Pneumonia

 

It is an inflammation of lung parenchyma, usually caused by bacteria and characterized by cough, productive sputum and fever.

 

  1. Classification

 

a)      on the basis of site of involvement

  • lobar pneumonia
  • bronchopneumonia
  • interstitial pneumonia

b)      on the basis of etiology

  • bacterial
  • viral
  • allergic
  • atypical
  • secondary pneumonia (aspiration pneumonia)

 

Etiology

 

Precipitating factor are upper respiratory tract infection, cigarette smoking. Alcohol, bronchial obstruction, immunosuppression and IV drug abuse.

 

Exciting factors

a)      bacteria

  • streptococcus pneumonia
  • staphylococcus aureus
  • Haemophilus influenza
  • klebsiella pneumonia
  • mycoplasma pneumonia

b)      viral

  • respiratory syncytial virus
  • Para influenza virus
  • rhino virus

 

Clinical features

 

Clinical features of the pneumonia vary with the immune state of the patient.

 

Symptoms

 

i)                    history of upper respiratory tract infections

ii)                   high grade fever

iii)                 headache, malaise, vomiting

iv)                 cheat pain

v)                  cough (productive)

vi)                 rusty sputum

 

Sign

 

i)                    patient look ill

ii)                   rapid pulse and shallow respiration

iii)                 chest movement less on affected side

iv)                 pleural rub and crepitation

v)                  signs of consolidation

vi)                 dull note on affected side

 

Investigation

 

i)                    Blood cp shows increased ESR, W.B.C.

ii)                   sputum culture for sensitivity to isolate the organism

iii)                 X-Ray chest may show homogenous opacity localized to affected side.

iv)                 Blood culture and sensitivity on fever spike

 

Management

 

  1. Antibiotics

Antimicrobial drug should be given according to the results of the culture and sensitivity which include

    • Ampicilllin 500 mg Q.I.D
    • Co-trimoxazole(septran DS ) 500 mg B.D
    • Erythromycin 500 mg Q.I.D

If patient is seriously ill then above drug regime should administered I.V.

 

  1. Analgesics
  • Inj pathedine 50-100 mg IM
  • Tab dolobid 1 bd
  • Tab ponstan 2 T.D.S

 

  1. Antitussive
  • Codeine tincture if unproductive cough
  • Expectorant (syp. Hydrylin) if productive cough.
  1. physiotherapy
  • to encourage the cough out sputum

 

Complications of pneumonia

 

Lung

 

  • Lung abscess
  • Pleural effusion
  • Pulmonary fibrosis
  • Empyema

 

CVS

 

  • Septic shock
  • Pericarditis
  • Endocarditis
  • Myocarditis

 

Joints

  • Septic arthritis

 

CNS

  • Meningitis

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