The pulmonary SYNDROME – pneumonia

Definition:

Pneumonia is an inflammation of the lung parenchyma located in the lobar or segmental.

Etiology:
– Factors antimicrobial – bacteria, viruses

Clinic – the pulmonary syndrome
– Decreased lung sonority
– Decreased breath sounds
– Increasing the vocal vibration transmission in the area
– Perception crackles in outbreak

Pathogenesis:
1. The pathogen enters the air or blood in the lung lobe, excite neuroreceptors of alveolar walls, capillary permeability increases with the passage of PMN and lymphocyte into air
2. Phase failure (Hepatizatie red) – due to conflict pathogen – PMN accumulate an amount of exudate in the alveoli leads to the disappearance of alveolar air and the pulmonary
3. Hepatizatie gray phase – becomes viscous exudate, purulent aspect taking
4. Abcedare phase – the content is removed from the outside area
                                                                                                 pneumococcal pneumonia

The etiologic agent: pneumococcus – bake Gram +

Pathogenic disease is favored by exposure to cold, damp, fatigue, immunosuppression

Clinical picture:
Debut – brutal, with unique chills, violent, 15-30min, followed by 39-40gr febrile rise, chest pain, polipnee, cough
Period status – occurs 5-6 hours after onset, cough with rusty sputum, viscous, general influenced high fever in plateau, naso-labial herpes
Ex clinical – the pulmonary syndrome

Laboratory picture:
– Ex blood – syndrome of acute inflammation laboratory
– Ex sputum – Gram stain – Gram + cocci, erythrocytes, leukocytes, alveolar cells
– Rx chest
1. in status – triangular opacity pointing the hilum and the periphery, homogeneous intensity subcostal;
2. During the resolution – aspect of “chessboard”

Charts:
– For healing under treatment
– For complications – pleurisy, pericarditis, myocarditis, endocarditis, nephritis, pneumonia

Treatment:
1. Prophylactic
– Avoid favoring environmental factors – cold, moisture, exposure to dust
– Avoiding congestion during virus outbreaks in people at high risk (children, elderly, debilitated – alcoholics, diabetics, immunodeficient)
– Increase body resistance – seasonal flu vaccine
2. Curative
– Hygienic-dietary: bed rest during the febrile period and again 3 days after lowering the temperature, well-ventilated room, wetting, liquid and semi-liquid diet with gradual resumption to normal food, vitamin therapy
– Medicines
A) Antibiotics
– Amoxicillin, ampicillin, augmentin – resistance or allergic reactions – erythromycin or cephalosporins
– Cephalosporins – cephalexin, Ceclor, cefuroxime
– Quinolone – ciprofloxacin
– Macrolides – claritronicina
B) antipyretic and expectorant cough or expectoration of thinners, analgesics
                                                                                                           Staphylococcal pneumonia

The etiologic agent: Staphylococcus – gram + bun

Pathogenesis: infection occurs by air, or iatrogenic marrow. Particular aspects of pneumonia is due stafiloccocice its enzymatic equipment – coagulase enzyme favors destruction of lung tissue to form microabscesses.
It affects young children, the elderly, people who have suffered from an illness anergy (measles, rubella, varicella), bran (diabetics, alcoholics, cirrhosis, smoking).

Clinical picture:
1. Time of onset – preceded by a staph infection localized cutaneous
– Febrile slow ascent
– Profuse sweating
– Repeated chills
2. During the state
– Fever
– Inspiratory dyspnoea with polipnee
– Cornaj, circulation
– Cyanosis (signs of respiratory failure)
– Clinical – areas around the pulmonary disseminated pulmonary area

Laboratory picture:
Ex blood: marked neutrophilic leukocytosis, leukopenia is a sign of high gravity, increase markers of acute inflammation, toxic granulation in neutrophils
Rx chest – multiple disseminated opaque areas on the surface of lung, homogeneous appearance, round, diffuse boundaries, central air cavities – PNEUMATOCELE

Charts:
– Healing under treatment
– Purulent pleurisy, piopneumotorax, septic metastases

Treatment – antibiotics and symptomatic
– If the staph is sensitive to penicillin Penicillin G begins with inj associated with Gentamicin and Kanamycin
– Staphylococcus resistant to penicillin – is given Oxacilina associated with gentamicin or kanamycin

                                                                                                                    Viral pneumonia

The etiologic agent – respiratory viruses

Clinical picture:
– Start sneezing, runny nose, hoarseness, dysphagia, retrosternal pain, growing progressive heating, headache, myalgia, fatigue, loss of appetite, nausea and vomiting
– Per state – high fever, chills small and repeated sweating, dry cough, painful, lymphadenopathy laterocervical
– Clinical ex – the pulmonary area based hemithorax

Laboratory picture:
– Eg blood – leukocytosis with lymphocytosis, moderately accelerated ESR
– Ex sputum – inconclusive
– Rx chest – the diffuse edges opaque glassy mate-diaphragm located hilio

Treatment:
1. prophylactic
– Detection and isolation of patients
– Avoiding congestion in epidemics
– Vaccination against influenza
2. curative
– Bed rest
– Liquid Diet
– Antipyretic analgesics, antitussives
– To prevent bacterial superinfection can manage type macrolide antibiotics – clarithromycin, azithromycin, doxycycline, Vibramycin
– It can be given antiviral treatment with amantadine or Acyclovir

                                                                                                            Anaerobic pneumonia

The etiologic agent: anaerobic cocci – peptostreptococ, peptococ, anaerobic bacilli – Bacteroides fragile clostridia

Pathophysiology – the path of insight – the aspiration of the digestive tract, by altering barrier glottis

Clinical picture:
– Toxemia
– Cough with sputum muco-purulent, fetid

Laboratory picture:
– Rx chest outbreaks condensation zones alternating with clarity
– In Blood – pronounced acute inflammatory syndrome
– Ex sputum – anaerobic bacteria

Treatment:
– Symptomatic
– Antibiotics – erythromycin or amoxicillin + metronidazole
                                                                                  Lung abscess (suppurative acute pneumonia)

Suppurative inflammation due to acute pulmonary parenchymal necrosis and evolves with removal of pus in sputum.

Conditions favoring:
– Neglected therapeutic lung
– Open chest trauma
– Exposure to cold, drafts, moisture
– High organic (underlying chronic diseases)

Clinical picture:
1. Period (suppuration closed) – fever, myalgia, loss of appetite. Malaise
2. Suppuration period open – fever, chills repeated sweating, coughing abundant purulent, bloody
3. Period abcedare – remove after a straight cough large amounts of fetid pus – vomica –
Clinical Ex: dyspnea, cyanosis, Hippocratic fingers on auscultation rales bullous

Laboratory picture:
– Rx chest – in per the suppuration closed – issue pneumonia round opacity with well defined edges in the suppuration per open – Clarifying area or zone hydro-air leakage
– Eg blood – acute inflammatory syndrome
– Ex sputum – leukocytes, elastic fibers, red blood cells, microbial germs

Treatment:
1. Prophylactic: fair treatment of lung diseases, avoiding physical and intellectual overexertion, smoke suppression, treatment of chronic diseases predisposing influenza immunoprophylaxis
2. hygienic-dietary – bed rest and hospitalization conditions, liquid diet, postural drainage
3. Medications – symptomatic antibiotics according to antibiogram (clindamycin, chloramphenicol, cephalosporins, gentamicin)
4. Surgery – no signs of healing under treatment, hemoptysis high suspicion of neo abcedat, evolutionary tendency toward fibrosis