4. 2 : Etiological classfication. the cause of pneumonia in patient is often difficult to determine because direct culture of lung tissue invasive and rarely performed. - culture obtained from upper respiratory tract or sputum genenally not accurately. PNEUMONIA

7. PNEUMONIA - Viral -Common Respiratory syncytial virus Parainflueza type 1 – 3 Influeza A . B Adenovirus Metapneumovirus - Un Common Rhinovirus Enterovirus Neonates Herpes simplex Neontes Cytomegalovirus Immunosuppressed person. Measles Varicella Hantavirus Sars agent.

8. -Fungal. Histoplasma capsulatum  Bird bat contact Cryptococcus neoformans  Bird contact. Aspergillus species  Immunosuppressed. Mucomycosis  Immunosuppressed Coccidioides immitis Blastomyces dermatitides PNEUMONIA - Rickettsial Coxiella burnetii  Goat sheep cattle exposure Rickettsia rickettsiae

10. PNEUMONIA Mycoplasma pneumoniae S. pneumoniae Chlamydia pneumoniae H . Influenza Influenza viruses adenovirus. > 18 yr Mycoplasma pneumoniae S. pneumoniae Chlamydia pneumoniae H . Influenza Influenza viruses adenovirus 5 – 18 yr Influenza viruses para fluenza viruses adenovirus S. pneumoniae H . Influenza Mycoplasma pneumoniae Chlamydia pneumoniae Group A straptococcus S . Aureus. 2 – 5 yr R.S.V Influenza viruses para fluenza viruses adenovirus S. pneumoniae H . Influenza Chlamydia trachomatis Mycoplasma pneumoniae Group A straptococcus 3 – 12 mo Chlamydia trachomatis Mycoplasma hominis cytomegalovirus. Afebrile Pneu Rsv . Influenza viruses para fluenza viruses – adenovirus S. pneumoniae . H . influenza 1-3 mo febrile Pneu Group B straptococcus – E coli streptococcus Pneumoniae – H influeza. Neonate <1mo Frequent Pathogens Age group

16. PNEUMONIA

20. PNEUMONIA Following changes stages: 1- congestion alveoli are failed with edema fluid and organism. 2- red hepatization alveoli contain polymorph RBCs fibrin edema and organism. 3-grey hepatization deposition of fibrin over the pleural surface phagocytosis starts inside the alveoli which are now filled with polymorph and fibrin. 4-resolution: neutrophil degenerate fibrin thread and remaining bacteria and digested and removed by phagocyte Clinical Manifestation Viral & bacterial pneumonia are often preceded by several day of symptoms of URTI typically rhinitis and cough. In viral pneumonia: fever is usually present lower than in bacteria. Tachypnea increased work of breathing accompanied by intercostal, subcostal and suprasternal retraction nasal flaring and use of accessory muscle. Severe infection accompanied by cyanosis and respiratory fatigue in infant. Auscultation of chest wheezing and crackle

21. PNEUMONIA In bacterial pneumonia: Sudden shaking chill followed high fever, cough, grunting, chest pain, drowsiness, rapid respiration, dry cough, anxiety circumoaral cyanosis. Physical finding: Depends on the stage of pneumonia diminished breath sound scattered crackels and rhonchi over affected lung. Increasing consolidation or complication. As effusion empyema or pyopneumothorax dullness on percussion and breath Sound. Diminished abdominal distension because of gastric dilation from swallowed air or ileus. Abdominal pain in lower lobe pneumonia Liver may seem enlarged because downward of diaphragm secondary to hyper inflation of lung Neck rigidity without meningitis in right upper lobe.

25. PNEUMONIA Deterioration in clinical status antibiotic therapy should be initiated Response to treatment: Patient with uncomplicated bacterial pneumonia respond to therapy with improvement in clinical symptom (fever, cough, tachypnea, chest pain) within 48-96 hrs. Slowly resolving pneumonia 1- complication as empyema. 2- bacterial resistance. 3- non bacterial etiology as viruses and aspiration of foreign bodies or food. 4- bronchial obstruction from endobronchial lesion foreign body or mucus plug. 5- pre-existing diseases such as immunodeficiencies- ciliary dyskinesia- cysticfibrosis pulmonary sequestration cystic adenomatoid malformation. 6- non infectious causes: - bronchoilitis obliterans. - hypersensitivity pneumonitis - eosinophils pneumonia - aspiration - wegener granulomatosis

26. PNEUMONIA Complication: Usually result of direct spread of bacterial infection within thoracic cavity. (pleural effusion- empyema- pericarditis) or bacteremia and hematologic spread meningitis suppurative arthritis osteomyelitis

27. X-RAYS Viral pneumonia x-ray

28. X-RAYS Lobar pneumonia x-ray (RUL)

29. X-RAYS bronchopneumonia x-ray

30. X-RAYS Staph pneumonia x-ray

31. THANKS ALOT