logging in or signing up COMMUNITY ACQUIRED PNEUMONIA dranishjoshi Download Post to : URL : Related Presentations : Let's Connect Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 9613 Category: Education License: All Rights Reserved Like it (4) Dislike it (0) Added: December 01, 2008 This Presentation is Public Favorites: 5 Presentation Description No description available. Comments Posting comment... By: drbibhashgogoi (53 month(s) ago) nice presentation Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript COMMUNITY ACQUIRED PNEUMONIA : COMMUNITY ACQUIRED PNEUMONIA Dr. MAULIK SHAH ICU REGISTRAR CRITICAL CARE DEPT. Pneumonia : Pneumonia Definition : It is defined as the infection of lung parenchyma. Types : CAP (Community acquired pneumonia) HAP (Hospital acquired pneumonia) VAP (Ventilator associated pneumonia) PNEUMONIA : PNEUMONIA CAP ETIOLOGY : ETIOLOGY Agent Factors Typical pathogens : Streptococcus pneumoniae Haemophilus influenza S. aureus GNB – Klebsiella Pneumoniae Pseudomonas aeruginosa Slide 5: Atypical pathogens : Chlamydiaophila pneumoniae Mycoplasma pneumoniae Legionella spp. Respiratory viruses – Influenza Adeno RSV Slide 6: Rare pathogens : Fungi Protozoa New viruses - Hantavirus Metapneumovirus Coronavirus (SARS) Changing trends : MDR strains of GNB and CA – MRSA can cause necrotising pneumonia HOST FACTORS : HOST FACTORS Breach of mechanical or immunological defences makes a host susceptible to infection POSSIBLE ETIOLOGICAL AGENT ACCORDING TO SUSCEPTIBILITY : POSSIBLE ETIOLOGICAL AGENT ACCORDING TO SUSCEPTIBILITY Alcoholism - Klebsiella pneumoniae, oral anaerobes,S Pneumoniae, M. Tb COPD and/or Smoking – H. influenza, Moraxella catarrhalis,Pseudomonas, S. Pneumoniae Structural lung disease – Pseudomonas aeruginosa,Burkholderia cepacia,S. aureus Decreased level of consciousness – Oral anaerobes, gram neg bacilli Slide 9: Exposure to birds – Chlamydia psittaci H. capsulatum Stay in hotel or on cruise ship in previous 2 weeks – Legionella PATHOPHYSIOLOGY : PATHOPHYSIOLOGY Host defences trigger inflammatory response which lead to clinical syndrome of pneumonia Inflammatory mediators from macrophages and neutrophils create alveolar capillary leak equivalent to that seen in ARDS. PATHOLOGY : PATHOLOGY Intact immunity or typical pathogen– Localisation of infection and so lobar pneumonia pattern 4 Stages : Edema Red Hepatization-Erythrocytes Gray Hepatization-neutrophils Resolution-Macrophages Immunocompromised or atypical pathogens- Bronchopneumonia pattern CLINICAL MANIFESTATIONS : CLINICAL MANIFESTATIONS CAP can vary from mild diseases to fatal in severity Symptoms : Cough, dyspnea, chestpain if parietal pleura involved Others : Fever, constitutional symptoms Signs DIAGNOSIS : DIAGNOSIS Clinical Radiological Etiological : Gram stain and culture of sputum Blood cultures Antigen tests PCR Serology DIFFERENTIAL DIAGNOSIS : DIFFERENTIAL DIAGNOSIS Acute exacerbation of COPD Heart Failure Pulmonary embolism Radiation Pneumonitis Acute Bronchitis TREATMENT : TREATMENT Principles : Decide according to severity whether the patient is a candidate for outpatient or inhospital treatment Try to cover organism as per local epidemiological pattern Keep in mind the drug resistance patterns IV drugs when hospitalised Cover for pseudomonas and MRSA when suspected Inhospital/Outpatient treatment decided as per PSI/CURB-65 criteria : Inhospital/Outpatient treatment decided as per PSI/CURB-65 criteria PSI (Pneumonia Severity Index) variables : 20 in number CURB variables : C-Confusion