Pneumonic consolidations

Pneumonia

It is an acute inflammation of the lung tissue characterized by alveolar filling, caused by variety of causes and most consistent cause is infection. It occurs in patients with normal as well as diseased lung. It is used to be classified according to radiological features as well as the infective agents. More useful classification is the one with reference to clinical situation.

Classification

1. Community acquired pneumonia

2. Hospital acquired pneumonia

3. Aspiration and aerobic pneumonias

4. Pneumonia in immune compromised host

5. AIDS related

6. Geographically restricted pneumonias

7. Recurrent pneumonia

Clinical features

Symptoms

-Male affected more 2-3:1 than female

-Fever, malaise, anorexia, and headache

-Preceding URTI in viral and mycoplasma infection

-Cough, chest pain, pleural pain

-Sputum usually mucoid, scanty or absent initially

-Purulence occurs later

-Pain abdomen, rigidity ileus in LL pneumonia

Signs

-Flushing with tachypnea and tachycardia

-Herpes labiales in pneumoccal pneumonia

-Chest movement restricted on side of lesion

-Inspiratory crackles are the most consistent finding

-Pleural rub may be present

-Rash in atypical pneumonias

Investigations

General

-Leucocytosis with neutrophilia

-Atypical infection occurs with normal count

-Cold agglutinin in mycoplasma

-Changed liver function and renal function

Specific

-Sputum microscopy with ideal sputum: buccal squamous epithelium <10/lpf

->25 leucocytes/lpf, or leucocyte to squamous cell ratio >5 adequate sputum

-Gram stain: Acid fast stain

-Induction of sputum: 20ml of 5% saline nebulized at high flow rate

Sputum immunodetection

-Pneumococcal antigen detection

-Legionella by direct immunoflorescent antibody test (DFAT)

-Also for Clamydia detection

-These tests are not altered by prior Antibiotics

Sputum Culture

-Not very yielding as they are contaminated by oropharyngeal flora

-Prior antibiotics alter the result

Management

General measures:

- Bed rest

-Adequate hydration

-Relief of fever and chest pain with analgesics

-Assessment of severity and admission if severe

Out patient treatment

-Penicillin, ampicillin or amoxycillin remains drug of choice (500mg 8hrly for 7-10days) for young adults.

-In older patients with preexisting disease Amoxyclav or amoxy and Doxy

-Another choice is Azithro- or Clarithro- mycin

-In atypical presentation Doxy or Macrolide

-Anaerobes with clinda (300 8hrly) with amoxyclav

In patientTreatment

-Injectable second and third generation cephalosporins

-Injectable B lactamase stable penicillin

-Flucloxacillin if staph infection suspected

-Treatment for 7-10 days, if cavitation treats for 3-4 weeks

Complications

-Pleural effusion and empyema

-Cavitation and abscess formation

-Bronchial obstruction

-Spread to distant sites and development of sepsis

-Resistance to antibiotics

-Late formation of localized bronchiectasis or fibrosis