Pneumonia

                         PNEUMONIA 

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus, causing symptoms such as cough with phlegm or pus, fever, chills, and difficulty breathing. It can range from mild to life-threatening and is especially serious for infants, young children, the elderly, and people with weakened immune systems.

1. Classification of Pneumonia

Pneumonia can be classified based on different criteria:

A. Based on Where It Was Acquired

  • Community-Acquired Pneumonia (CAP):
    • Acquired outside healthcare settings.
  • Hospital-Acquired Pneumonia (HAP):
    • Occurs 48 hours or more after hospital admission.
  • Ventilator-Associated Pneumonia (VAP):
    • Occurs in people on mechanical ventilation.
  • Healthcare-Associated Pneumonia (HCAP):
    • In non-hospitalized patients with extensive healthcare contact.

B. Based on Causative Organism

  • Bacterial Pneumonia:
    • Commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, or Staphylococcus aureus.
  • Viral Pneumonia:
    • Caused by influenza, RSV, SARS-CoV-2, etc.
  • Fungal Pneumonia:
    • Seen in immunocompromised individuals; caused by Histoplasma, Cryptococcus, etc.
  • Atypical Pneumonia:
    • Caused by organisms like Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Legionella pneumophila.

C. Based on Radiologic Pattern

  • Lobar Pneumonia:
    • Affects a large and continuous area of a lobe of the lung.
  • Bronchopneumonia:
    • Patchy inflammation in both lungs.
  • Interstitial Pneumonia:
    • Involves the areas in between the alveoli.

2. Causes of Pneumonia

  • Bacteria: Streptococcus pneumoniae (most common), Haemophilus influenzae, Mycoplasma pneumoniae
  • Viruses: Influenza virus, SARS-CoV-2, RSV, adenovirus
  • Fungi: Pneumocystis jirovecii, Histoplasma capsulatum, Cryptococcus
  • Parasites: Rarely, such as Toxoplasma gondii

Risk factors include smoking, chronic diseases (COPD, diabetes), immunosuppression, recent surgery, and age extremes.

3. Diagnosis of Pneumonia

  • History and Physical Examination:

    • Symptoms: cough, fever, shortness of breath, chest pain.
    • Signs: crackles, decreased breath sounds, egophony.

  • Investigations:

    • Chest X-ray: Confirms presence, location, and extent.
    • Blood Tests: CBC, CRP, blood cultures.
    • Sputum Analysis: Gram stain, culture, PCR.
    • Pulse Oximetry/ABG: To assess oxygenation.
    • CT Scan: For complicated or unclear cases.
    • Urine Antigen Tests: For Legionella or Streptococcus pneumoniae.

4. Treatment of Pneumonia

Treatment depends on severity, cause, and patient factors.

A. General Measures

  • Rest, fluids, oxygen if hypoxic
  • Hospitalization if severe or with risk factors

B. Antibiotics (for Bacterial Pneumonia)

  • Outpatient CAP:
    • Macrolide (azithromycin) or doxycycline
  • Inpatient Non-ICU CAP:
    • Beta-lactam (e.g., ceftriaxone) + macrolide or respiratory fluoroquinolone
  • ICU CAP:
    • Beta-lactam + macrolide or fluoroquinolone
  • HAP/VAP:
    • Broad-spectrum antibiotics (e.g., piperacillin-tazobactam, vancomycin) tailored to local resistance

C. Antivirals (if viral cause)

  • Oseltamivir for influenza
  • Supportive care for viral pneumonia unless complications

D. Antifungals (if fungal cause)

  • Amphotericin B, fluconazole, or others based on the pathogen

5. Prevention of Pneumonia

  • Vaccinations:
    • Pneumococcal vaccine
    • Influenza vaccine
    • COVID-19 vaccine
  • Hand hygiene and avoiding smoking
  • Managing chronic diseases properly 

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