Pneumonia презентация

ATYPICAL PNEUMONIA:
BRONCHOPNEUMONIA: INFLAMMATION OF THE LUNG THAT IS CENTERED IN THE BRONCHIOLES AND LEADS TO THE PRODUCTION OF A MUCOPURULENT EXUDATE THAT OBSTRUCTS SOME OF THESE SMALL AIRWAYS AND CAUSES PATCHY CONSOLIDATION OF THE ADJACENT LOBULES
INTERSTITIAL PNEUMONITIS: INFLAMMATION OF INTERSTITIUM – WALLS OF THE ALVEOLI, THE ALVEOLAR SACS AND DUCTS AND THE BRONCHIOLES

ETIOLOGIC AGENTS AND EMPIRICAL ANTIBIOTIC THERAPY FOR COMMUNITY ACQUIRED PNEUMONIA
NEONATES: GBS, GR (-), STREP. PNEUMONIAE, HAEMOPHILUS
TREATMENT: AMPICILLIN + GENTAMYCIN (OR CEFOTAXIME) + ANTISTAPHYLOCOCCAL AGENT IF STAPH AUREUS IS SUSPECTED
1-3 MONTH: RSV, OTHER RESPIRATORY VIRUSES, S. PNEUMONIAE, H. INFLUENZAE
TREATMENT: CEFUROXIME OF CEFOTAXIME OR CEFTRIAXONE + OXACILLIN
AFEBRILE PNEUMONIA: CHLAMIDYA TRACHOMATIS, MYCOPLASMA HOMINIS, UREAPLASMA UREALYTICUM, CMV
TREATMENT: ERYTHROMYCIN, AZITROMYCIN OR CLARITHROMYCIN

3-12 MONTH: RSV, OTHER RESPIRATORY VIRUSES, S.PNEUMONIAE, H. INFLUENZAE, CHLAMYDIA TRACHOMATIS, MYCOPLASMA PNEUMONIAE, STREP GR A
TREATMENT:
OUTPATIENT: AMOXICILLIN, ERYTHROMYCIN, AZITHROMYCIN
HOSPITAL: AMPICILLIN OR CEFUROXIME
SEVERELY ILL: CEFTRIAXONE + ERYTHROMYCIN
2-5 YEARS: RESPIRATORY VIRUSES, S. PNEUMONIAE, H. INFLUENZAE, M. PNEUMONIAE, CHLAMYDIA PNEUMONIAE, S. AUREUS, GR A STREP
TREATMENT:
OUTPATIENT: AMOXICILLIN, ERYTHROMYCIN, AZITHROMYCIN
HOSPITAL: AMPICILLIN OR CEFUROXIME
SEVERELY ILL: CEFTRIAXONE + ERYTHRO

5-18 YEARS: M. PNEUMONIAE, S. PNEUMONIAE, CHLAMYDIA PNEUMONIAE, H. INFLUENZA, RESPIRATORY VIRUSES
TREATMENT:
OUTPATIENT: MACROLIDES
HOSPITAL: MACROLIDES WITH AMPICILLIN
SEVERELY ILL: CEFTRIAXON + MACROLIDES

CLINICAL PATTERN OF PNEUMONIA

LABORATORY AND IMAGING
WBC
BLOOD CULTURE- POSITIVE IN 10-20% OF PATIENTS
SEVERELY ILL PATIENTS WITH RECCURENT PNEUMONIA, OR PNEUMONIA UNRESPONSIVE TO EMPIRICAL THERAPY- BRONCHOSCOPY WITH BRONCHOALVEOLAR LAVAGE FOR MICROBIOLOGICAL DIAGNOSES
EMPYEMA- THORACOCENTESIS
X- RAY
US
CT

DIFFERENTIAL DIAGNOSIS
PULMONARY EDEMA (CARDIOGENIC AND NON- CARDIOGENIC)
ALLERGIC PNEUMONITIS
ASPIRATION
LUNG CONTUSION
HEMORRHAGE
FOREIGN BODY

DIFFERENTIAL DIAGNOSIS OF RECCURENT PNEUMONIA
HEREDITARY DISORDERS
CF
SICKLE CELL DISEASE
DISORDERS OF IMMUNITY
AIDS
BRUTON AGLOBULINEMIA
SELECTIVE IGG SUBCLASS DEFICIENCIES
COMMON VARIABLE IMMUNODEFICIENCY
SCID
DISORDERS OF LEUKOCYTES
CGD
HYPER IGE (JOB) SYNDROME
LAD

DISORDERS OF CILIA
IMMOTILE CILIA SYNDROME
KARTAGENER SYNDROME
ANATOMIC DISORDERS
SEQUESTRATION
LOBAR EMPHYSEMA
GE REFLUX
FOREIGN BODY
T-E FISTULA
BRONCHIECTASIS
ASPIRATION (OROPHARYNGEAL INCOORDINATION)
ASTHMA

TREATMENT
SUPPORTIVE TREATMENT
SPECIFIC TREATMENT
EMPIRICAL ANTIBIOTIC TREATMENT

COMPLICATIONS
PARAPNEUMONIC EFFUSION
EMPYEMA
PNEUMATOCELE
BRONCHIECTASIS
LUNG ABSCESS

STRIDOR
STRIDOR IS A HARSH, HIGH PITCHED RESPIRATORY SOUND
PRODUCED BY TURBULENT AIRFLOW THAT IS USUALLY
INSPIRATORY, BUT MAY BE BIPHASIC; IT IS A SIGN OF UPPER
AIRWAY OBSTRUCTION

DIFFERENTIAL DIAGNOSIS OF STRIDOR
INFECTIONS
ACUTE (VIRAL) LARYNGOTRACHEOBRONCHITIS
PARAPHARYNGEAL ABSCESS
EPIGLOTTITIS
BACTERIAL TRACHEITIS
PHARYNGITIS
LARYNGOPHARYNGEAL DIPHTERIA
LARYNGEAL PAPILLOMATOSIS
EXTRINSIC INFLAMMATORY MASS COMPRESSING THE TRACHEA (E.G. TUBERCULOSIS)

NONINFECTION CONDITIONS
SPASMODIC CROUP
ANGIONEUROTIC EDEMA
FOREIGN BODY ASPIRATION
INGESTION OF CAUSTICS OR HOT FLUID
TRAUMA, SMOKE INHALATION
LARYNGOMALACIA
CONGENITAL SUBGLOTTIC STENOSIS
EXTRINSIC MASS COMPRESSING THE TRACHEA (VASCULAR MALFORMATION, HEMANGIOMA, CYSTIC HYGROMA)
VOCAL CORD PARALYSIS
HYPOCALCEMIA

AGE RELATED DIFFERENTIAL DIAGNOSIS
INFANCY
LARYNGOMALACIA
SUBGLOTTIC STENOSIS (CONGENITAL, ACQUIRED AFTER INTUBATION)
HEMANGIOMA
VASCULAR RING
TODDLERS
VIRAL CROUP
SPASMODIC (RECCURENT CROUP)
FOREIGN BODY
LARYNGEAL PAPILLOMATOSIS
BACTERIAL TRACHEITIS
DIPHTHERIA

2-3 YEARS AND OLDER
VIRAL CROUP
SPASMODIC CROUP
INHALATION INJURY
FOREIN BODY
ANAPHYLAXIS
ANGIOEDEMA
TRAUMA

CLINICAL MANIFESTATIONS
HARSH (BARKING) COUGH
LABORED BREATHING, SUPRASTERNAL, INTERCOSTAL, SUBCOSTAL RETRACTIONS
± WHEEZING
± FEVER
± TOXICITY
± DROOLING