"Pneumonia"

Pneumonia

Pneumonia is an inflammation of lungs followed by the accumulation of blood cells, fibrin and exudates in the alveoli. The effected part of the lungs becomes consolidated.

Introduction:

The term pneumonia includes any inflammation condition of lungs in which some or all alveoli are filled with fluid and blood cells. A common type of pneumonia is bacterial pneumonia caused by most frequently pneumococci. In pneumonia the gas exchange functions of the lungs change in different stages of the disease. In early stages the pneumonia process might be well localized to only one lung with alveolar ventilation reduced, while blood flow through the lungs continues normally. This results in two abnormalities

  • Reduction in total surface area of respiratory membrane
  • Decrease ventilation perfusion ratio. Both these condition caused hypoxia and hypercapnia

Causes

  1. Bacterial or viral infection
  2. Inhaling noxious chemical substances

 Epidemiology

  Pneumonia is responsible for one sixth of all death in the United States. Defects in innate immunity and humeral immunodeficiency typically lead to an increased incidence of infection with pyogenic bacteria. On the other hand cell mediated immune defects leads to increased infection with intracellular microbes such as mycobacteria and herpesvirses as well as with microorganism of low virulence such as pneumocystis carini.

An estimated 2 to 3 million people in USA develop pneumonia each year and out which about 45,000 die. Bacteria is the most common cause of pneumonia in adults > 30 year.

Signs and symptoms:"Pneumonia"

 Fever:

 Febrile reaction results in raise in temp up to 38 degree centigrade

 Cynosis

 Due to decrease oxygen in the blood

 Compression of chest and chest pain

 Due to consolidation means lungs or alveoli are filled with fluid and cellular debris.

Purulent sputum

 (Sputum containing pus)Due to inflammation and accumulation of dead leukocytes (pus)

Cough

 Symptom of an acute lower respiratory tract illness eg coughs due to inflammation and irritation of mucus

 Tachypnoea

 (Excessive breathing) due to decrease oxygen supply

Diagnostic tests:

Pneumonia is a multi etiological, if recurrent this through up certain diagnostic possibilities that must be considered Are important such as travel history, occupation, pet keeping hobbies.etc.

  Established diagnose

  •  Cxp (CT chest)
  •  Serology (atypical pneumonia organism)
  • Sputum test (including induced sputum bronchoscopy and BAL; microscopy and culture)
  • Blood cultures
  • HIV test
  • Alter blood gases

Ultrasound of chest (pulmonary function test)

Treatment:

Below is the treatment depending upon the condition of patient.

Acute exacerbations of chronic bronchitis:

  • Amoxicillin (500mg after every 8 hr, for 5 days)
  • Side effect (anemia, liver problem, jaundice, colitis)
  • Tetracycline (100 mg every 12 hr)
  • Side effects (angioodema, inflammation of tounge, photosensitivity)

Low or moderate severity community acquired pneumonia:

  • Amoxicillin
  • Doxycyclinine (7 day or 14 days)
  • Side effect (angiodema, inflammation of tongue)

High severity community acquired pneumonia of unknown etiology:

  • Co_amoxiclav (500mg every 8hr)
  • Side effects (nausea, vomiting, skin rash)
  • Clarithomycin (250-500mg, B.D, 5_10 days)
  • Side effects (abdominal pain)
  • Cefiroxime (250_500mg, B.D, 5_10 days)
  • Side effects (kidney, liver problems.jundice)

Pneumonia possibly caused by atypical pathogenesis:

  • Calithromycine

Hospital acquired pneumonia:

  • Co_amoxiclav
  • Cefuroxime

Pneumococcal vaccine:

Following are two different type of vaccination prescribed against pneumonia.

Pmeumococcal polysaccharide vaccine:

  •  Brand name: Pneumovax 11(sanofi)
  • Injection: I.M OR subcutaneously (5 ml adult and child above 2 year)

Pneumococcal polysaccharide conjugate vaccine:

  • Brand name: Prevanar (Wyeth)
  • Injection: I.M (2 month_ 5 year child 5_ 10 ml)

References:

  • Centers for Disease Control and Prevention. Recommended adult immunization schedule–United States, 2012.MMWR. 2012;61(4)
  • Limper AH. Overview of pneumonia. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 97.
  • Niederman M. In the clinic. Community-acquired pneumonia. Ann Intern Med. 2009;151(7).
  • Torres A, Menandez R, Wunderink R. Pyogenic bacterial pneumonia and lung abscess. In: Mason RJ, Broaddus VC, Martin TR, et al. Murray & Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 32.
  • Robbins Basic Pathology (8th edition) by Vinay Kuma, Abul K Abbas

Compiled by:

  1. Rizwan sattar (Pharm D)
  2. Asma ayub (Pharm D)

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