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Pneumonia
Clinical Features: A) Depending on Route of Infection:-
By Inhalation Initially respiratorycomplaints followed by ConstitutionalSymptoms. Cough,Expectoration:initially mucoid then purulent &mucopurulent, sometimes bloodtinged.
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By Hematogenous Route: --Initially constitutional follwed by repiratorysymptoms.
Fever , Arthralgia , MyalgiaAbdominal Pain, Vomiting ,Loose-motion.
Pneumonia
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Pneumonia
B)Depending upon Type Of Pneumonia:-
1) Typical Community Acquired P. :--
Short History,Cough with Expectoration,Pleuritic Chest Pain(over affected lobe),Hemoptysis,
Fever usually High grade withChills & Rigors.
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Pneumonia
2) Atypical Pneumonia :Subacute presentation-indolent course.Dry Cough,
if Productive cough- sputum is scanty &mucoid,Low grade fever,Loss of appetite,
Malaise,Signs of Anaemia.
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Pneumonia
3)Aspiration Pneumonia :-History of Aspiration,Chronic Cough,
Low grade fever,Breathlessness,Sputum is Foul Smelling,Anorexia,
Weight Loss.
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Pneumonia Clinical Findings:
Patient: presents withSweating,Dehydration,
Ill Look,Fever,Tachypnoea,Tachycardia,
Breathing- shallow,Rapid
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Pneumonia Systemic Exam :-Over Affected Area
Respiratory Movements Decrease. No Mediastinal Displacement,
Tactile Vocal Fremitus Increases, PERCUSSION:
Mild Tenderness,Impaired note,
Flat note- if Synpneumonic Effusion .
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Pneumonia
AUSCULTATION:Initially -- vesicular sounds decrease inintensity, Early inspiratory crackles.Later -- High pitched Bronchial breathing,
coarse crepitations,aegophony,whisperingpectoriloquy,increased vocal resonance,pleural rub,other signs of complications ifpresent.
Pulm.Function: mild restrictive effect,decrease in VC , FEV.
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Investigations Pneumonia:
Sputum Microscopy: Gram stain & otherspecific stains. Sputum Culture: Limitations contamination
by oropharyngeal flora.
Blood Culture: +ve in 20-30 percent cases Counter-immuno-electrophoresis (C.I.E)
on blood,urine,sputum to detect pneumo-coccal antigen,
Serological Tests- for specific organisms-mycoplasma, legionella.
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Pleural Fluid- to exclude empyema.Biochemical,microbiological,cytological ex-amination.
Bronchoscopy,TTNA,Trans-bronchial lung
biopsy -- more invasive when other testsNON-CONCLUSIVE.
Chest-X-ray: Homogenous/Nonhomogenousopacity,Air-bronchogram.
Localisation: Silhoutte sign,Lateral chest x ray.
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Inv: CXR Radiographic response to Treatment :
Usually lags behind clinical response. Various Patterns -Confluent lobar : Strep.pneumoniae.Cavitation; Necritizing pneumonia -
stap. ,gram neg. organisms.Bulging Fissures: Klebsiella,PTB. Etc.Miliary pattern- MTB, Viral, H.capsulatumPneumatoceles: S.aureus,S.pyogenes,
Kleb.pneumoniae.Cavities:M.TB,Anaerobes,Fungal pneum.
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Investigations Pneumonia :
Blood Gas Analysis (A.B.G): Hypoxaemia. Routine H'gram- PMNs Leukocytosis, if
severe sepsis- Leukopenia.
Cold Agglutinins Mycoplasma. Gas Liquid Chromatography- Anaerobic
organisms.
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Complications of Pneumonia Pleural Effusion- Exudate,small-self limited Empyema. Pericarditis-Persistent fever,chest pain,
pericardial rub, cxr: cardiomegaly. Septicaemia. Meningitis. Infective Endocarditis. Jaundice -- Hepatocellular injury or
hemolysis in G-6PD Deficiency. Pumonary Oedema or A.R.D.S. S.I.A.D.H,Rhabdomyolysis, Pneumothorax
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