Pneumonia

FL, 33 y/o female, sought consult for fever.

Six days prior to consult, patient developed cough, non-productive, intermittent,

not accompanied by fever, chest pains or difficulty of breathing. Patient took
Carbocisteine syrup 1 Tbsp three times s day.

Two days prior consult, patient noted that the cough became more frequent, this
time productive of yellowish phlegm. There is also mild to moderate chest pain which
becomes pronounced during coughing and during inspiration.

One day prior to the consult, patient developed fever recorded at 38.5ºC. Patient
took Paracetamol 500mg tab every hour with temporary relief of the fever. The fever was
accompanied with body malaise and anorexia. Patient still complained of cough
productive of yellowish phlegm.

The patient is anon-smoker, non-alcoholic beverage drinker with no previous

history of PTB, Diabetes Mellitus, HPN and CVD.

Physical Examination

 Vital Signs
Temperature: 38ºC
Respiratory Rate: 28/min
Pulse Rate: 96bpm
Blood Pressure: 110/70

 Symmetrical lung expansion,

(+) crackles, R lower lung field, (-) wheezes,
(-) retractions PMI 5th LICS, MCL, (-) Murmurs

 Abdomen flabby, nontender, (+) bowel sounds,

(-) Cyanosis, (-) Edema

Management

Patient was prescribed with:

- Amoxicillin 500 mg cap 3 times a day to be taken for 7 days
- Paracetamol 500 mg tab every 4 hours for fever
- Sputum sample was taken subjected to Culture and Sensitivity Test
- Patient was eventually sent home and advised for follow up.
PNEUMONIA

Pneumonia in an immunocompromised host describes a lung infection that occurs

in a person whose infection-fighting mechanisms are significantly impaired. People who
are immunocompromised have a defective immune response. Because of this, they are
susceptible to infections by microorganisms that are present everywhere, but do not
normally cause disease in healthy people.

Causes of Pneumonia

Pneumonia is caused by viruses, bacteria, or (in rare cases) parasites or other

organisms. In up to 65% of cases, the organism (such as bacteria or virus) that is causing
pneumonia is not identified even with testing. In adults, pneumonia is most often caused
by bacteria such as Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus
influenzae, and Legionella. The Legionella bacteria was responsible for a well-known
outbreak of pneumonia called Legionnaires’ disease.

Young children are more likely to develop pneumonia from exposure to a virus,
such as the parainfluenza and influenza viruses, respiratory syncytial virus, and
adenovirus. The chickenpox virus can cause pneumonia in adults and children.
Mycoplasma pneumoniae is the cause of walking pneumonia, more likely to occur in
older children and younger adults. Bird droppings, specifically poultry, carry an organism
called Chlamydia psittaci, which can also cause pneumonia.

Most cases of pneumonia are contracted by breathing in small droplets that

contain the bacteria or virus that can cause pneumonia. These droplets get into the air
when a person infected with these germs coughs or sneezes. In other cases, pneumonia is
caused when bacteria or viruses that are normally present in the mouth, throat, or nose
inadvertently enter the lung. During sleep it is quite common for people to aspirate
secretions from the mouth, throat, or nose. Normally, the body's reflex response
(coughing back up the secretions) and immune system will prevent a pneumonia from
starting.

However, if a person is in a weakened condition from another illness, a severe

pneumonia can develop. People with emphysema, heart disease, and swallowing
problems, as well as alcoholics, drug users and those who have suffered a stroke or
seizure are at higher risk for developing pneumonia.

Once the bacteria, virus or fungus enter the lungs, they usually settle in the air
sacs of the lung where they rapidly grow in number. This area of the lung then becomes
filled with fluid and pus as the body attempts to fight off the infection. Bacterial
pneumonias tend to be the most serious and, in adults, the most common cause,
especially Streptococcus pneumoniae (pneumococcus).

Respiratory viruses are the most common causes of pneumonia in young children,
peaking between the ages of 2 and 3. By school age, the bacterium Mycoplasma
pneumoniae becomes more common.

Bacterial pneumonia

Is caused by various bacteria.The Streptococcus pneumoniae is the most common

bacterium that causes bacterial pneumonia. It usually occurs when the body is weakened
in some way, such as illness, malnutrition, old age, or impaired immunity, and the
bacteria are able to work their way into the lungs. Bacterial pneumonia can affect all
ages, but those at greater risk include persons who abuse alcohol, persons who are
debilitated, post-operative patients, persons with respiratory diseases or viral infections,
and persons who have weakened immune systems.

The symptoms of bacterial pneumonia include shaking, chills, chattering teeth,

severe chest pain, high temperature, heavy perspiring, rapid pulse, rapid breathing, bluish
color to lips and nailbeds, confused mental state or delirium, cough that produces rust-
colored or greenish mucus. Viral pneumonia is caused by various viruses, and is the
cause of half of all cases of pneumonia.

