Pneumonia

Definition
Pneumonia is an inflammation of the pulmonary parenchyma,
distal from the terminal bronchioles that include the respiratory
bronchioles, and the alveoli, and leads to consolidation of lung
tissue and local gas exchange disturbances caused by
microorganisms (bacteria, viruses, fungi, protozoa).
Clasification
1. By its nature:
a. Primary pneumonia, that is, pneumonia is affected in people
who do not have certain risk factors.
b. Secondary pneumonia, which occurs in people with
predisposing factors.
Clasification
2. Based on the cause germs:
a. Bacterial pneumonia / typical
b. Atypical pneumonia
c. Viral pneumonia
d. Mushroom pneumonia
Clasification
3. Clinically and epidemiologically based
a. Community-acquired pneumonia (CAP)
b. Hospital-acquired Pneumonia (HAP)
c. Aspiration pneumonia
Epidemiology
• The mortality rate in the UK is about 5-10%.
• By age, more are found in children.
• In the United States pneumonia reaches 13% of respiratory
infections in children under 2 years.
• UNICEF estimates that 3 million children worldwide die from
pneumonia every year.
Etiology
• Pneumonia can be caused by various kinds of microorganisms
ie bacteria, viruses, fungi, protozoa, which are mostly caused by
bacteria.
• The most common cause of pneumonia is the gram-positive
bacteria, Streptococcus pneumonia.
• The most common cause of pneumonia virus is respiratory
syncytial virus (RSV), parainfluenza virus, influenza virus and
adenovirus.
Pathophysiology
There are four anatomic stages of pneumonia divided into:
1. Stadium Kongesti
2. Stadium Red Hepatisasi
3. Gray Hepatization Stadium
4. Final Stage (Resolution)
Clinical Manifestations
• Major Symptoms:
a. Cough
b. Sputum productive
c. Fever (temperature> 38c)
• Minor Symptoms:
a. hard to breathe
b. chest pain
c. pulmonary consolidation on physical examination
d. leukocyte count> 12,000
Diagnosis
1. On physical examination:
• chest look part of the sick left behind breathing time
• on palpation fremitus may harden
• on dim percussion
• in auscultation, the sound of bronchovesikuler breath to
bronchial is sometimes weakened. It may be accompanied by a
fine ronkhi, which then becomes rough wet ronkhi at the stage
of resolution.
Diagnosis
• 2. Supporting investigation :
• Laboratory examination
• Radiological examination
• Examination of blood cultures
• Sputum examination
• Serological examination
Differential Diagnosis
• Tb
• Atelectasis
• Pleural effusion
Management
• antibiotics
• general supportive therapy
• replacement therapy
Complications
• pleural effusion
• Empyema
• systemic complications
• Hypoxemia
• lung abscess
• chronic pneumonia
• bronchiectasis
Prognosis
The prognosis of pneumonia is generally favorable if antibiotic
therapy is adequate, patient predisposing factors and presence
or absence of complications.