Pneumo

nia
Samuel efraim runtulalo
0961050202

Definition
Pneumonia dalam arti umum adalah
peradangan parenkim paru yang
disebabkan oleh MO (bakteri, virus,
jamur, parasit) namun pneumonia
juga dapat disebavkan oleh bahan
kimia ataupun karena paparan fisik
seperti suhu atau radiasi.
Peradangan prenkim paru yang
disebabkan oleh penyebab selain MO
(fisik, kimia, alergi) sering disebut

Classification
Klasifikasi pneumonia dapat berdasarkan;
Anatomi
Etiologi
Gejala klinik
Lingkungan

Berdasarkan anatomi :
Segmen
Lobus: bronkus dan bronkiolus sering disebut
bronkopneumonia

 Menurut gejala kliniknya

Pneumonia klasik : batuk produktif
Pneumonia atipik : batuk nonproduktif, terjadi pada jaringan
interstisial, jadi tidak menimbulkan
eksudat

Menurut lingkungan kejadian :

Community acquired pneumonia
Hospital acquired pneumonia
Immunocompromised pneumonia

 MO lain penyebab CAP adalah :

Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis
Staphylococcus aureus
Klebsiella pneumoniae
Pseudomonas aeruginosa
Legionella pneumophila

 Haemophilus influenzae is a pleomorphic, gram-negative

organism that is a major cause of life-threatening acute lower
respiratory tract infections and meningitis in young children.
In adults it is a very common cause of community-acquired
acute pneumonia. This bacterium is a ubiquitous colonizer of
the pharynx, where it exists in two forms: encapsulated (5%)
and unencapsulated (95%).
Typically, the encapsulated form dominates the
unencapsulated forms by secreting an antibiotic called
haemocin that kills the unencapsulated H. influenzae.
Although there are six serotypes of the encapsulated form
(types a to f), type b, which has a polyribosephosphate
capsule, used to be the most frequent cause of severe
invasive disease.
With routine use of H. influenzae conjugate vaccines, the
incidence of disease caused by the b serotype has declined
significantly. By contrast, infections with nonencapsulated
forms are increasing. Also called nontypeable forms, they
spread along the surface of the upper respiratory tract and
produce otitis media (infection of the middle ear), sinusitis,
and bronchopneumonia.

Streptococcus
pneumoniae/pneumococcus,
The most common cause of community-acquired acute
pneumonia.
The presence of numerous neutrophils containing the
typical gram-positive, lancet-shaped diplococci
supports the diagnosis of pneumococcal pneumonia,
but it must be remembered that S. pneumoniae is a
part of the endogenous flora in 20% of adults
Therefore false-positive results may be obtained.
Isolation of pneumococcifrom blood cultures is more
specific but less sensitive (in the early phase of illness,
only 20% to 30% of patients have positive blood
cultures).
Pneumococcal vaccines containing capsular
polysaccharides from the common serotypes are used
in patients at high risk.

Moraxella catarrhalis
Moraxella catarrhalis is being
increasingly recognized as a cause
of bacterial pneumonia, especially in
the elderly. It is the second most
common bacterial cause of acute
exacerbation of COPD. Along with S.
pneumoniae and H. influenzae, M.
catarrhalis constitutes one of the
three most common causes of otitis
media in children.

Staphylococcus aureus
Staphylococcus aureus is an important cause
of secondary bacterial pneumonia in children
and healthy adults following viral respiratory
illnesses (e.g., measles in children and
influenza in both children and adults).
Staphylococcal pneumonia is associated with a
high incidence of complications, such as lung
abscess and empyema. Intravenous drug
abusers are at high risk of developing
staphylococcal pneumonia in association with
endocarditis. It is also an important cause of
hospital-acquired pneumonia, as will be
discussed later.

 This occurs when protective

processes fail to prevent inhaled or
blood-borne microbes reaching and
colonising the lungs. The following
are some predisposing factors.

Distribution of infected tissue in:

A. Bronchopneumonia. B. Lobar
pneumonia.

Robbins and Cotran Pathologic Basis of Disease

Eighth Edition

Bronchopneumonia.
Gross section of lung
showing patches of

Lobar pneumoniagray
hepatization, gross
photograph. The lower lobe is

Impaired coughing.
The effectiveness of coughing as an aid to
the removal of infected mucus may be
reduced when the individual is unconscious
or by damage to:
sensory nerve endings in the walls of the
respiratory passages
the cough reflex centre in the medulla oblongata
nerves to the respiratory passages, lungs and
muscles of respiration
the diaphragm and intercostal muscle

Focused assessment in suspected

community-acquired pneumonia (CAP)

Urgent investigation in suspected

community-acquired pneumonia
(CAP)
Chest X-ray

Liver function tests

Arterial blood gases and pH

(if oxygen saturation is <92%
or there are clinical features of
severe pneumonia)

Urine stick test

Sputum culture (in CAP if

severe, or if non-severe and no
prior antibiotic therapy)
Blood culture (2)
Full blood count
C-reactive protein
Blood glucose
Sodium, potassium,
creatinine and urea

Urine for pneumococcal antigen

in all severe CAP and in nonsevere CAP if antibiotic therapy
has been started before
admission
Urine for Legionella antigen in
all severe CAP or if clinical
suspicion of Legionella is high
Blood for Mycoplasma serology
in all severe CAP or if clinical
suspicion of Mycoplasma is high
(acute/convalescent samples
needed)

Features to look for on the chest Xray in suspected pneumonia

Feature

Comment

Focal shadowing

Required to make the diagnosis of

pneumonia, but may initially be
absent in patients who are severely
neutropenic or hypovolemic, and in
early Pneumocystis carinii (jiroveci)
pneumonia

Pleural effusion

If present, aspirate a sample and

send for Gram stain and culture

Cavitation

Particularly associated with

tuberculosis and Staphylococcus
aureus infection, but may also occur
in Gram-negative and anaerobic
infections

Pneumothorax

May occur in cavitating

pneumonias and is particularly
Acute medicine,a practicalassociated
guide to the
management
medical
with
P. carinii of
(jiroveci)

Differential diagnosis of suspected

pneumonia
Pulmonary vascular
disorder:
Pulmonary embolism
Pulmonary edema

Neoplastic disorders :

Bronchial carcinoma
Alveolar cell carcinoma
Lymphoma

Other disorders :
Drug toxicity (e.g.
amiodarone pneumonitis)
Subdiaphragmatic
abscess

Immune-mediated
disorders:
Wegener granulomatosis
Diffuse alveolar
hemorrhage in pulmonary
renal syndromes
Systemic lupus
erythematosus
Sarcoidosis
Acute interstitial
pneumonia
Eosinophilic pneumonia
syndromes
Bronchiolitis obliterans
organizing pneumonia

hospital- acquired
pneumonia

Acute medicine,a practical guide to the management of medical

emergencies. 4th ed.