pneumonia
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Pneumonia Is a infection and inflammatory disease of lung tissues. Naturally human respiratory system has preventive actions and structures from the pathogens.

  • Cough reflex –
  • Pseudo ciliary columnar epithelium
  • Ig A antibody
  • Macrophages

Causes

Most commonly bacteria

Streptococcus pneumonia

H. flu- common in who have underlying lung diseases

Mycoplasma pneumonia-  Most common youngers ( Boolean of skin , tympanic membrane infection are specific symptoms

Chlamydia pneumonia

Legionella – transmitted through contaminated water , Air conditioner. This will decreases sodium ion level in the blood plasma

Staphylococcus aureus- Methadone resistance. Most common in the condition of post intra venous drug users

Klebsiella-   Most common in chronic alcohol users.

Pseudomonas- Most common in HIV like immune deficiency patients. This will cause structural abnormality in the respiratory system.

Viral causes

Para influenza (RSV)

Influenza

Cyto magalo virus (CMV)- Most common in patients who have immno deficiency and organ transplanted)

Fungal causes

Pneumo Cystic Pneumonia( PCP)

Histoplasmiasis

Coccioids – Transmitted through soil

Classification

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According to site

  Broncho Pneumonia – it will effect respiratory tract also. Diffusely spread type

  Lobar Pneumonia – Local effect.

According to type of pathogen

   Typical Pneumonia-  caused by most common microbes

    Example – Streptococcus pneumonia

    Atypical Pneumonia – caused by uncommon microbes

     Example – fungal infections

According to transmission –

Community acquired – transmitted from community or patients who have admitted less than two days in the hospital. Most commonly caused by streptococcus pneumonia, H.flu, Myco plasma pneumonia, Chlamydia, Legionella bacteria groups.

Hospital Acquired –  transmitted from hospital in patients who are admitted in hospital above two days.  This is most commonly  caused by staphylococcus aureus, psuedomonus pneumonia, Klegialla, seratia, Entero bacteria. These multi drug resistance pathogenic bacteria.

 This is classified into two

Ventilator acquired Pneumonia (VAP)- transmitted above 48 – 72 hours from admission.

Health Care Associated (HCA) – infected in  the in patients who are  admitted in hospital above thirty days.

Symptoms

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Patients who have typical Pneumoia will have increased heart rate, increased respiratory rate, Fever , Cough with mucopurulent sputum, fatigue, shortness of breath.

As well as in patients who have atypical pneumonia will have general, extra Respiratory symptoms like Headache, fatigue, Malaise, myalgia, low grade pyrexia( chronic mild fever), dry cough.

Complications

  • Thrombo embolism
  • Pleural effusion
  • Meningitis
  • Lung abscess
  • Hypoxia
  • Lobar collapse

Diagnostic workup

Physical examination

Inspection

can observe increased respiratory rate and usage of accessory muscles it will leads to Intercostal retraction so that patient will have pleural pain.

Palpation

Able to test chest expansion. In hear we should place our palms on the both side of the chest. Then ask the patient to  breath deeply. In hear if the expansion of chest can be noticed using our hand movement. Normally it is  symmetrical. But in the condition of lobar pneumonia unilateral chest expansion will be reduced.

In tactile fructus test we can feel the trimatus.

Percussion- dull sound will be there

Auscultation- bronchial breath sounds, crackles can be heard. Also patient will have positive bronchophony, ego phony, whisper pecticuli due to increased lung density.

Investigation

Consolidation can be noticed in lobar pneumonia. White opacity in the base of lung in broncho pneumonia. Interstitial (atypical) pneumonia Diffuse, Patchy Lighter on hilum.

CT scan also can be done.

In sputum cytology, if the sputum is

Rusty blood- streptococcus pneumonia

Jelly like appearance – klebsiella

Foul smell – Anaerobic bacteria

Green – Pseudomonas and H.flu

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