Mycoplasma pneumonia

It is caused by mycoplasmas, the smallest free-living agents of disease in

humankind, which have the characteristics of both bacteria or viruses, but which are not
classified as either.

They generally cause a mild, widespread pneumonia that affects all age groups.
Symptoms include a severe cough that may produce some mucus. Mycoplasma
pneumonia often affects younger people and may be associated with symptoms outside of
the lungs (such as anemia and rashes), and neurological syndromes (such as meningitis,
myelitis, and encephalitis).

Aspiration pneumonia

Is an inflammation of the lungs and bronchial tubes caused by inhaling foreign

material, usually food, drink, vomit, or secretions from the mouth into the lungs. This
may progress to form a collection of pus in the lungs (lung abscess).
The response of the lungs depends upon the characteristics and amount of the
aspirated substance. The more acidic the material, the greater the degree of lung injury,
although this may not necessary lead to pneumonia.

Atypical pneumonia
 Refers to pneumonia caused by certain bacteria - namely, Legionella
pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae. While atypical
pneumonias are commonly associated with milder forms of pneumonia, pneumonia due
to Legionella, in particular, can be quite severe and lead to high mortality rates.

Atypical pneumonia due to Mycoplasma and Chlamydophila usually cause milder

forms of pneumonia and are characterized by a more drawn out course of symptoms
unlike other forms of pneumonia which can come on more quickly with more severe
early symptoms.

Cytomegalovirus (CMV)

Is a member of a group of herpes-type viruses that can cause an infection of the

lungs in immune-suppressed persons. This infection is particularly common in solid
organ transplant and bone marrow transplant recipients. Infection with CMV is very
common. The majority of healthy adults have antibodies (an indication of previous
infection) to CMV in their blood.

Usually CMV produces no symptoms, but serious CMV infections can occur in
people with impaired immunity, such as those with AIDS, organ transplant and bone
marrow transplant recipients, and people receiving chemotherapy or other
immunosuppressive treatments.

CMV disease is a common complication of organ transplantation. CMV

pneumonia occurs in 20% of bone marrow transplant recipients. CMV pneumonia is
often present simultaneously with pneumocystis pneumonia. Decreased oxygen levels in
the blood (hypoxemia) in association with CMV pneumonia often predicts a fatal
outcome.

Hospital-acquired pneumonia

Is an infection of the lungs contracted during a hospital stay. Pneumonia is a very

common illness. It is caused by many different organisms and can range in seriousness
from mild to life-threatening.

Hospital-acquired pneumonia tends to be more serious because defense

mechanisms against infection are often impaired during a hospital stay, and the kinds of
infecting organisms are more dangerous than those generally encountered in the
community.

Risk factors predisposing people to hospital-acquired pneumonia are alcoholism,

older age, immunosuppression from medications or diseases, recent illness, and risk of
aspiration.

Community-acquired pneumonia (CAP)

 Caused by the typical bacterial pathogens, namely, Streptococcus pneumoniae,
Haemophilus influenzae, and Moraxella catarrhalis. The remaining 15% are caused by
atypical pathogens, namely Mycoplasma pneumoniae, Chlamydia pneumoniae, and
Legionella species. Unusual aerobic gram-negative bacilli (for example, Pseudomonas
aeruginosa, Acinetobacter, Enterobacter) rarely cause CAP.

Legionnaire's disease

Is an acute respiratory infection caused by the bacterium Legionella pneumophila,

which can cause a broad spectrum of disease from mild cough and fever to a serious
pneumonia. The bacteria that cause Legionnaire's disease have been found in water
delivery systems and can survive in the warm, moist, air conditioning systems of large
buildings including hospitals.

Pneumocystis carinii pneumonia

Is an infection of the lungs caused by the fungus Pneumocystis carinii. PCP is a

pneumonia caused by the fungal organism Pneumocystis carinii, which is widespread in
the environment, and is not a pathogen (does not cause illness) in healthy individuals.

Fungal pneumonia

Pneumonia caused by fungal infection of the lungs is rare in people who are normally
healthy.

Fungal pneumonia can affect people who travel to places where these infections
are commonly found. For example, some parts of the USA, Mexico, South America and
Africa.

The medical names for fungal pneumonia include histoplasmosis, coccidioidomycosis

and blastomycosis.

Viral pneumonia

Is an inflammation (irritation and swelling) of the lungs caused by infection with

a virus. Pneumonia is an infection of the lung that affects 1 out of 100 people annually.
Viral pneumonia is caused by one of several viruses, including influenza, parainfluenza,
adenovirus, rhinovirus, herpes simplex virus, respiratory syncytial virus, hantavirus, and
cytomegalovirus.

