Pneumonia

Definition
Acute respiratory illness associated with
recently developed radiological pulmonary
shadowing which may be segmental, lobar or
multi-lobar.
It is usually characterized by consolidation, in
which the alveoli are filled with a mixture of
exudates, bacteria and leukocytes.
Clinical features
Fever
Rigors
Shivering
Vomiting
Loss of appetite

Pulmonary symptoms include:

Cough [short, painful, dry, later accompanied with
mucopurulent sputum]
Hemoptysis [in patients with Streptococcus pneumonie]
Pleuretic chest pain, referred to shoulder or anterior
abdomen
Upper abdominal tenderness
 Clinical Features
Streptococcus pneumoniae: Rust-colored sputum
Pseudomonas, Haemophilus, and pneumococcal species:
May produce green sputum
Klebsiella species pneumonia: Red currant-jelly sputum
Anaerobic infections: Often produce foul-smelling or bad-
tasting sputum
Newborns and infants may not show any sign of the
infection. Or they may vomit, have a fever and cough, appear
restless or tired and without energy, or have difficulty
breathing and eating.

Older people who have pneumonia sometimes have sudden

changes in mental awareness.
Classification

Type 1
Lobar pneumonia
Bronchopneumonia

Type 2
Community acquired
Hospital acquired
Suppurative and aspirational
Immunocompromised hosts
Lobar pneumonia
Radiological and pathological term applied to
homogenous consolidation of one or more
lung lobes
Associated with pleural inflammation
Bronchopneumonia
Patchy alveolar consolidation

Associated with bronchial and bronchiolar

inflammation often affecting both lower lobes
Community acquired pneumonia
(CAP)
Spread by droplet infection
Occurs in previously healthy patients
Once the organism settles in alveoli an
inflammatory response is stimulated
Classical pathological response:

1. Congestion
2. Red and then grey hepatisation
3. Resolution with little or no scarring
Predisposing factors
Old age
Cigarette smoking
Upper respiratory tract infection
Recent influenza infection
Pre existing lung disease
Corticosteroid therapy
Alcohol
Related organisms
Majority of CAP are due to S. pneumonie

Young adults
Mycoplasma pneumoniae
Chlamydia pneumoniae

Elderly
Haemophilus influenza

Foreign travels
Legionella
Staph aureus
Investigations
Radiological examination
Chest x-ray helps in differentiating between lobar and broncho
Spotting complications such as intrapleural abscess, empyema

Microbiological investigations

Assessment of gas exchange

Measures SaO2, assists in monitoring response to oxygen
therapy.
Arterial blood gas sampled for SaO 2 <92% or with
severe pneumonia to assess for ventilatory failure

General blood tests

A very high WBC count is seen in severe pneumonia. Urea,
electrolytes and LFTs. C-reactive protein is raised
CURB-65 score
Hospital acquired pneumonia
Refers to new episode of pneumonia
occurring 2days after admission

Post operation

Aspiration pneumonia

Bronchopneumonia developing in patients

with lung disease
Suppurative and aspirational
pneumonia
Consolidation in which there is destruction of
lung parenchyma by inflammatory process
Micro abscess formation with pus that may
rupture and escape into bronchus
Caused by staph aureus, klebsiella
pneumoniae, strep pyogenes, h. influenza
After aspiration of septic material during
operation on nose, mouth or throat under
GA. Vomitus during anesthesia or coma
Clinical features
Productive cough
Pleural pain
Sudden expectoration of copious sputum
High pyrexia
Profound systemic upset
Pleural rub
Signs of consolidation

On chest x-ray homogenous lobar or segmental opacity

consistent with consolidation or collapse
A large dense opacity which may cavitate and show fluid
level, shows in lung abscess
Pneumonia in immunocompromised
patients
Patients receiving immunosupressive drugs
and those with diseases causing defects of
cellular or humoral immune mechanisms

Gram negative bacteria; pseudomonas

aeruginosa
Clinical features
Fever
Cough
Breathlessness

Infiltrations on chest x-ray