Skip to main content

Suppurative Pneumonia & Pneumonia in Immunocompromised Patients!

SUPPURATIVE PNEUMONIA (ASPIRATION PNEUMONIA) AND PNEUMONIA IN IMMUNOCOMPROMOISED PATIENTS 



SUPPURATIVE PNEUMONIA


Definition:

"Suppurative pneumonia is characterized by destruction of the lung parenchyma by inflammatory process and although microabscessation formation is characteristic histological feature, pulmonary abscess" is usually taken to refer lesion which is a large, localized collection of pus or a cavity lined by chronic inflammatory tissue from which pus has escaped by rupture into bronchus".


Etiology:

  1. Inhalation of septic material during operations on the nose, mouth, throat under general anesthesia
  2. Bulbar
  3. Vocal cord palsy
  4. Esophageal reflux
  5. Alcoholism

Infecting Organism:

  • Bacterioder melaninogenicus
  • Anaerobic/microaerophilic cocci
  • B. fragilis
  • S. aureus (most common)
  • K.pneumoniae
  • S.pneumonia.

*Leimerres Syndrome is a rare cause of pulmonary abscesses. Usually, causative agent is F.secrophorum. Illness signs include sore throat, painful swollen neck, fever, rigors, dyspnea.
A non-infective form of Aspiration pneumonia is exogenous lipid pneumonia may follow aspiration of animal, vegetable, mineral oil.



Clinical Features:

  1. Cough with sputum
  2. Pleural pain
  3. Pyrexia
  4. Systemic upset
  5. Weight loss

Investigations:

  1. Chest Pain: to confirm the diagnosis and exclude complication.
  2. Pulse Oximetry: to monitor response to oxygen therapy, if SaO2 < 93% features of sever pneumonia, identify ventilatory failure or acidosis.
  3. Cell count: ESR, Neutrophil leukocytosis
  4. Microbiological studies: for severe CAP and those that do not respond to initial therapy (Gram stain, sputum culture, blood culture)
  5. Renal Function test: Urea and Electrolytes
  6. Liver Function test: Elevated C-Reactive protein
  7. Complete Blood Count (CBC)
  8. Chest X-Ray


Management:

The goal for management involves:
  • Oxygen therapy
  • Fluid balance
  • Antibiotic therapy
  • In severe illness--Nutrition support

1. Oxygen Therapy:
  • Oxygen should be administered to all the patients with tachypnea, hypoxemia, hypotension with the aim of maintaining SaO2 at >92%.
  • Indicated for: Referral to Intensive Therapy Unit (ITU) including.
  1. Persistent hypoxia SaO2 <90% despite high concentration of O2.
  2. Severe acidosis
  3. Circulatory shock
  4. Reduced conscious level.

2. IV Fluids:
  • should be considered in patients with severe illness, older patients, those who are vomiting. Oral fluid intake is encouraged.

3.Antibiotic Therapy:

IV Co-Amoxiclav 102g three times daily.
  • If anaerobic bacterial infection;
            Oral Metronidazole 400mg three times daily.

  • If Community acquired MRSA suspected;
           Oral non-beta lactam antibiotics used- Tetracycline, Clindamycin

  • Treatment for 4-6 weeks - patients with lung abscess

4. Physiotherapy

5. Surgery (if no improvement)




PNEUMONIA IN IMMUNO-SUPPRESSED HOST:

  • Patients immunocompromised by drugs or disease are at a high risk of pulmonary infection.

Etiology:

  • Defective phagocytic function: caused by;
       Acute leukemia
       Cytotoxic drugs
      Agranulocytosis
Infecting organisms:
       Gram positive bacteria ( S.aureus)
       Gram negative bacteria
       Fungi (e.g.: Aspergillus fumigatus)

  • Defects in Cell-mediated Immunity: caused by;
       Immunosuppressive drugs
      Cytotoxic drugs
      Chemotherapy
  Infecting organism:
     Virus (Adenovirus)
     Fungi


  • Defects in Antibody Production: caused by;
      Chronic lymphocytic pneumonia
       Infecting organism:
       H.influenza



Clinical Features:

Fever


Investigations:

  1. Bronchoscopy
  2. BAL
  3. Surgical lung biopsy
  4. Transbronchial biopsy
  5. Microbiological tests
  6. High Resolution Chromatography (HRCT): for differentiating likely cause such as cavitation seen with mycobacteria and fungi)


