PNEUMONIA - MEF by ert554898

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									    Nikola Blažević
Mentor: A. Žmegač Horvat
-   inflammation of the lungs caused by infection

-   many different causes: bacteria, viruses, fungi, idiopathic

-   damages ALVEOLI > exudate (fluid) > consolidates > lack of oxygen
NORMAL ALVEOLI 




  PNEUMONIA   
                            DIAGNOSIS
1.   Symptoms (dyspnea, cough)
2.   Physical examination
3.   X-ray (not always reliable)
4.   Blood test (high white cell count >
     inflammation)
5.   Sputum cultures
6.   CT (most reliable)
                    COMBINED FINDINGS
Prediction rule for the frequency of inflammation:
       Temperature > 100 degrees F (37.8 degrees C)
       Pulse > 100 beats/min
       Crepitations
       Decreased breath sounds
      Absence of asthma

Probability of inflammation based on the number of findings:
     5 findings - 84% to 91% probability
     4 findings - 58% to 85%
     3 findings - 35% to 51%
     2 findings - 14% to 24%
     1 finding - 5% to 9%
     0 findings - 2% to 3%
                          Classification
Early classification schemes:
• Anatomical: 1. lobar pneumonia(streptoccocus or klebsiella pneumoniae)
                 2. multilobar pneumonia
                 3. interstitial pneumonia(viruses or atypical bacteria)
• Radiological
• Microbiological

Combined clinical classification:
     1. ACUTE(less than three weeks duration)
         - classic bacterial bronchopneumonia
         - atypical(interstitial pneumonitis)
         - aspiration pneumonia syndromes
     2. CHRONIC
         - non-infectious
         - mycobacterial                                  Streptococcus pneumoniae
         - fungal
         - bacterial infections caused by airway obstruction
Community-acquired pneumonia (CAP)
   - in a person who has not recently been hospitalized!
     - most common type of pneumonia
     - home care, oral antibiotics
Most common cause of CAP  H. influenzae
  Streptococcus pneumoniae  most common cause of CAP worldwide
                             viruses
                             atypical bacteria
Fourth most common cause of death in UK and sixth in US
Hospital-acquired pneumonia (nosocomial)
 - acquired during or after hospitalization for another illness or
   procedure, 72h latency time after admission
 - 5% patients develop HAP
 - more deadly
Microorganisms (more resistant):
•   MRSA (methicillin-resistant Staphylococcus aureus)
•   Pseudomonas
•   Enterobacter
•   Serratia


Risk factors :
•   mechanical ventilation
•   decreased amounts of stomach acid
•   immune disturbances
•   heart and lung diseases
•   Severe acute respiratory syndrome (SARS)
•   Bronchiolitis obliterans organizing pneumonia (BOOP)
•   Eosinophilic pneumonia
•   Aspiration pneumonia
•   Dust pneumonia




                                           SARS
-   oral antibiotics, rest, lots of fluid!
-   home care  no hospitalization needed
-   people with other medical problems and elderly  hospitalization if
    pneumonia persists

Bacterial pneumonia  treated with antibiotics:
                           - amoxicillin
                           - fluoroquinolones
                           - cephalosporins
                           - aminoglycosides

Viral pneumonia  influenza A  rimantadine , amantadine
Bacterial pn.  resolves within 2 to 4 weeks
    - 1/20 people with pneumococcal pneumonia die
    - half of the people who develop MRSA on ventilator die
Viral pn.  lasts longer than bacterial
Mycoplasmal pn.  4 to 6 weeks to resolve
                        - low mortality
•   Vaccination  H. influenzae and S. pneumoniae in the 1st year
                  - repeat after 5-10 years
•   Abtibiotics  Group B Streptococcus and Chlamydia trachomatis
    positive pregnant women
•   Treating underlying illnesses (e.g. AIDS) can decrease the risk of
    pneumonia
•   Smoking  cigarette smoke interferes with many of the body's
    natural defenses against pneumonia
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