Pneumonia

1. PNEUMONIA

2. •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“.

3. • 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.

4. 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.

5. 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.

6. 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 pneumophilia and staphylococcus aureus.

7. 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.

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

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

10. Mycoplasmal Pneumonia (also known as
'walking pneumonia')
•It is similar to bacterial pneumonia, whereby
the mycoplasmas proliferate and spread -
causing infection.

11. 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.

12. 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.

13. 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.

15. 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

16. 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.

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

18. 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

19. 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.

20. 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"

21. 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 the pleural
space, causing a rub heard by auscultation, and it may lead to
resolution or to organization and pleural adhesions"

22. 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.

23. 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.

24. 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 blood-stained as the
pneumonia progresses.

25. 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

26. 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

27. 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.

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

29. 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

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