BRONCHOPNEUMONIA PATHOPHYSIOLOGY PDF

Bronchopneumonia is a type of pneumonia, a condition that causes inflammation of the lungs. Symptoms can range from mild to severe and may include coughing, breathing difficulties, and fever. Causes include bacterial, viral, or fungal chest infections. According to the Centers for Disease Control and Prevention CDC , pneumonia is responsible for around 51, deaths each year in the United States, with the majority of these cases being in adults aged 65 years old or more. In this article, we look at what bronchopneumonia is, along with its symptoms, causes, and treatment. We also cover prevention.

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In industrialized nations, it is the leading infectious cause of death. Pneumonia is most commonly transmitted via aspiration of airborne pathogens primarily bacteria, but also viruses and fungi but may also result from the aspiration of stomach contents. The most likely causal pathogens can be narrowed down based on patient age, immune status, and where the infection was acquired community-acquired or hospital-acquired.

Pneumonia is classified based on clinical features as either typical and atypical; each type has its own spectrum of commonly associated pathogens. Typical pneumonia manifests with sudden onset of malaise , fever , and a productive cough. On auscultation, crackles and bronchial breath sounds are audible. Atypical pneumonia manifests with gradual onset of unproductive cough , dyspnea , and extrapulmonary manifestations. Auscultation is usually unremarkable.

Some patients may present with elements of both types. Diagnostics include blood tests for inflammatory parameters and pathogen detection in blood, urine , or sputum samples.

Chest x-ray in cases of typical pneumonia shows opacity restricted to one lobe, while x-ray in atypical pneumonia may show diffuse, often subtle infiltrates. Together with the characteristic clinical features, newly developed pulmonary infiltrate on chest x-ray confirms the diagnosis. Management consists of empiric antibiotic treatment and supportive measures e.

References: [1] [2] [3]. Pneumonia can be classified according to etiology, location acquired, clinical features, and the area of the lung affected by the pathology. References: [6] [7].

References: [9]. Typical pneumonia is characterized by a sudden onset of symptoms caused by lobar infiltration. Suspect bacterial pneumonia in immunocompromised patients with acute high fever and pleural effusion!

Atypical pneumonia typically has an indolent course slow onset and commonly manifests with extrapulmonary symptoms. As it is not always possible to clearly distinguish between typical and atypical pneumonia , this classification does not have a major impact on patient management. References: [10] [11] [8] [12] [13]. Pneumonia is a clinical diagnosis based on history, physical examination, laboratory findings, and CXR findings.

Consider microbiological studies and advanced diagnostics based on patient history, comorbidities, severity, and entity of pneumonia. Severe CAP. A new pulmonary infiltrate on chest x-ray in a patient with classic symptoms of pneumonia confirms the diagnosis. Typical pneumonia usually appears as lobar pneumonia on x-ray , while atypical pneumonia tends to appear as interstitial pneumonia.

However, the underlying pathogen cannot be conclusively identified based on imaging results alone. Every patient should be assessed individually and clinical judgment is the most important factor.

They have not been validated for determining the necessity for ICU admission. Previously healthy patients without comorbidities or risk factors for resistant pathogens. Patients with comorbidities or risk factors for resistant pathogens. Risk factors for Pseudomonas aeruginosa. Risk factors for MRSA. Patients not at high risk for mortality and without risk factors for MRSA infection.

Patients not at high risk for mortality but with risk factors for MRSA infection. Patients at high risk for mortality.

Patients with structural lung disease e. References: [24]. References: [25] [26] [27] [28]. We list the most important complications.

The selection is not exhaustive. References: [29] [30]. References: [31] [32]. References: [33] [34] [35]. Panlobar pneumonia involves all the lobes of a single lung. In the case of a large unilateral pulmonary abscess , it may be helpful to position the patient so that the affected lung is in the dependent position in order to prevent pus from filling the unaffected lung.

