Pneumonia

Pneumonia:

• Hospitalized ‘ill’ patients –Gram negative organisms.
• Alcohol excess ass with aspiration pneumonia (anaerobes>> add metronidazol to antibiotic regimen) and klebsila ( upper lobe + gelatinous sputum).

• Immunosuppression (e.g. AIDS or treatment with cytotoxic agents) – organisms include Pneumocystis jiroveci, Mycobacterium avium-intracellulare,cytomegalovirus.

• Intravenous drug users (may be multiple abcesses in x ray)>> Staph. aureus infection, G+ve cocci. Chlamydia psittaci exposed to infected birds, especially parrots and has chronic course.

• Persistent changes on the chest X-ray after 6 weeks suggest a bronchial abnormality, usually a carcinoma. No improvement with copious sputum >> abscess and empyema.

• Diagnosis of L. pneumophila (shower in hotels) suggested by: a prodromal virus-like illness, a dry cough, confusion or diarrhea, lymphopenia without marked leucocytosis, hyponatraemia., Hypoalbuminaemia and high serum levels of liver aminotransferases. Urinary antigen test and confirmed by direct immunofluorescent staining of the organism. ttt Azithromycin + add rifampicine in sever case.

• CRUB-65 if =2 hospitals and if > 2 ICU