bacterial pneumonia sung chul hwang, m.d. dept. of pulmonary and critical care medicine ajou...
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Bacterial Pneumonia
Sung Chul Hwang, M.D.
Dept. of Pulmonary and Critical Care Medicine
Ajou University School of Medicine
Epidemiology
• 6th leading cause of death in U.S.• Number one Among the infectious disea
ses• 4 million patients annually in US• Incidence 12/1,000/year• Mortality in OPD patients 1-5 %, but Inp
atients 25%, ICU 50-60%
Definition
• Pneumonia is the inflammation of lower respiratory tracts including alveoli, interstitial tissues, and broncioles by the microorganisms, chemical irritations or by an immunological process
Classifications & Terminology
• Community Acquired Pneumonia Nosocomial Pneumonia Ventilator Associated Pneumionia• Mild, moderate, severe • Bacterial, viral, fungal, parasitic• Primary vs. Secondary• Immune compromised vs. Normal immunity• Lobar vs interstitial• Typical vs. Atypical
Severe Community Acquired Pneumonia
• Respiratory rate > 30/min• PaO2/FiO2 ratio < 250mmHg• Need for Mechanical Ventilation• Diffuse bilateral involvement or multiple lobes,
incresing infiltration > 50% within 48 hours• B.P. < 90systolic or 60 mmHg diastolic• Need for vasopressors• Renal failure
Mycoplasma Pneumonia
Mycoplasma Pneumonia
Mycoplasma Pneumonia
Streptococcal Pneumonia
Streptococcus pneumoniae
Gram + Diplococci
Streptococcal Pneumonia
Streptococcal Pneumonia
Staphylococcus aureus
BAL Fluid
Staphylococcal Pneumonia
Pneumatocele
Staphylococcal Pneumonia
Staphylococcal Pneumonia
Staphylococcal Pneumonia
Osler’s Node
Pseudomonas Pneumonia
Pseudomonas Pneumonia
Pseudomonas Pneumonia
Ecthyma gangrenosum
Immunofluorescent Ab Test
RSV Antigen Detection
Legionella Pneumonia
Legionella Pneumonia
Legionella pneumophila by Silver impregnation Stain
Pneumonia in COPD
CMV Inclusion in BAL
Sputum Gram Stain
Treatment of CAP <60yrs/OPD/no Comorbid conditions
• Pathogens : S. pneumoniae, Mycoplasma& Chlamydia pne
umoniae, H. indfluenzae, RSV, Legionella, S. aureus
• Treatment : 2nd Generation Cephalosporin + Macrolide or Q
uinolone monotherapy
Treatment of CAP >60yrs/OPD/with Comorbid conditions
• Pathogens : S. pneumoniae, RSV, H. indfluenzae, Gram (-)
rod, S. aureus, Morexella catarrhalis, Legionella spp.
• Treatment : 2nd Generation Cephalosporin + TMX/SFX, or
beta lactam/betalactam inhibitor + Macrolide
Treatment of Severe CAP
• Pathogens : S. pneumoniae, Legionella spp. Gram (-)
rod, Mycoplasma,H. indfluenzae,S. aureus • Treatment : 3rd Generation Cephalosporin with anti-Pseud
omonal activity or + other anti Pseudomonal agent (Imipenem/quinolone) + Macrolide
Aspiration Pneumonia
Aspiration Pneumonia
Lipoid Pneumonia
Lipoid Pneumonia