Question

A 64-year-old retired postal worker with a medical history of extensive facial reconstruction for squamous cell carcinoma of the head and neck and a 10 year history of smoking, presented with progressive shortness of breath, productive cough, purulent sputum, and a fever of 39 C 2 days prior to admission to the hospital   On physical examination at the hospital, he had a temperature of 37.3 C, respiratory rate of 18/min, pulse rate of 103 beats/min, blood pressure of 154/107 mm Hg, and pO2 of bibasilar fine crackles. He was seen to have a left lower lobe infiltrate on chest radiograph. His admission white blood count (WBC) was 10,600 with 70% neutrophils, and his hemoglobin was 9.4. Sputum gram stain at admission revealed > 25 polymorphonuclear cell. Two blood cultures obtained at admission revealed the organism grew on blood agar and showed α-hemolysis with optichin (Taxo-P) sensitivity. The gram stain demonstrated gram positive cocci in chain arrangement.   It should be noted that this is the patient’s third episode of this illness in the past month.  Bacterial isolates from all three episodes belonged to the same serotype (type 23). He had been treated with a 10 day dose of Clarithromycin.

case study

epiduology

pathogenesis

clinical manification

lab test and treatment

Answer 1

#. Condition - Pneumonia

It is the result of an inflammatory process that primarily affects the gas exchange area of the lung . In response to inflammation, fluid and RBC's from capillaries pour into the alveoli

Leukocytes (or WBCs)and macrophages move into the affected area to kill the bacteria that is causing the infection.

#. The major pathologic changes in pneumonia :-

inflammation of alveoli

alveolar consolidation

Atelectasis

It is estimated that more than how many die from pneumonia each year 60,000

Pneumonia is specially life threatening in individuals whose lungs are already damaged from COPD, asthma, or smoking

Risk of death is higher among those with ,heart disease, diabetes, or a weakened immune system.

Causes for pneumonia include :-

bacteria, viruses, fungi, tuberculosis, anaerobic organisms, aspiration, and the inhalation of irritating chemicals

#. Pathophysiology of pneumonia

-Exudate decreases both ventilation and diffusion: Secretions cause partial occlusion of bronchi or alveoli

-Thickening of alveolar wall

-Hypoventilation because ventilation/perfusion mismatch- blood leaves lungs poorly oxygenated resulting in arterial hypoxemia.

-Fibrin and edema from inflammation may lead to stiff lung with decreased compliance and decreased vital capacity/scarring of the lung

#. Common Manifestations of pneumonia

-Fever

-Orthopnea

-Poor appetite

-Diaphoresis

-Fatigue

-Hypoxemia

#. Two criteria that should be present for diagnosis:

-Symptoms (cough, fever, pleuritic chest pain, purulent sputum, etc.) and signs of lower respiratory tract infection (mean duration of 6 days at presentation in one study)

-Radiographic infiltrate (chest x-ray or CT scan)- if you don't see an infiltrate on CT- it is highly unlikely that they have pneumonia

#. Two criteria that should be present for diagnosis:

Caveats

-Criteria are not 100% specific for pneumonia (mimicking conditions exist)

-Chest x-rays can be negative (12% in one study of patients with pneumococcal pneumonia*), but CT scans should not be.

#. Treatment include :-

Antibiotics

Fluids

Oxygen therapy

Rest

Mechanical ventilation if required