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PULMONARY INFECTIONS (PNEUMONIA (TYPES (LOBAR PNEUMONIA
Most Common…
PULMONARY INFECTIONS
PNEUMONIA
FEATURES
- AN INFECTION OF THE LUNG PARENCHYMA
- OCCURS WHEN NORMAL DEFENCES ARE IMPAIRED
- COUGH REFLEX
- MUCOCILLIARY ESCALATOR
STRATIFY RISK
CURB 65%
- CONFUSION
- UREA
- RESP RATE > 30
- sBP < 92-94
- AGE > 65
- O2 SAT
PRESENTATION
HISTORY
- COUGH
- TACHYPNOEA
- FEVER
- PLEURITIC CHEST PAIN
EXAMINATION
- DECREASED BREATH SOUNDS
- DULLNESS TO PERCUSSION
INVESTIGATION
- ELEVATED INFLAMMATORY MARKERS
- CXR
TYPES
LOBAR PNEUMONIA
- Most Common Cause of CAP
- Consolidation of Entire Lobe
- Usually Bacterial
- S. pneumo 95%
- Kleb. pneumo 5%
FOUR CLASSIC PHASES
- 1) Congestion
- 2) Red Hepatisation
- 3) Grey Hepatisation
- 4) Reolution
- Type 2 pneumocyte
- Regeneration of lining of Alveolar air sacs
BRONCHOPNEUMONIA
- Scattered, patchy consolidation centered around bronchioles
- Often multifocal & bilateral
- Bacterial infection
- S. aureus
- Hib
- pseud
- Moraxella
- Legionella
INTERSTITIAL PNEUMONIA
- Diffuse interstitial infiltrate
- Relatively mild URTI
- Low grade fever
- min. sputum
- cough
- Biopsy: empty air sacs
- Atypical bugs
- Mycoplasma pneumo
- Chlamydia pneumo
- RSV, CMV, Flu, Coxiella
ASPIRATION PNEUMONIA
- Px @ Risk of Aspiration
- Classically in R lower lobe
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DIAGNOSIS
- SPUTUM GRAM STAIN
- CULTURES
- CXR
TUBERCULOSIS
- Inhalation of aerosolised Mycobacterium TB (MTB)
1°
- Focal caseating necrosis:
- Lower lobe
- Hilar lymph node
- Foci undergo fibrosis & calcification
- Generally asymptomatic
- Leads to +ve PPD (skin test)
2°
- Commonly assoc. c AIDS
- Occurs @ apex of lung
- Forms cavitary foci of caseous necrosis
- May lead to Miliary TB
CLINICAL FEATURES
- Night sweats
- Cough -> haempptysis
- Wt. loss
** FIRST PRIMARY TB IS OFTEN
ASYMPTOMATIC
SPREAD LOCATIONS
- Meninges
- Kidney
- Vertebrae
BIOPSY
- Caseating granulomas
- RED Acid fast bacilli (AFB)