Infection Pneumonia

Infection Pneumonia

Pathology:                   Inflammationof the lung parenchyma as a result of an infection. Community acquired (CAP) orhospital acquired (HAP) developing 48hrs after admission  


Aetiology:                     Certaingroups are at increased risk of pneumonia: diabetics, COPD, previoussplenectomy, underlying cardiorespiratory disease, elderly and HIV patients.


Common Causes of CAP                      Common Causes of HAP

Streptococcus Pneumonia                      Gram Negative Bacteria

Haemophilus Influenza                           Staphylococcus Aureus

Mycoplasma Pneumonia                         Streptococcus Pneumonia


Symptoms:                  Pleuriticpain, productive cough, rigors and shortness of breath.

AtypicalPneumonias cause atypical symptoms.

Mycoplasma:Erythema multiforme (‘target lesions’), erythema nodosum and DIC. Legionella: Flu-like symptoms. Urinetested for antigen


Signs:                              Pyrexia,dyspnea, tachypnoea, confusion, cough with purulent sputum. Auscultation mayreveal crackles and bronchial breathing. A dull percussion note may be present


Investigations:          Chest X-Ray: Consolidation andpotentially pleural effusions

Bloods: FBC, U&E, CRP and liver function tests,ABG, blood cultures.

Sputum culture and gram stain: Suspected cases of TB - Acid Fast Bacilli.

Urine antigen: Pneumococcal (moderate to highseverity), legionella (high severity)

Bronchoscopy: in persistent cases post course ofantibiotics


Treatment:                  Oxygen: Aim for oxygen saturations of94-98%

IV Fluids: Fluid balance should be assessed andsupplemented as required

IV/PO Antibiotics: Amoxicillin for non-severe, Tazocin for SeverePneumonia.  

                                      Legionella Pneumonia - Clarithromycin & Rifampicin


Text Box: 	CURB-65 Score For Community Acquired Pneumonia

Urea >7mmol/L
Respiratory Rate >30/min
Blood Pressure <90 systolic or <60 diastolic
65 – ≥65 years 

CURB-65 Score 0-1: <3% mortality – Home Treatment
CURB-65 Score 2: 9% mortality – Hospital Admission
CURB-65 Score 3-5: 15-40% mortality – Urgent Admission













Complications:          Septicaemia, para-pneumonic effusions, empyemaand cavity  formation


Prognosis:                   Dependenton CURB-65 Score.

Postdischarge, patients should have a follow up Chest X-Ray at 6 weeks










Figure 2.1 Right lowerlobe pneumonia

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