Pattern of involvement Lobar pneumonia Classic typical pneumonia of an entire lobe ; primarily caused by pneumococci Characterized by inflammatory intra-alveolar exudate , resulting in consolidation Can involve the entire lobe or the whole lung Stages Macroscopic findings Microscopic findings Congestion day 1—2 Parenchymal partial consolidation Red-purple Alveolar lumens with serous exudate , bacteria , and rare inflammatory cells Red hepatization day 3—4 Parenchymal consolidation Red-brown Dry and firm Liver —like consistency Reversible Alveolar lumens with exudate rich in fibrin , bacteria, erythrocytes , and inflammatory cells Alveolar walls thickened Gray hepatization day 5—7 Uniformly gray Liver —like consistency Alveolar lumens with suppurative exudate neutrophils and macrophages Erythrocytes and most bacteria have been degraded.

Alveolar walls thickened Resolution day 8 to week 4 Gradual aeration of the affected segment Enzymatic fibrinolysis Macrophages remove the suppurative exudate. Often has an indolent course walking pneumonia Miliary pneumonia : multiple small infiltrations caused by hematogenous dissemination e. Typical pneumonia Typical pneumonia is characterized by a sudden onset of symptoms caused by lobar infiltration.

Severe malaise High fever and chills Productive cough with purulent sputum yellow-greenish Crackles and decreased bronchial breath sounds on auscultation Enhanced bronchophony , egophony , and tactile fremitus Dullness on percussion Tachypnea and dyspnea nasal flaring, thoracic retractions Pleuritic chest pain when breathing , often accompanying pleural effusion Pain that radiates to the abdomen and epigastric region particularly in children Suspect bacterial pneumonia in immunocompromised patients with acute high fever and pleural effusion!

Atypical pneumonia Atypical pneumonia typically has an indolent course slow onset and commonly manifests with extrapulmonary symptoms. Nonproductive, dry cough Dyspnea Auscultation often unremarkable Common extrapulmonary features include fatigue, headaches, sore throat, myalgias , and malaise.

Low PCT level after 2—3 days of antibiotic therapy can help facilitate the decision to discontinue antibiotics. Imaging Chest x-ray posteroanterior and lateral Indications: all patients suspected of having pneumonia Findings may include: Lobar pneumonia Opacity of one or more pulmonary lobes Presence of air bronchograms : appearance of translucent bronchi inside opaque areas of alveolar consolidation Bronchopneumonia Poorly defined patchy infiltrates scattered throughout the lungs Presence of air bronchograms Atypical or interstitial pneumonia Diffuse reticular opacity Absent or minimal consolidation Parapneumonic effusion A new pulmonary infiltrate on chest x-ray in a patient with classic symptoms of pneumonia confirms the diagnosis.

Begin empiric antibiotic therapy based on severity and patient risk factors e. Provide supportive care. Re-evaluate therapy after 48 hours earlier if the patient's condition deteriorates or new information becomes available. Criteria for hospitalization Every patient should be assessed individually and clinical judgment is the most important factor. CURB score 0 or 1 : The patient may be treated as an outpatient. CRB score if serum urea is not known or unavailable CRB score of 0: The patient may be treated as an outpatient.

Points are distributed based on patient age, comorbidities, and lab results. Any patient being treated in a primary care setting should be re-examined after 48—72 hours to evaluate the efficacy of the prescribed antibiotic. Additional considerations : Knowing local resistance patterns of S. Anaerobic coverage is not routinely recommended for suspected aspiration pneumonia unless lung abscess or empyema is suspected.

Seven days of therapy are usually sufficient. Supplemental oxygen as needed for hypoxia See also airway management and ventilation. Incentive spirometer Antipyretics , analgesics as needed e. Order microbiological workup as indicated by patient severity and risk factors. Start empiric antibiotic therapy based on patient risk factors and need for hospitalization see treatment of pneumonia. Administer supplemental oxygen if patient is hypoxemic.