Most cases of viral pneumonia are mild and get better without treatment, but some
cases are more serious and require hospitalization. People at risk for more serious viral
pneumonia typically have impaired immune systems such as people with HIV, transplant
patients, young children (especially those with heart defects), the elderly, and people
taking medications to suppress their immune systems in the treatment of autoimmune
disorders.

Walking pneumonia

Walking pneumonia is pneumonia that is usually mild enough that the child does
not have to stay in bed. Before the advent of antibiotics, pneumonia was often fatal, but
most community-acquired pneumonias are readily treatable today.

This is often called walking pneumonia because although they can be very ill the
patients are still mobile. Some people with walking pneumonia never realise they are ill
at all, but merely feel 'run down' and exhausted.

When physicians diagnose someone with walking pneumonia, they are usually
talking about an infection with an organism called mycoplasma pneumoniae. Walking
pneumonia is most common between the ages of 5 and 15, and accounts for 70% of
pneumonias in children aged 9 to 15.

A decrease in energy level may be the earliest sign, followed by cold symptoms.
The person may complain of a headache, runny nose, and sore throat, and sometimes may
have a fever. Unlike a cold, it gradually gets worse over about two weeks, with an
increasingly moist cough and possible hoarseness as the disease settles into the chest.

Complications of pneumonia
Complications of pneumonia that may occur include buildup of fluid in the space
between the lung and chest wall (pleural effusion), pockets of pus that form in the space
between the lung and chest wall (empyema) or in the lung itself (lung abscess), secondary
bacterial lung infection after a viral infection, secondary infection, such as a vaginal
infection or infections of the digestive system, because of antibiotic therapy, bacteria in
the bloodstream (bacteremia) or throughout the body (septicemia), infection caused by
swelling of the covering of the spinal cord (meningitis), infection of a joint caused by
spread of bacteria through the bloodstream (septic arthritis), and infection of the heart
muscle or the sac surrounding the heart (endocarditis or pericarditis).

Abscesses in the lung are thick-walled, pus-filled cavities that are formed when
infection has destroyed lung tissue. They are frequently a result of aspiration pneumonia
if a mixture of organisms is carried into the lung. Abscesses can cause hemorrhage
(bleeding) in the lung if untreated, but antibiotics that target them have significantly
reduced their danger.

Failure can occur if pneumonia leads to mechanical changes in the lungs (called
ventilatory failure) or oxygen loss in the arteries (called hypoxemic respiratory failure).
Bacteremia (bacteria in the blood) is the most common complication of pneumococcus
infection, but rarely does this infection spread to other sites. Bacteremia is also a frequent
complication of infection with other gram-negative organisms, including Haemophilus
influenzae.

Signs and Symptoms of Pneumonia

The symptoms of pneumonia vary from mild to severe. Many factors affect how serious
pneumonia is, including the type of germ causing the infection and your age and overall
health.

See your doctor promptly if you:

• Have a high fever

• Have shaking chills
• Have a cough with phlegm, which doesn’t improve or worsens
• Develop shortness of breath with normal daily activities
• Have chest pain when you breathe or cough
• Feel suddenly worse after a cold or the flu

People with pneumonia may have other symptoms, including nausea (feeling sick to
your stomach), vomiting, and diarrhea.

Symptoms may vary in certain populations. Newborns and infants may not show any
signs of the infection or may vomit, have a fever and cough, or appear restless, sick, or
tired and without energy.

Older adults and people who have serious illnesses or weak immune systems may
have fewer and milder symptoms.

Symptoms of bacterial pneumonia

Symptoms of bacterial pneumonia can develop gradually or suddenly. Symptoms

include:

• High fever (up to 105 degrees)

• Drowsiness
• Rapid breathing
• Chills
• Cough with mucus (might be yellowish or have blood)
• Chest pain
• Blue tint on lips or under the nails (severe cases)
Symptoms of viral pneumonia

Early symptoms, which are similar to flu symptoms, include:

• Fever
• Dry cough
• Headache
• Sore throat
• Loss of appetite
• Muscle pain

Additional symptoms about a day later:

• High fever
• Cough with mucus
• Shortness of breath

Additional symptoms of severe cases:

• Extreme breathlessness
• Blue tint on lips or under the nails

DIAGNOSIS

A doctor who suspects pneumonia begins by taking a thorough medical history

and performing a physical examination. Bacterial pneumonias often come on suddenly;
creating a cough that produces mucous that is often colored or "rusty", fever, and pain
along the chest wall.

The Physical Examination

The most important diagnostic tool for pneumonia may be the stethoscope. In pneumonia,
as air passes through mucous and fluids in the lungs, it creates sounds called rales and
rhonchi. The doctor will strongly suspect pneumonia if rales are heard on one side of the
chest and while the patient is lying down.

