Pneumonia
Posted on 03. Jan, 2012 by afyakenya in Blog
Bacterial pneumonia is caused by a pathogenic infection of the lungs and may present as a primary disease process or as the final coup de grace in the individual who is already debilitated. For example, historical review of the 1918-19 influenza pandemic in the United States suggests that the majority of deaths were not a direct effect of the influenza virus, but they were from bacterial co-infection.
Community-acquired pneumonia (CAP) is defined as pneumonia that develops in the outpatient setting or within 48 hours of admission to a hospital.
Health-Care Associated Pneumonia (HCAP) is defined as pneumonia that develops in the outpatient setting or within 48 hours of admission to a hospital in patients with increased risk of exposure to Multi-Drug Resistant (MDR) bacteria as a cause of infection.
Risk factors for exposure to MDR bacteria in HCAP include the following:
-Hospitalization for 2 or more days in an acute care facility within 90 days of current illness.
-Exposure to antibiotics, chemotherapy, or wound care within 30 days of current illness.
-Residence in a nursing home or long-term care facility.
-Hemodialysis at a hospital or clinic.
-Home nursing care (infusion therapy, wound care.)
-Contact with a family member or other close person with infection due to MDR bacteria.
Nosocomial infections are generally described as those acquired in the hospital setting.
Aspiration pneumonia develops after the inhalation of oral secretions and colonized organisms. The term aspiration pneumonia refers specifically to the development of an infectious infiltrate in patients who are at increased risk of oropharyngeal aspiration.
As previously discussed, patients at increased risk of aspiration are also at increased risk of developing pneumonia secondarily. Associated factors are as follows:
-Alcoholism.
-Altered mental status.
-Gastroesophageal reflux disease (GERD.)
-Seizure disorder.
The clinical presentation of bacterial pneumonia varies. Sudden onset of symptoms and rapid illness progression are associated with bacterial pneumonias. Chest pain, difficulty in breathing, coughing up blood , decreased exercise tolerance, and abdominal pain from pleuritis are also highly indicative of a pulmonary process.
The presence of cough, particularly cough productive of sputum, is the most consistent presenting symptom.
Nonspecific symptoms such as fever, rigors or shaking chills, and malaise are common. For unclear reasons, the presence of rigors may suggest pneumococcal pneumonia more often than pneumonia caused by other bacterial pathogens. Other nonspecific symptoms that may be seen with pneumonia include headache, abdominal pain, nausea, vomiting, diarrhea, anorexia and weight loss, and altered mental status.
Administration of influenza vaccine decreases fall and/or winter risk of viral influenza, which decreases the risk of bacterial superinfection. This vaccine is especially important in patients who are elderly and in those with comorbidity
A number of preventative strategies have been applied in the prevention of nosocomial pneumonia. Some of these probably are effective or promising, and some are currently being evaluated.
The efficacious regimens are hand washing and isolation of patients with multiple resistant respiratory tract pathogens. Hand washing between patient contacts is a basic and often neglected behavior by medical personnel.
Potential complications of bacterial pneumonia include the following:
-Destruction and fibrosis/organization of lung parenchyma, with scarring potential.
-Bronchiectasis.
-Necrotizing pneumonia.
-Frank cavitation.
-Empyema.
-Pulmonary abscess.
-Respiratory failure.
-Acute respiratory distress syndrome.
-Ventilator dependence.
-Superinfection.
-Death.
Kind regards,
Oduwo Noah Akala
Executive Chairman,
Afya Kenya Foundation.
www.afyakenyafoundation.org
“Providing Care That Cares!”
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