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Prof. Dr. Bilun Gemicioğlu

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Presentation on theme: "Prof. Dr. Bilun Gemicioğlu"— Presentation transcript:

1 Prof. Dr. Bilun Gemicioğlu
Pneumonia Prof. Dr. Bilun Gemicioğlu

2 Definition Pneumonia is a lung parenchyma infection caused by bacteria, a virus or fungi, with a consolidation on radiological examination. Pneumonitis is an inflammation of the lungs caused by chemical or radiation therapy but not with infectious agents.



5 Spread of lung infections
Inhalation Aspiration of oropharingeal secretion Hematogenic spread Direct spread (thorax wall, mediastinum)

6 Predisposing factors of pneumonia
Airways mechanical barrier damage Specific and/or nonspecific immune defense mechanisms injury Bronchial obstruction Micro aspiration of upper respiratory truck secretion. Lung edema Viral infections.

7 Diagnostic Methods History, physical examination Chest X-Ray
Sputum examination (gram stained) Sputum , blood cultures Serological tests Peripheral blood analysis

8 Diagnosis Symptoms fever, shaking chills,
cough, sputum (expectoration), pleuritic pain. Others: (dispnea, fatigue, sweating, loss of appetite...) Physical signs: increased vibration thoracic impaired percussion (matity), end inspiratory rales (crepitations) and bronchial breathing (tuber soufle) Others (cyanosis, tachipnea, tachicardia...)

9 Diagnosis Radiology: lobar opacities, interstitial images,
bronchopneumonic (patchy) opacities, Others (absea, pneumatocele, pleurisy...)

10 Chest X-Ray Gold standart test for pneumonia
For differencial diagnosis For grading pneumonia severity For examining complications

11 Normal Chest X Ray in Pneumonia
-First 24 hours -Dehydration -Elderly -Neutropenia -Pneumocystis carinii

12 Classification with anatomical localization
Lobar consolidation Bronchopneumonia Interstitial pneumonia

13 Classification with ethiology
Bacterial Viral Fungal Parazites

14 Classification with targeting therapy
Community acquired pneumonia Hospital acquired pneumonia (Nosocomial) Immunosuppresed (immunocompromised) patients pneumonia

15 Community acquired pneumonia
Pneumonia acquired outside hospital frequently in healthy persons

16 Caracteristics of community acquired pneumonia (CAP)
Typical pneumonia Atypical pneumonia acute subacute, fever,chills subfebril fever productive cough non productive cough pleural pain nonrespiratory symptoms physical signs ( + ) physical signs ( - ) lobar consolidation non-lobar infiltration Agents S. pneumoniae M.pneumonia H. Influenzae C.pneumoniae Gr(-)aerop bacillus L. Pneumophila Aneorobes Virus

17 Lobar pneumonia

18 Lobar pneumonia

19 Bronchopneumonia

20 Interstitial pneumonia

INTENSIVE CARE Mild pneumonia, Moderate pneumonia Severe pneumonia

22 CAP Therapy: Group I No antibiotic usage Penicillin, No comorbidity
With comorbidities Pneumococci resistant to penicillin Gram (–) agents Usage of antibiotic last three months Usage of corticosteroid Penicillin, Macrolide, Floroquinolone, ß laktame + Macrolide

23 CAP Therapy: Group II CAP Therapy: Group 2 H.influenzae
S.pneumoniae H.influenzae M.pneumoniae C.pneumoniae Mix infection) Enteric Gram negatives ! Virus First choise Alternatif ________________________________________ Penicillin G ± makrolide Levofloksasin Aminopenicillin ± makrolide Moksifloksasin Aminopenicillin / β-laktamase inhibitor ± macrolide Non- antipseudomonal cefalosporin II-III ± macrolide

24 CAP Therapy: Group III No risk of P. aeruginosa
Non pseudomonal cefalosporin III+ macrolide or Non pseudomonal cefalosporin III + (moksifloksasin or levofloksasin) With risk of P. aeruginosa Anti-pseudomonal cefalosporin (sefepim-seftazidim) Ureidopenicillin/beta-laktamase inhibitor (piperasilin.. Karbapenem + siprofloksasin

25 Duration of the therapy
After fever drop week - Pneumococcic pneumonia days - Legionella pneumonia days - Mycoplasma ve C. pneumoniae days Severe pneumonia weeks

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