. Dr. Bilun Gemicioğlu

Pneumonia. Prof. Dr. Bilun Gemicioğlu. Pneumonia is a lung parenchyma infection caused by bacteria, a virus or fungi , with a consolidation on radiological examination. Pneumonitis is an inflammation of the lungs caused by chemical or radiation therapy but not with infectious agents.

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Prof. Dr. Bilun Gemicioğlu

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  1. Pneumonia Prof. Dr. Bilun Gemicioğlu

  2. Pneumonia is a lung parenchyma infection caused by bacteria, a virus or fungi, with a consolidation on radiological examination.Pneumonitis is an inflammation of the lungs caused by chemical or radiation therapy but not with infectious agents. Definition

  3. Spread of lung infections • Inhalation • Aspiration of oropharingeal secretion • Hematogenic spread • Direct spread (thorax wall, mediastinum)

  4. Predisposing factors of pneumonia • Airways mechanical barrier damage • Specific and/or nonspecific immune defense mechanisms injury • Bronchial obstruction • Micro aspiration of upper respiratory truck secretion. • Lung edema • Viral infections.

  5. Diagnostic Methods • History, physical examination • Chest X-Ray • Sputum examination (gram stained) • Sputum , blood cultures • Serological tests • Peripheral blood analysis

  6. Diagnosis Symptoms fever, shaking chills, cough, sputum (expectoration), pleuritic pain. Others: (dispnea, fatigue, sweating, loss of appetite...) Physical signs: increased vibration thoracic impaired percussion (matity), end inspiratory rales (crepitations) and bronchial breathing (tuber soufle) Others (cyanosis, tachipnea, tachicardia...)

  7. Diagnosis Radiology: lobar opacities, interstitial images, bronchopneumonic (patchy) opacities, Others (absea, pneumatocele, pleurisy...)

  8. Chest X-Ray • Gold standart test for pneumonia • For differencial diagnosis • For grading pneumonia severity • For examining complications

  9. Normal Chest X Ray in Pneumonia • -First 24 hours • -Dehydration • -Elderly • -Neutropenia • -Pneumocystis carinii

  10. Classification with anatomical localization • Lobar consolidation • Bronchopneumonia • Interstitial pneumonia

  11. Classification with ethiology • Bacterial • Viral • Fungal • Parazites

  12. Classification with targeting therapy • Community acquired pneumonia • Hospital acquired pneumonia (Nosocomial) • Immunosuppresed (immunocompromised) patients pneumonia

  13. Pneumonia acquired outside hospital frequently in healthy persons Community acquired pneumonia

  14. Caracteristics of community acquired pneumonia (CAP) Typical pneumoniaAtypical pneumonia acute subacute, fever,chills subfebril fever productive cough non productive cough pleural pain nonrespiratory symptoms physical signs ( + ) physical signs ( - ) lobar consolidation non-lobar infiltration Agents S. pneumoniae M.pneumonia H. Influenzae C.pneumoniae Gr(-)aerop bacillus L. Pneumophila Aneorobes Virus

  15. Lobar pneumonia

  16. Lobar pneumonia

  17. Bronchopneumonia

  18. Interstitial pneumonia

  19. CAP THERAPY GROUP 1 OUTPATIENT-CLINIC GROUP 2 HOSPITAL GROUP 3 INTENSIVE CARE Mild pneumonia, Moderate pneumonia Severe pneumonia

  20. No antibiotic usage No comorbidity With comorbidities Pneumococci resistant to penicillin Gram (–) agents Usage of antibiotic last three months Usage of corticosteroid CAP Therapy: Group I Penicillin, Macrolide, Floroquinolone, ß laktame + Macrolide

  21. CAP Therapy: Group 2 CAP Therapy: Group II • S.pneumoniae • H.influenzae • M.pneumoniae • C.pneumoniae • Mix infection) • Enteric Gram negatives ! • Virus First choise Alternatif ________________________________________ Penicillin G ± makrolide Levofloksasin Aminopenicillin ± makrolide Moksifloksasin Aminopenicillin / β-laktamase inhibitor ± macrolide Non- antipseudomonal cefalosporin II-III ± macrolide

  22. CAP Therapy: Group III No risk of P. aeruginosa • Non pseudomonal cefalosporin III+ macrolide or • Non pseudomonal cefalosporin III + (moksifloksasin or levofloksasin) With risk of P. aeruginosa • Anti-pseudomonal cefalosporin (sefepim-seftazidim) or • Ureidopenicillin/beta-laktamase inhibitor (piperasilin.. or • Karbapenem + siprofloksasin

  23. Duration of the therapy Afterfeverdrop1 week - Pneumococcicpneumonia7-10 days - Legionellapneumonia14-21 days - MycoplasmaveC. pneumoniae 10-14 days Severe pneumonia2-3 weeks

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