Pneumonia is the accumulation of secretions and inflammatory cells in the alveolar spaces within the lungs caused by infection. The infecting organism, the inflammatory response and the disturbances of gas exchange caused by alveolar involvement are responsible for the clinical manifestations.
Pneumonia can be classified as community acquired, nosocomial (hospital acquired), or pneumonia in patients with underlying damaged lung, or in immunocompromised patients.
Community-acquired pneumonia spread by droplet infection.
Nosocomial pneumonia or hospital-acquired pneumonia is the pneumonia occurring in patients at least two days after admission to the hospital.
Factors predispose to pneumonia.
X Cigarette smoking
X Old age
X Alcohol
X Upper respiratory infection
X Preexisting lung disease
X Recent influenza infection
Causes
1) Bacterial- streptococcus pneumonia, microplasma pneumonia, chlamydia pneumonia, gram-negative pathogens and Staphylococcus aureus
2) Primary atypical:
a) Viral: psittacosis, respiratory Syncytial virus, measles and influenza, cytomegalovirus, herpes zoster, adenovirus
b) Rickettsial -Coxiella burnetti
c) Mycoplasmal- mycoplasma pneumoniae
3) Protozoa-entameoba histolytica
4) Yeast and fungi- actinomycosis, aspergillosis, nocardiosis, histoplasmosis
5) Chemical pneumonias
a) Aspiration of vomit
b) Dysphagic pneumonia caused by pharyngeal diverticulum, achlasia cardia or hiatus hernia
c) Lipoid pneumonia: kerosene, paraffin, petroleum.
d) Toxic gases and smokes:
6) Radiation pneumonia
BASED ON THE ANATOMICAL PART OF THE LUNG PARENCHYMA INVOLVED.
Pneumonia can be classified as.
1)LOBAR PNEUMONIA: It occurs due to acute bacterial infection of a part of a lobe or complete lobe.
2)BRONCHO PNEUMONIA:acute bacterial infection of terminal bronchioles.
3)INTERSTITIAL PNEUMONIA:this is mainly confined to the interstitial tissue within the lung.
CLINICAL FEATURES:
SYMPTOMS:
General symptoms:
X Malaise
X Fever, rigors
X Night sweats
X Vomiting
In the elderly, confusion and disorientation.
Pulmonary symptoms:
X Dyspnoea
X Cough and sputum which is often blood stained and rusty and difficult to expectorate.
Pleural symptoms:
X Pain aggravated by cough deep breath or movement Usually localized tothe site of inflammation.
SIGNS:
General: patient appears ill with tachycardia, rapid respiratory rate, high fever, dry skin, herpes labialis, confusion, and hypotension.
Pulmonary:
a)Early signs:slight impairment of the percussion knots over the affected area, with weakness of breath sounds or possibly harshness with prolonged expiration and fine crackles on deep inspiration or after cough.
b)Signs of consolidation on 2nd or 3rd day
c)Resolution:most signs disappear by the end of 2nd week. But fine crackles and impairment of the percussion notes may be found longer.
INVESTIGATION
Routine investigation:
A- blood test-
a) White cell count marginally raised or may even be normal.
b) Neutrophil leucocytosis in bacterial etiology
c) C-reactive protein-CRP – typically elevated
B-Sputum culture
C-Blood culture
D-Chest x-ray
E-Microbiological investigations
Homeopathic remedies for pneumonia-
Antim ars, veratrum viride, Phos, Pulsatilla, Antimtart,etc.