Consider advanced diagnostic evaluation. Continuous pulse oximetry Trend inflammatory markers , procalcitonin. Narrow antibiotic therapy as soon as feasible. Mycoplasma pneumonia [12] [13] Epidemiology One of the most common causes of atypical pneumonia More common in young children Outbreaks may occur in schools, colleges, prisons, and military facilities. Clinical features See atypical pneumonia. Generalized papular rash; erythema multiforme [23] Diagnostics Subclinical hemolytic anemia : associated with elevated cold agglutinin titers IgM Interstitial pneumonia , often with reticulonodular pattern on chest x-ray Treatment : macrolides , doxycycline , and fluoroquinolones Legionnaires' disease Pneumocystis pneumonia Tuberculosis Primary influenza pneumonia Various viral infections e.

Definition : Aspiration is the inhalation of foreign material into the respiratory tract. It most commonly occurs after instrumentation of the upper airways or esophagus e.

Aspiration pneumonitis Aspiration of gastric acid that initially causes tracheobronchitis, with rapid progression to chemical pneumonitis May cause ARDS in extreme cases Risk factors Altered consciousness : alcohol , sedation, general anesthesia ; , stroke Apoplexy and neurodegenerative conditions Gastroesophageal reflux disease , esophageal motility disorders Congenital defects e.

Less commonly: monomicrobial lung abscess caused by S. Mortality increases with age. The mortality risk can be evaluated with the CURB score. Pneumococcal vaccination Influenza vaccination Smoking cessation References: [33] [34] [35]. It appears that JavaScript is disabled in your browser. Gram-negative pathogens Pseudomonas aeruginosa Enterobacteriaceae Staphylococci Staphylococcus aureus Streptococcus pneumoniae.

Most commonly S. Atypical pathogens Mycoplasma pneumoniae Chlamydophila pneumoniae Chlamydophila psittaci primarily transmitted by parrots Legionella Viruses e. Escherichia coli Streptococcus agalactiae Group B streptococcus Streptococcus pneumoniae Haemophilus influenzae. Uncommon organisms e. Parenchymal partial consolidation Red-purple. Alveolar lumens with serous exudate , bacteria , and rare inflammatory cells.

Parenchymal consolidation Red-brown Dry and firm Liver —like consistency Reversible. Alveolar lumens with exudate rich in fibrin , bacteria, erythrocytes , and inflammatory cells Alveolar walls thickened.

Uniformly gray Liver —like consistency. Alveolar lumens with suppurative exudate neutrophils and macrophages Erythrocytes and most bacteria have been degraded.

Alveolar walls thickened. Enzymatic fibrinolysis Macrophages remove the suppurative exudate.

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Bronchopneumonia: Symptoms, Risk Factors, and Treatment

Most pneumonia occurs when a breakdown in your body's natural defenses allows germs to invade and multiply within your lungs. To destroy the attacking organisms, white blood cells rapidly accumulate. Along with bacteria and fungi, they fill the air sacs within your lungs alveoli. Breathing may be labored. A classic sign of bacterial pneumonia is a cough that produces thick, blood-tinged or yellowish-greenish sputum with pus.

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What is bronchopneumonia?

Pneumonia is a category of lung infections. It occurs when viruses, bacteria, or fungi cause inflammation and infection in the alveoli tiny air sacs in the lungs. Bronchopneumonia is a type of pneumonia that causes inflammation in the alveoli. Someone with bronchopneumonia may have trouble breathing because their airways are constricted.

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In industrialized nations, it is the leading infectious cause of death. Pneumonia is most commonly transmitted via aspiration of airborne pathogens primarily bacteria, but also viruses and fungi but may also result from the aspiration of stomach contents. The most likely causal pathogens can be narrowed down based on patient age, immune status, and where the infection was acquired community-acquired or hospital-acquired. Pneumonia is classified based on clinical features as either typical and atypical; each type has its own spectrum of commonly associated pathogens. Typical pneumonia manifests with sudden onset of malaise , fever , and a productive cough.

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