|Video: Pneumonia Overview|
Overview Pneumonia is infection in the lower respiratory tract and is characterised by fevers, purulent sputum, leucocytosis, low oxygen levels and new lung infiltrates (consolidation) on radiographic imaging. The infection is identified by the site of consolidation. Consolidation is where the lung tissue is filled with fluid (ie. water, blood, pus, microbes). Types of pneumonia include lobar pneumonia (infection affects a whole lobe of a lung) and bronchopneumonia (affects the bronchioles through out a lung lobe).
Classification by location acquired
- Community Acquired Pneumonia (CAP)
- Hospital Acquired Pneumonia (HAP) also known as Nosocomial Pneumonia
- Ventilator associated pneumonia
|Remember Hospital acquired pneumonia is lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization|
Classification by microorganism
- Typical bacterial pneumonia
- Atypical bacterial pneumonia
Classification by lung involvement
- Lobar pneumonia
- Pleural Pneumonia
- Elderly >65yo
- Recent travel
- Antibiotics use
- Recent respiratory tract infection
- Underlying respiratory disease (cystic fibrosis)
Signs and Symptoms
|Cardinal symptoms: Cough (productive), Dyspnoea, Pleuritic chest pain, Fever.|
Examination findings include signs of consolidation on affect side and lobe
- Decreased chest expansion on affected side
- Dullness on percussion
- Bronchial breath sounds and whispering pectoriloquy +/- crackles/rales on site of consolidation
- +/- increase vocal fremitus and resonance
|S. pneumoniae||H. influenzae||S. aureus||M. pneumoniae||M. catarrhalis||Gram – Enterobacteriae||Klebsiella spp.||Legionalla spp.|
Management depends on where the pneumonia was acquired and what the causative agent is or might be. The standard is antibiotic therapy.
Assessment of severity
There are scoring criteria’s that exists to help identify whether a patient should be admitted to hospital. These include PSI and CURB-65 (CORB-65)
Some patients with mild illness, good social circumstances and no significant co-morbidities may be safely discharges with oral antibiotics, simple analgesia for pleuritic chest pain and follow up with doctors.
For patients with a high severity score (CURB-65 or SMART-COP or PSI index) admission to hospital is advised with commencement of IV antibiotics.