Definition Inflammatory processes are generally acute lung parenchyma. Morbidity and mortality • 5-11 cases per thousand people per year. • Increased frequency in young childr en and elderly. • Lethality: 1% of cases (up to 50% among patients requiring ICU admission). Etiology For chemical pneumonia For physical agents by biological agents (infectiou s) Other Bacterial Pneumonia (infectious) Community-acquired pneumonia - CAP nosocomial pneumonia (NP) ------------------- -------------------- ---------------------- CAP affects patients outside the hos pital or onset in the first 72 hours (CDC) after admission. Pathways • • • • • For inhalation by aspiration By focusing distance (Hematogenous) by co ntiguity For local reactivation Agent identification • In 50% of cases at most. • In 60-80% of cases, when we include serological tec hniques. CAP • S. pneumoniae - up to 43% of cases • M. pneumoniae (*) • C. pneumoniae (*) • H . • influenzae Legionella sp (*) • Viruses • S. aureus • Others • • Mista M. tub erculosis PN • P. • Other aeruginosa Gram-negative bacteria S.aureus • • polymicrobial (*) Atypical: 1 / 3 of cases Clinical • RSV infection -------------------------- • Fever • Chills • Cough • Chest pain • Sputum • Other Physical examination • Tachypnea: correlates with the severity of clinical signs of pulmonary consoli dation • - Cracking rales / Blow tube - FTV increased - dullness to percussion 1 / 3 of cases • Pleural effusion? "Syndromic approach" Typical (Pneumococcus) atypical (Mycoplasma) Not an accurate predictor of microbiological cause. The clinical expression of d isease is also determined by epidemiological and functional status of the patien t. Radiological diagnosis It is essential to: - Diagnosis - Evaluation of gravity - Identification of complications - Monitori ng the progress and response to treatment Pneumonia PD Pneumonia with cavities Pneumatoceles in staphylococcal pneumonia Microbiological examination of sputum collection, processing, techniques and interpretation • Sample taken a deep cough, before antibiotics • Processing <2 hours after the collection • Techniques - Gram - Ziehl-Neelsen (AFB) - For fungi (selected cases) • Direct examination (Gram) - <10 epithelial cells and> 25 PMN field-100X Serology and antigen detection • Mycoplasma • cryoagglutinins for urinary antigen for Legionella pneumophila -- -------------------------------------- ------------------ • Need to show serocon version, which delays the diagnosis Other tests • • • • • • • • Blood test Glucose Urea Electrolytes and creatinine Biochemistry of liver pH and gases Blood samples for HIV serology Invasive diagnostic methods • • Bronchoscopy Thoracentesis - Lavage (BAL) - Brushed - Biopsy • • transtracheal aspirate aspiration biopsy • Surgeries - Video-assisted (BPVA) - Mini-thoracotomy - the open sky Risk classification Class I II III IV V Mortality 0.1 0.6 2.8 8.2 29.2 Local treatment Outpatient Am bulatory Brief Hospitalization Hospital (ICU) Stratification by age, sex, area of residence, comorbidities, physical abnormali ties, laboratory and radiological (Manual Pulmonology 2002, BTA). Outpatient treatment • fluoroquinolones • Macrolides (or elderly patients with associated comorbiditi es) • Beta-lactams Hospital treatment Pseudomonas? NO YES Cipro + beta-lactam or aminoglycoside anti-P Beta-lactam anti-P + aminoglycoside + macrolide Fluoroquinolone Cephalosporin 2nd, 3rd or 4th + macrolide When suspicion of Pseudomonas aeruginosa • structural lung disease (eg, bronchiectasis) • Recent use of antibiotics and / or steroids • Malnutrition Treatment - other situations • Anaerobic - Amoxicillin and clavulanate - Ampicillin with sulbactam - Clindamycin • S. aureus - Oxacillin - Vancomycin • P. carinii - Sulfamethoxazole with trimethoprim (add prednisone) Some questions • The duration of treatment: 7-21 days • Sequential treatment • Supplemental oxy gen - SpO2 <90% - PaO2 <60mmHg • The therapeutic failure Conduct in the pleural effusion (SD) • Puncture DP parapneumonic pleural empyema • Drainage tube closed (water-sealed) open + • Drainage Therapy • Pulmonary De cortication Recommended Reading • Manual Pulmonology 2002 - BTS • www.pneumoatual.com.br> Themes> • www.sbpt.org CAP in adults.br> Publications> Guidelines for Community-acquired pneumonia in immunocompetent adults GRATEFUL FOR ATTENTION Google Docs blogdopg.blogspot.com scribd.com