1. Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine

2. Epidemiology 6th leading cause of death in U.S. Number one Among the infectious diseases 4 million patients annually in US Incidence 12/1,000/year Mortality in OPD patients 1-5 %, but Inpatients 25%, ICU 50-60%

3. Definition Pneumonia is the inflammation of lower respiratory tracts including alveoli, interstitial tissues, and broncioles by the microorganisms, chemical irritations or by an immunological process

4. Classifications & Terminology Community Acquired Pneumonia Nosocomial Pneumonia Ventilator Associated Pneumionia Mild, moderate, severe Bacterial, viral, fungal, parasitic Primary vs. Secondary Immune compromised vs. Normal immunity Lobar vs interstitial Typical vs. Atypical

12. Severe Community Acquired Pneumonia Respiratory rate > 30/min PaO2/FiO2 ratio < 250mmHg Need for Mechanical Ventilation Diffuse bilateral involvement or multiple lobes, incresing infiltration > 50% within 48 hours B.P. < 90systolic or 60 mmHg diastolic Need for vasopressors Renal failure

13. Mycoplasma Pneumonia

16. Streptococcal Pneumonia

17. Streptococcus pneumoniae Gram + Diplococci

18. Streptococcal Pneumonia

20. Staphylococcus aureus BAL Fluid

21. Staphylococcal Pneumonia Pneumatocele

22. Staphylococcal Pneumonia

24. Osler’s Node

25. Pseudomonas Pneumonia

27. Ecthyma gangrenosum

28. Immunofluorescent Ab Test RSV Antigen Detection

29. Legionella Pneumonia

30. Legionella pneumophila by Silver impregnation Stain

31. Pneumonia in COPD

32. CMV Inclusion in BAL

33. Sputum Gram Stain

34. Treatment of CAP <60yrs/OPD/no Comorbid conditions Pathogens : S. pneumoniae, Mycoplasma& Chlamydia pneumoniae, H. indfluenzae, RSV, Legionella, S. aureus Treatment : 2 nd Generation Cephalosporin + Macrolide or Quinolone monotherapy

35. Treatment of CAP >60yrs/OPD/with Comorbid conditions Pathogens : S. pneumoniae, RSV, H. indfluenzae, Gram (-) rod, S. aureus, Morexella catarrhalis, Legionella spp. Treatment : 2 nd Generation Cephalosporin + TMX/SFX, or beta lactam/betalactam inhibitor + Macrolide

36. Treatment of Severe CAP Pathogens : S. pneumoniae, Legionella spp. Gram (-) rod, Mycoplasma,H. indfluenzae,S. aureus Treatment : 3 rd Generation Cephalosporin with anti- Pseudomonal activity or + other anti Pseudomonal agent (Imipenem/quinolone) + Macrolide

37. Aspiration Pneumonia

39. Lipoid Pneumonia