CLINICAL, MICROBIOLOGICAL AND RADIOLOGICAL

STUDY OF COMMUNITY ACQUIRED PNEUMONIA

Dissertation submitted to

Dr. N.T.R. University of Health Sciences

Vijayawada, Andhra Pradesh.

In partial fulfillment for the degree of

M.D., (GENERAL MEDICINE)

Degree Examination
To be held in April 2013
By

Dr. J. CHANDRASEKHAR.,

M.B.B.S.,

Under the esteemed guidance of

Dr. M.V.V.TIRUMALA RAO,

Professor
Department of Medicine
Rangaraya Medical College
KAKINADA
2010-2013

M.D.,

CERTIFICATE

This is to certify that this dissertation entitled CLINICAL,

MICROBIOLOGICAL AND RADIOLOGICAL STUDY OF COMMUNITY
ACQUIRED PNEUMONIA is the bonafide record of original work done by
Dr. J. CHANDRASEKHAR., M.B.B.S., who is post graduate student under our
guidance and supervision, in partial fulfillment of the rules and regulations laid down
by N.T.R UNIVERSITY OF HEALTH SCIENCES, Vijayawada, to appear for M.D.
(General Medicine) degree examination to be held in April, 2013.

Kakinada
Date:

Dr. K.S.R.SWAMY, M.D.,

Professor & HOD,
Department of Medicine,
Rangaraya Medical College,
Kakinada.

Dr. M.V.V.TIRUMALA RAO, M.D.,

Professor,
Department of Medicine,
Rangaraya Medical College,
Kakinada.

PRINCIPAL
Rangaraya Medical College

Kakinada

ACKNOWLEDGEMENT
I am extremely grateful to my esteemed teacher and guide
Dr. M.V.V.TIRUMALARAO M.D., Professor of Medicine, Government
General Hospital, Kakinada for his support and expert guidance throughout
the study.
I express my deep sense of gratitude to my learned Professor
Dr. K.S.R.SWAMY, M.D., for his continuous encouragement and inspiration
towards betterment of my study.
I thank my teachers Dr. A.VEERRAJA, M.D., Dr. C.S.S.SHARMA,
M.D., Dr.P.YASODAMMA, M.D., Dr.S.S.K.R.BHIMESWARARAO, M.D.,
who are a constant inspiration to me.
I am very much indebted to SUPERINTENDENT, Government
General Hospital, Kakinada and PRINCIPAL, Rangaraya Medical College
for their valuable support in using the hospital facilities for my dissertation
work.
I am thankful to the Department of Microbiology and Radiology for
extending facilities to undertake various investigations.
My thanks are also due to my colleague Postgraduates for their
cooperation and I am greatly indebted to all the patients and their relatives for
their endurance during my study.
I give my special thanks to my wife Mrs.Ch Vidyavathi who is
extremely supportive to me throughout this dissertation work.

Dr. Chandrasekhar Jenjeti

LIST OF ABBREVIATIONS
AFB

Acid Fast Bacilli

BBS

Bronchial Breath Sound

BP

Blood Pressure

COPD

Chronic Obstructive Pulmonary Disease

CAP

Community Acquired Pneumonia

CFT

Compliment Fixation Test

CRP

C- Reactive Protein

CXR

Chest X-Ray

CCF

Congestive Cardiac Failure

DIC

Disseminated Intravascular Coagulation

ECG

Electrocardiogram

ESR

Erythrocyte Sedimentation Rate

ELISA

Enzyme-linked Immunosorbant Assay

HIV

Human Immuno Virus

HR

Heart Rate

ICU

Intensive Care Unit

LDH

Lactate Dehydrogenase

RR

Respiratory Rate

TC

Total Count

Tnf

Tissue Necrotizing Factor

SIADH

Syndrome of Inappropriate Anti Diuretic Hormone

VF

Vocal Fremitus

VR

Vocal Resonance

LRTI

Lower Respiratory Tract Infection

WBC

White Blood Cells

CONTENTS
S.No.
1.
2.
3.

PART - I
INTRODUCTION
HISTORICAL REVIEW
ANATOMY OF LUNGS AND DEFENSE

Page No.
1-2
3-7
8-15

4.
5.
6.
7.
8.
9.
10.

MECHANISMS
DEFINITION OF COMMUNITY ACQUIRED
PNEUMONIA
ETIOLOGY AND EPIDEMIOLOGY
PATHOLOGY & CLASSIFICATION
CLINICAL FEATURES
DIAGNOSIS & SEVERITY ASSESSMENT
MANAGEMENT
SPECIFIC TYPES OF PNEUMONIA

16
17-20
21-24
25-27
28-33
34-41
42-48

PART II
11.

AIMS AND OBJECTIVES

12.

MATERIALS AND METHODS

50-51

13.

OBSERVATIONS

52-67

14.

DISCUSSION
SUMMARY AND CONCLUSIONS
BIBLIOGRAPHY
CASE SHEET PROFORMA
MASTER CHART

68-77

15.
16.
17.
18.

49

78-79
80-89
90-93
94-95

PART I

PART II