Its pulmonary parenchymal infection by different infectious agents (bacteria, virus, fungi and parasites). Age is the first epidemiological factor to consider before pneumonia, as each age group is related to a specific microorganisms.
Several mechanisms entry of infectious agents:
By microaspiration bronchopulmonary secretions from oropharyngeal : is the most common mechanism in the production of pneumonia. Inhalation of aerosols from contaminated air (most common mechanism of viral pneumonia, Coxiella, Legionella, Mycoplasma or Chlamiydia).
By spreading blood (pneumonia Stapilococcus addicted to intravenous drugs). For contiguity infections from organs or structures near the lung from the outside or from wounds after surgery (rare). In all these cases there is an alteration of pulmonary defense mechanisms as well as an excessive presence of microbes that exceed these mechanisms.
Depending on whether the infection is in the hospital or not, there are two major groups of pneumonia:
Nosocomial pneumonia (minimum 72h after hospitalization)
1. Community-acquired pneumonia (outpatient):
Typical syndrome: It follows a viral condition after which abruptly starts high fever, productive cough, pleuritic pain side tip that increases with coughing and deep inspiration, chills and dyspnea. In 10-15% can identify a cold sore.
It is characteristic of Streptococcus pneumoniae and Haemophilus influenzae.
Atypical syndrome: more insidious onset with fever without chills, irritative cough and extrapulmonary symptoms such as headache, muscle and joint pain, sore throat, nausea, vomiting and diarrhea.
Typical of Mycoplasma pneumoniae and Chlamydia.
In the elderly, this distinction is not so clear you tend to be, may develop pneumonia without fever or chills or dyspnea, and present with disturbances of consciousness and other nonspecific symptoms and signs.
2. Nosocomial pneumonia:
May present similarly to acquired pneumonia either as the typical form with fever, chills, and productive cough or other times, the clinic is very low and slow start. According to the patient’s underlying disease entered, dominated some other infectious agents (eg pneumonia is common in diabetics E.coli).
It requires the completion of a chest radiograph for suspected pneumonia so that it can diagnose. The typical community-acquired pneumonia, are presented with a pattern that is characteristic of alveolar condensation with bronchogram air (80% of cases will have been listening to the patient in the form of lung crackles). The radiologically atypical presented with an interstitial infiltrate, with characteristic clinical-radiological dissociation (physical examination is usually normal).
There are no specific radiographic patterns to identify the infectious agent.
The examination of sputum has a low profitability, either by the normal flora contamination oropharyngeal as by prior administration of antibiotics ..
Sputum culture positive in only half of bacterial pneumonia.
There immunological techniques to try to identify infectious agents from sputum blood and urine.
Involves the use of antibiotics depending on the patient to be treated, which may be empirical (not known causative) or if it has been recognized specific infectious agent.
In the case of community-acquired pneumonia, empiric treatment usually lasting 7-10 days.
Antibiotic treatment should be accompanied by a series of general measures such as rest, smoking cessation, adequate hydration and analgesia for fever and / or pleuritic pain.
In cases in which the patient meets two more of the following criteria: substantial alteration in the chest radiograph (involvement of more than one lobe or bilateral pleural effusion or pulmonary cavitation), trouble following the treatment at home, lack of tolerance to oral therapy, decompensated underlying disease and / or immunosuppression, should be referred to a hospital for treatment.
In nosocomial pneumonia treatment is based on the results of the cultures of the sputum sample. Treatments are usually up to 21 days,
There is a moderately effective vaccine with 60% effectiveness. It is indicated in adults over 65 and children over 2 years and adults at high risk of infection by pneumococcus : asplenia, renal failure or nephrotic syndrome, sickle cell anemia, HIV, immunocompromised, cystic fibrosis, diabetes mellitus, transplant , alcoholism, cirrhosis, chronic lung disease, cardiovascular disease, CSF fistulae.
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