The doctor may also tap lightly on the person's chest, a diagnostic tool called
"percussion". A dull thud instead of a hollow drum-like sound may indicate that the lung
has become firm and inelastic from inflammation, called consolidation; or that fluid may
be collecting in between the layers of the lung membrane, called pleural effusion.
Several tests may be ordered to help in the diagnosis:

• Chest x-rays may show signs of infection in the lungs. Different types of
pneumonia often will have different patterns on the x-ray.
• Blood and sputum tests may be performed to collect a specimen if the doctor
needs to determine the organism causing the pneumonia.
• A lung biopsy may be performed in severe cases.

TREATMENT

Treatment depends on the severity of symptoms and the type of organism causing
the infection.

Bacterial pneumonia (caused by the streptococcus pneumonia bacteria) is often

treated with penicillin, ampicillin-clavulanate (Augmentin) and erythromycin. Bacterial
pneumonia (caused by the hemophilus influenza bacteria) is treated with antibiotics, such
as cefuroxime (Ceftin), ampicillin-clavulanate (Augmentin), ofloxacin (Floxin), and
trimethoprim-sulfanethoxazole (Bactrim and Septra). Bacterial pneumonia (caused by
legionella pneumophilia and staphylococcus aureus bacteria) are treated with antibiotics,
such as erythromycin.

Viral pneumonia does not respond to antibiotic treatment. This type of pneumonia
usually resolves over time. If the lungs become infected with a secondary bacterial
infection, the doctor will prescribe an appropriate antibiotic to eliminate the bacterial
infection.

Mycoplasma pneumonia is often treated with antibiotics, such as erythromycin,

clarithromycin (Biaxin), tetracycline or azithromycin (Zithromax).

Risk factors
Adults age 65 or older and very young children, whose immune systems aren't fully
developed, are at increased risk of pneumonia. You're also more likely to develop
pneumonia if you:

 Have certain diseases.

These include immune deficiency diseases such as HIV/AIDS and chronic

illnesses such as cardiovascular disease, emphysema and diabetes.

 Smoke, or abuse alcohol.

Millions of microscopic hairs (cilia) cover the surface of the cells lining
your bronchial tubes. The hairs beat in a wave-like fashion to clear your airways
of normal secretions, but irritants such as tobacco smoke paralyze the cilia,
causing secretions to accumulate.
  Are hospitalized in an intensive care unit.

Pneumonia acquired in the hospital tends to be more serious than other

types of pneumonia.

 Are exposed to certain chemicals or pollutants.

Exposure to air pollution or toxic fumes can also contribute to lung

inflammation, which makes it harder for the lungs to clear themselves.

 Have had surgery or experienced a traumatic injury.

People who've had surgery or who are immobilized from a traumatic

injury have a higher risk of pneumonia because surgery or serious injuries may
make coughing — which helps clear the lungs — more difficult and lying flat can
allow mucous to collect in your lungs, providing a breeding ground for bacteria.

Prevention

You usually don't "catch" pneumonia from someone else. Instead, you develop the
disease because your immune system is temporarily weakened, often for no known
reason.

 Get vaccinated

Because pneumonia can be a complication of the flu, getting a yearly flu

shot is a good way to prevent viral influenza pneumonia, which can lead to
bacterial pneumonia. In addition, get a vaccination against pneumococcal
pneumonia at least once after age 55, and if you have any risk factors, every five
years thereafter.

A vaccine known as pneumococcal conjugate vaccine can help protect

young children against pneumonia. It's recommended for all children younger
than age 2 and for children 2 years and older who are at particular risk of
pneumococcal disease, such as those with an immune system deficiency, cancer,
cardiovascular disease or sickle cell anemia. Side effects of the pneumococcal
vaccine are generally minor and include mild soreness or swelling at the injection
site.

 Wash your hands

Your hands are in almost constant contact with germs that can cause
pneumonia. These germs enter your body when you touch your eyes or rub the
 inside of your nose. Washing your hands thoroughly and often can help reduce
your risk.

 Don't smoke

Smoking damages your lungs' natural defenses against respiratory

infections.

 Take care of yourself.

Proper rest and a diet rich in fruits, vegetables and whole grains along with
moderate exercise can help keep your immune system strong.

 Protect others from infection

If you have pneumonia, try to stay away from anyone with a

compromised immune system.
 TRINITYUNIVERSITY OF ASIA
ST.LUKES COLLEGE OFNURSING

MICROBIOLOGY ANDPARASITOLOGY

PNEUMONIA
A CASE STUDY

MARCH 09, 2009

PRESENTED BY:
Atanoza, MaryAnn
Balajadia, Precious Jem
Carmona, Ralph Kervin
Combes, Exxon
Cruz, Ralph Joseph