Management:

The goal for management involves:
  • Oxygen therapy
  • Fluid balance
  • Antibiotic therapy
  • In severe illness--Nutrition support

1. Oxygen Therapy:
  • Oxygen should be administered to all the patients with tachypnea, hypoxemia, hypotension with the aim of maintaining SaO2 at >92%.
  • Indicated for: Referral to Intensive Therapy Unit (ITU) including.
  1. Persistent hypoxia SaO2 <90% despite high concentration of O2.
  2. Severe acidosis
  3. Circulatory shock
  4. Reduced conscious level.

2. IV Fluids:
  • should be considered in patients with severe illness, older patients, those who are vomiting. Oral fluid intake is encouraged.

3.Antibiotics:
Brad spectrum antibiotics- 3rd Generation Cephalosporin and Antisaphylococcal antibiotic
                                                                          or
                        Antipseudomonal penicillin and Aminoglycosides


Labels:

Comments

Post a Comment

Popular posts from this blog

Diabetes Mellitus: Types!

TYPES OF DIABETES MELLITUS 1. TYPE1 DM Type 1 DM is usually diagnosed before age 30 years, but it can develop at any age. T1DM is an autoimmune disease in which insulin producing B-cells are destroyed. The presence of Human Leucocyte Antigens (HLAs ) is associated with the development of T1DM. In addition, these individuals often develop Islet cell antibodies , Insulin Autoantibodies or Glutamic Acid decarboxylase autoantibodies . At the time of development of diagnosis of T1DM, it is usually believed that most of the patients have 80-90%loss of beta cells. The remaining beta cells function at the diagnosis creates a " HONEYMOON PERIOD" during which the blood glucose levels are easier to control, and smaller amounts of insulin are required. after this, the remaining beta cells function is completely lost, and the patients become completely deficient of insulin and hence require exogenous insulin.  2. TYPE1.5 DM:  Also referred as Latent autoimmune diabetes in Adults (LAD)
Post a Comment
Read more

Diabetes Mellitus: Pharmacotherapy- Gliptins and a-Glycoside Inhibitors!

  PHARMACOTHERAPY:  Medications classifications include:  Sulfonyl Urea's Nonsylfonylurea Secretagogues (a-Glinides) Biguanides Thiazolidinediones a-Glucosidase Inhibitors Dipeptidyl Peptidase-4 Inhibitors (Gliptins) Sodium-glucose co-transporter (SGLT) Inhibitors  Central-Acting Dopamine Agonists Bile Acid Sequestrants Insulin therapy 5. a-GLUCOSIDASE INHIBITORS Acarbose and Miglitol are a-glucosidase inhibitors currently approved in the United States. Mechanism of Action: An enzyme that is along the brush border of the intestine cells called a-glucosidase; breaks down the complex carbohydrates into simple sugars, resulting in absorption. The a-glucosidase inhibitors work by delaying the absorption of carbohydrates from the intestinal tract, which reduces the rise in postprandial glucose levels. Therapy: As a monotherapy , a-glucosidase inhibitors primarily reduce post-prandial glucose excursions.  Clinical Use: FPG concentrations have been decreased by 40-50mg/dL and A1c level
Post a Comment
Read more

GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD)!

MANAGEMENT OF GASTRO-ESOPHAGEAL REFLUX DISEASE  "GERD refers to the endoscopically determined esophagitis or endoscopy-negative reflux disease" . "GERD is the term used to describe any symptomatic clinical condition or histopathological alteration resulting from episodes of reflux of acid, pepsin and occasionally, bile into the esophagus from the stomach". Patients with uninvestigated "reflux-like" symptoms should be managed as patients with uninvestigated dyspepsia. There is currently no evidence that H.pylori should be investigated in patients with GERD. Symptoms: Heartburn is the characteristic symptom of GERD. Acid regurgitation Dysphagia Belching Upper abdominal discomfort Bloating and postprandial fullness Chest pain Hoarseness Cough Complications include: Esophageal ulceration Formation of specialized columnar-lined esophagus at the gastro-esophageal junction known as Barretts Esophagus . Mechanism of Acid Reflux: The mechanism of acid reflux is mu
Post a Comment
Read more