U-Urea(>7 mmols) R-Respiratory rate (>30) B-Blood pressure (<90 sys or <60 diastolic) Slide 18: Outpatient treatment – PSI class 1&2 CURB score 0 Inhospital treatment – PSI class 4&5 CURB score >2 ANTIBIOTIC GROUPS : ANTIBIOTIC GROUPS Macrolides-Covers atypical org. but DRSP cases ineffective B-Lactams-No atypical coverage but DRSP cases effective Fluroquinolones-Less resistance and covers both Aminoglycosides-Add on drug for pseudomonas Drugs for MRSA Slide 21: Bacteremic Pneumococcal Pneumonia – Dual therapy preferred Definitive Treatment : Definitive Treatment What if organism isolated sensitive to Penicillins and we have started with B lactum+Macrolide or Fluroquinolones What if no response and drug resistant to FQ+Macrolides+Penicillins (MDR) DURATION OF THERAPY : DURATION OF THERAPY Uncomplicated CAP : 5-day course suffices Bacteremic CAP/Virulent organism – 10-14 days Response to treatment in otherwise uncomplicated CAP: : Response to treatment in otherwise uncomplicated CAP: Fever- Falls in 2 days Leucocytosis-decreases in 4 days Physical findings persist slightly longer Chest radiographic abnormalities may take 4-12 weeks to resolve What if patient fails to improve? : What if patient fails to improve? Consider – Noninfectious condition Resistance to drug Superinfection with new nosocomial pathogen COMPLICATIONS : COMPLICATIONS Seen usually when MDR pathogens present Respiratory Failure Shock and Multiorgan failure with DIC Metastatic infection Lung Abscess Complicated pleural effusion PROGNOSIS : PROGNOSIS Depends on – Age Presence of co-morbidities Site of treatment PREVENTION : PREVENTION Immunocompromised/Susceptible –Vaccination Community outbreak – Chemoprophylaxis+Vaccination Slide 29: I hope I was not boring !!!!! You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
COMMUNITY ACQUIRED PNEUMONIA dranishjoshi Download Post to : URL : Related Presentations : Let's Connect Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 9613 Category: Education License: All Rights Reserved Like it (4) Dislike it (0) Added: December 01, 2008 This Presentation is Public Favorites: 5 Presentation Description No description available. Comments Posting comment... By: drbibhashgogoi (53 month(s) ago) nice presentation Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript COMMUNITY ACQUIRED PNEUMONIA : COMMUNITY ACQUIRED PNEUMONIA Dr. MAULIK SHAH ICU REGISTRAR CRITICAL CARE DEPT. Pneumonia : Pneumonia Definition : It is defined as the infection of lung parenchyma. Types : CAP (Community acquired pneumonia) HAP (Hospital acquired pneumonia) VAP (Ventilator associated pneumonia) PNEUMONIA : PNEUMONIA CAP ETIOLOGY : ETIOLOGY Agent Factors Typical pathogens : Streptococcus pneumoniae Haemophilus influenza S. aureus GNB – Klebsiella Pneumoniae Pseudomonas aeruginosa Slide 5: Atypical pathogens : Chlamydiaophila pneumoniae Mycoplasma pneumoniae Legionella spp. Respiratory viruses – Influenza Adeno RSV Slide 6: Rare pathogens : Fungi Protozoa New viruses - Hantavirus Metapneumovirus Coronavirus (SARS) Changing trends : MDR strains of GNB and CA – MRSA can cause necrotising pneumonia HOST FACTORS : HOST FACTORS Breach of mechanical or immunological defences makes a host susceptible to infection POSSIBLE ETIOLOGICAL AGENT ACCORDING TO SUSCEPTIBILITY : POSSIBLE ETIOLOGICAL AGENT ACCORDING TO SUSCEPTIBILITY Alcoholism - Klebsiella pneumoniae, oral anaerobes,S Pneumoniae, M. Tb COPD and/or Smoking – H. influenza, Moraxella catarrhalis,Pseudomonas, S. Pneumoniae Structural lung disease – Pseudomonas