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https://upload.medbullets.com/topic/117037/images/pneumonias.jpg
https://upload.medbullets.com/topic/117037/images/pneumonia.jpg
Snap Shot
  • A 77-year-old man is brought in by EMS after waking up in the middle of the night covered in sweat, with a high fever, and a coughing up yellow sputum. A chest xray is shown.
Introduction
  • Definition 
    • infection of lung parenchyma that usually occurs in defined lobar patterns, though may also present more diffusely
    • Clinically defined as fever, cough and new infiltrate on CXR
  • Pathophysiology
    • See Microbiology of Pneumonia topic 
  • Risk factors
    • impaired cough reflex 
    • damage to respiratory cilia
    • mucus plugs
Classification
  • Classic patterns include
    • lobar
      • intra-alveolar exudate which consolidates
      • may involve entire lung or be confined to 1 lobe
      • 4 stages  
    • brochopnuemonia
      • acute inflammatory infiltrates from bronchioles into adjacent alveoli
      • patchy distribution
      • involves ≥ 1 lobes
    • interstitial
      • diffuse patchy inflammation localized to interstitial areas of alveolar walls
      • distribution involving ≥ 1 lobes
      • generally less severe than lobar or bronchopneumonia
Presentation
  • Symptoms
    • classically presents with sudden-onset of
      • fever
      • productive cough
        • purulent yellow-green
        • hemoptysis
      • dyspnea
      • night sweats
      • pleuritic chest pain
    • atypical presentations are gradual in onset and flu-like
      • dry cough
      • headaches
      • myalgias
      • sore throat
  • Physical exam
    • auscultation of the lungs reveals
      • decreased or bronchial breath sounds
      • crackles/rales
      • wheezing
      • E-to-A egophany
        • with consolidation
    • percussion reveals
      • dullness over affected lobe(s)
      • tactile fremitus
        • increased with consolidation
        • decreased with pleural effusion
Evaluation
  • CXR
    • may show lung opacification/consolidation in affected lobe(s)
    • establishes diagnosis in combination with Gram stain or culture
  • CBC
    • elevated WBC count
  • Sputum Gram stain and cultures
    • identify pathogen
    • directs antimicrobial therapy
Treatment
  • Pharmacologic
    • empiric antibiotics directed at most likely pathogens (depends on clinical scenario)
    • organism-specific antibiotics if organism identified
 

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