Pneumonia

What is Pneumonia :  

Is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli. Typical signs and symptoms include a varying severity and combination of productive or dry cough, chest pain, fever, and trouble breathing, depending on the underlying cause. its usually caused by infection with viruses or bacteria and less commonly by other microorganisms.

Clinical manifestations :

  • Fever 

  • Rigors 

  • Chills 

  • Headache 

  • Dry cough then mucoid sputum , maybe there is streaks of blood 

  • Chest pain ( stabbing)

  • Dyspnea 

  • Tachycardia 

  • Tachypnea 

  • Central cyanosis 

  • By percussion : there is dullness

  • By auscultation : crepitation , bronchial breathing 

Complications :

  • Pleural effusion 

  • Lung abscess 

  • Pneumothorax 

  • Sepsis ( encephalitis – endocarditis – arthritis – hepatitis ) 

  • Collapse of the lung 

  • Convulsions – confusion 

  • Acute respiratory distress syndrome 

Deferential Diagnosis : 

  • Bronchogenic carcinoma 

  • Pulmonary edema 

  • SLE 

Investigations :

  • Culture 

  • Serological 

  • Blood picture ( increase WBCs)

  • Increase ESR 

  • ABG ( hypoxia – normocapnea or hypocapnea)

  • X-ray : homogenous opacity ( lobar pneumonia or bronchopneumonia)

  • CT 

Treatment : 

  1. Penicillin , ampicillin , cephalosporins

  2. For mycoplasma and other microorganisms : erythromycin and tetracyclin 

Bronchopneumonia 

Causes :

  • In most cases it occurs because of descends (which is going down) infection of the bronchi in an acute bronchitis.  Inflammatory foci in different sizes are formed in the lung parenchym, which contain purulent exudates when there are bacterial causal 

  • Bronchopneumonia can also be secondary (complication of some other disease):
    • Viral infection (influenza, measles)
    • Aspiration of food or vomiting
    • Obstruction of bronchus with foreign body, neoplasm and others.
    • Inhalation of poisonous gases
    • Major surgery
    • Severe chronic diseases (tuberculosis), malnutrition

Manifestations :

  • fever

  • cough that brings up mucus

  • shortness of breath

  • chest pain

  • rapid breathing

  • sweating

  • chills

  • headache

  • muscle aches

  • fatigue

  • confusion or delirium, especially in older people

investigations :

  • A computed tomography (CT) scan produces a picture similar to an X-ray but in more detail. 

  • A sputum culture tests a sample of mucus from lungs to determine the cause of the infection.

  • A bronchoscopy involves putting a camera down throat to look at your bronchial tubes. This can be done to determine if there are other factors causing bronchopneumonia.

  • Finally, a pulse oximetry. measures the amount of oxygen in your blood. The results of this test can tell the extent or severity of the infection and its effect on ability to absorb oxygen.

Treatment :

Viral bronchopneumonia normally does not require medical treatment and improves on its own in one to two weeks. Antivirals can help reduce the length of your illness and the severity of your symptoms.

If bacterial bronchopneumonia, antibiotics to destroy the bacteria causing the infection. Most people feel better within one to three days after starting antibiotics. However, it is important that you finish your entire course of antibiotics to prevent the infection from returning.

a fever reducer or cough medication for both viral and bacterial bronchopneumonia. These medications can help relieve your symptoms, but will not cure you.

Home treatment can also help relieve symptoms. Home treatment includes:

  • rest

  • drinking plenty of warm fluids

  • using a humidifier

  • drinking plenty of water

Admission to the hospital if have the following criteria :

  • the age over 65

  • breathing is rapid

  • blood pressure drops

  • become confused

  • need breathing assistance

  • Hospital treatment may include intravenous (IV) antibiotics. If blood oxygen levels are low, may be given oxygen therapy to help return blood oxygen levels to normal.

By Dr. Mustafa Aljubbawy



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