aeruginosa,Burkholderia cepacia,S. aureus Decreased level of consciousness – Oral anaerobes, gram neg bacilli Slide 9: Exposure to birds – Chlamydia psittaci H. capsulatum Stay in hotel or on cruise ship in previous 2 weeks – Legionella PATHOPHYSIOLOGY : PATHOPHYSIOLOGY Host defences trigger inflammatory response which lead to clinical syndrome of pneumonia Inflammatory mediators from macrophages and neutrophils create alveolar capillary leak equivalent to that seen in ARDS. PATHOLOGY : PATHOLOGY Intact immunity or typical pathogen– Localisation of infection and so lobar pneumonia pattern 4 Stages : Edema Red Hepatization-Erythrocytes Gray Hepatization-neutrophils Resolution-Macrophages Immunocompromised or atypical pathogens- Bronchopneumonia pattern CLINICAL MANIFESTATIONS : CLINICAL MANIFESTATIONS CAP can vary from mild diseases to fatal in severity Symptoms : Cough, dyspnea, chestpain if parietal pleura involved Others : Fever, constitutional symptoms Signs DIAGNOSIS : DIAGNOSIS Clinical Radiological Etiological : Gram stain and culture of sputum Blood cultures Antigen tests PCR Serology DIFFERENTIAL DIAGNOSIS : DIFFERENTIAL DIAGNOSIS Acute exacerbation of COPD Heart Failure Pulmonary embolism Radiation Pneumonitis Acute Bronchitis TREATMENT : TREATMENT Principles : Decide according to severity whether the patient is a candidate for outpatient or inhospital treatment Try to cover organism as per local epidemiological pattern Keep in mind the drug resistance patterns IV drugs when hospitalised Cover for pseudomonas and MRSA when suspected Inhospital/Outpatient treatment decided as per PSI/CURB-65 criteria : Inhospital/Outpatient treatment decided as per PSI/CURB-65 criteria PSI (Pneumonia Severity Index) variables : 20 in number CURB variables : C-Confusion U-Urea(>7 mmols) R-Respiratory rate (>30) B-Blood pressure (<90 sys or <60 diastolic) Slide 18: Outpatient treatment – PSI class 1&2 CURB score 0 Inhospital treatment – PSI class 4&5 CURB score >2 ANTIBIOTIC GROUPS : ANTIBIOTIC GROUPS Macrolides-Covers atypical org. but DRSP cases ineffective B-Lactams-No atypical coverage but DRSP cases effective Fluroquinolones-Less resistance and covers both Aminoglycosides-Add on drug for pseudomonas Drugs for MRSA Slide 21: Bacteremic Pneumococcal Pneumonia – Dual therapy preferred Definitive Treatment : Definitive Treatment What if organism isolated sensitive to Penicillins and we have started with B lactum+Macrolide or Fluroquinolones What if no response and drug resistant to FQ+Macrolides+Penicillins (MDR) DURATION OF THERAPY : DURATION OF THERAPY Uncomplicated CAP : 5-day course suffices Bacteremic CAP/Virulent organism – 10-14 days Response to treatment in otherwise uncomplicated CAP: : Response to treatment in otherwise uncomplicated CAP: Fever- Falls in 2 days Leucocytosis-decreases in 4 days Physical findings persist slightly longer Chest radiographic abnormalities may take 4-12 weeks to resolve What if patient fails to improve? : What if patient fails to improve? Consider – Noninfectious condition Resistance to drug Superinfection with new nosocomial pathogen COMPLICATIONS : COMPLICATIONS Seen usually when MDR pathogens present Respiratory Failure Shock and Multiorgan failure with DIC Metastatic infection Lung Abscess Complicated pleural effusion PROGNOSIS : PROGNOSIS Depends on – Age Presence of co-morbidities Site of treatment PREVENTION : PREVENTION Immunocompromised/Susceptible –Vaccination Community outbreak – Chemoprophylaxis+Vaccination Slide 29: I hope I was not boring !!!!!