PNEUMONIA

Pneumonia is defined as "inflammation

of the lung caused by bacteria, in
which the air sacs (alveoli) become
filled with inflammatory cells and the
lungs become solid.

 Pneumonia is "a severe form of acute lower

respiratory infection that specifically affects
the lungs".
During a Pneumonia infection, the alveoli of
one or both lungs fill up with pus or fluid.
This increases the work of breathing, and
thus gaseous exchange cannot occur as it
normally would.

Types of Pneumonia
Aspiration Pneumonia
Aspiration Pneumonia results when food, drink,
vomit, secretions or other foreign material is
inhaled and causes an inflammatory response in
the lungs and bronchial tubes.
Aspiration Pneumonia occurs predominantly in the
right lung because its total capacity is greater than
that of the left lung.

Atypical Pneumonia
This term refers of Pneumonia caused by
the following bacteria: Legionella
pneumophila, Mycoplasma pneumoniae,
and Chlamydophila pneumoniae.
Atypical pneumonia is caused by bacteria
and does not respond to the normal
antibiotics used for treatment.

Bacterial Pneumonia
Bacterial Pneumonia occurs when
pneumonia-causing bacteria masses and
multiplies in the lungs.
The alveoli become inflamed and pus is
produced, which spreads around the lungs.
The bacteria that caused Bacterial
Pneumonia are: streptococcus pneumonia,
hemophilus influenza, legionella

Bronchial Pneumonia
Bronchopneumonia is a descending
infection starting around the bronchi and
bronchioles.
The terminal bronchioles become blocked
with exudates and form consolidated
patches. This results in atelectasis.

Community-acquired
Pneumonia
This means the infection was
acquired at home.
With this type of pneumonia the most
common cause is 'Streptococcus
Pneumonia.

Hospital-acquired
Pneumonia
Patients develop features after being
in hospital for 24 hours or longer
Infectious agent is often Gramnegative bacteria such as
'Escherichia coli or Klebsiella.

Mycoplasmal Pneumonia
(also known as 'walking
pneumonia')

It is similar to bacterial pneumonia,

whereby the mycoplasmas proliferate
and spread - causing infection.

Pneumocystis carinii Pneumonia

Pneumocystis carinii pneumonia is the result of
a fungal infection in the lungs caused by the
Pneumocystis carinii fungus.
This fungus does not cause illness in healthy
individuals, but rather in those with a
weakened immune system.

Ventilator Associated Pneumonia

(VAP)
This type of pneumonia usually occurs two
days after a hospitalised patient has been
intubated and been receiving mechanical
ventilation.
This is especially a life-threatening infection as
patients who require mechanical support are
already critically ill.

Viral Pneumonia
Viral Pneumonia is believed to be the
cause of half of all pneumonias. The
viruses invade the lungs and then
multiply- causing inflammation.

Risk factors
flu
cancer
AIDS
heart disease
diabetes
asthma
chronic bronchitis
emphysema
chronic obstructive pulmonary disease
brochiectasis
immunosuppressive disorders and therapy
debility or stroke
coma
problems with swallowing
alcoholism
intravenous drug abuse

Risk factors
The elderly, infants and young children are more at risk
of contracting community-acquired pneumonia than
young and middle-aged adults.
Frequent exposure to cigarette smoke increases the risk
of developing Pneumonia.

Stages of Pneumonia
Pneumonia has four stages, namely
1. consolidation,
2. red hepatization,
3. grey hepatization
4. resolution.

Stage of Consolidation
Occurs in the first 24 hours
Cellular exudates containing neutrophils,
lymphocytes and fibrin replaces the alveolar air
Capillaries in the surrounding alveolar walls
become congested
The infections spreads to the hilum and pleura
fairly rapidly
Pleurisy occurs
Marked by coughing and deep breathing

Stage of Red Hepatization

Occurs in the 2-3 days after consolidation
At this point the consistency of the lungs
resembles that of the liver
The lungs become hypeaemic
Alveolar capillaries are engorged with blood
Fibrinous exudates fill the alveoli
This stage is "characterized by the presence of
many erythrocytes, neutrophils, desquamated
epithelial cells, and fibrin within the alveoli.

Stage of Grey Hepatization

Occurs in the 2-3 days after Red Hepatization
This is an avascular stage
The lung appears "gray-brown to yellow because
of fibrinopurulent exudates, disintegration of red
cells, and hemosiderin"
The pressure of the exudates in the alveoli
causes compression of the capillaries
"Leukocytes migrate into the congested alveoli"

Stage of Resolution
This stage is characterized by the "resorption and
restoration of the pulmonary architecture"
A large number of macrophages enter the
alveolar spaces
Phagocytosis of the bacteria-laden leucocytes
occurs
"Consolidation tissue re-aerates and the fluid
infiltrate causes sputum"
"Fibrinous inflammation may extend to and across

SEGMENTS AFFECTED FROM

PNEUMONIA
a) BRONCHIAL PNEUMONIA it involves the terminal bronchial
and alveoli.
b) LOBAR PNEUMONIA It involves one or more entire lobes.
c) SEGMENTAL PNEUMONIA It involves the a segment of lobes.
d) BILATERAL PNEUMONIA It affects the lobes in both lungs.
e) INTERSTITIAL PNEUMONIA It is also called reticular
pneumonia. It involves inflammatory response within the lung
tissues surrounding the airspaces.

f) ALVEOLAR PNEUMONIA It is also acinar pneumonia. There is

fluid accumulation in a lung distal air spaces.

g) NECROTIZING PNEUMONIA : it causes the death of a portion

of lung tissues. X ray examination reveal cavity at the formation at
the site of necrosis. Necrotic lung tissue ,which does not heal
constitutes a permanent loss of functioning parenchyma.

SIGNS AND SYMPTOMS

Initially symptoms are similar to that of a cold followed
by:
a high fever (pyrexia)
chills
a productive cough
Sputum may be discoloured and may become bloodstained as the pneumonia progresses.

SIGNS AND SYMPTOMS

dyspnoea
sharp chest pain
worsening cough
headaches
malaise
muscle pains
cyanosis due to poorly oxygenated blood
loss of appetite
rapid breathing
wheezing or grunting during breathing
intercostal muscle recession during breathing
vomiting

DIAGNOSIS
Physical examination
crackles and wheezing may be heard while auscultating

Chest X-ray
usually done to confirm the diagnosis. The X-ray will show
decreased lung expansion and opacity on the affected side.

Sputum samples and blood tests

MEDICAL MANAGEMENT
Bacterial Pneumonia can be treated with penicillin
and/or antibiotics
Viral Pneumonia cannot be treated with antibiotics, as
they have no effect. This type of pneumonia normally
resolves over time.
Mycoplasma Pneumonia is usually treated with
antifungals.

MEDICAL MANAGEMENT
Bed rest
Breathing exercises
Analgesic administration
Cough suppressant medication
Antipyretics
Oxygen therapy (when indicated)

Physiotherapy Management
Modified postural drainage - this allows gravity to drain
secretions from specific segments of the lungs
Vibration - to mobilize secretions
Coughing and huffing exercises - to expectorate
secretions
Administer humidification - to mobilize secretions
Breathing exercises - Localized and Diaphragmatic
IPPB administration - to increase lung volumes
Mobilization of the patient - done to increase air entry,
increase chest expansion, and to loosen secretions

COMPLICATIONS
Pleural effusion
Empyema
Lung abscess
Bacteremia
Septicemia
Meningitis
Septic arthritis
Endocarditis or pericarditis