Pneumonia课件PPT推荐.ppt

1、Pneumonia,Definition,Pneumonia is an acute infection of the parenchyma of the lung（肺实质）,caused by bacteria,fungi（真菌）,virus,parasite（寄生虫）etc.Pneumonia may also be caused by other factors including X-ray,chemical,allergen,Epidemiology,The morbidity and mortality of pneumonia are high especially in old

2、 people.,Etiology,There are two factors involved in the formation of pneumonia,including pathogens and host defenses.,Classification,Classification of anatomyClassification of pathogenClassification of acquired environment,.Classification by pathogen,Pathogen classification is the most useful to tre

3、at the patients by choosing effective antimicrobial agents,Bacterial pneumonia,（1）Aerobic Gram-positive bacteria,such as streptococcus pneumoniae,staphy-lococcus aureus,Group A hemolytic streptococci（2）Aerobic Gram-negative bacteria,such as klebsiella pneumoniae,Hemophilus influenzae,Escherichia col

4、i（3）Anaerobic bacteria,Atypical pneumonia,Including Legionnaies pneumonia,Mycoplasmal pneumonia,chlamydia pneumonia.,Fungal pneumonia,Fungal pneumonia is commonly caused by candida（念珠菌）and aspergilosis（曲菌）.pneumocystis jiroveci（肺孢子虫）,Viral pneumonia,Viral pneumonia may be caused by adenoviruses,resp

5、iratory syncytial virus,influenza,cytomegalovirus,herpes simplex,Pneumonia caused by other pathogen,Rickettsias（a fever rickettsia）,（立克次体）parasites（寄生虫）protozoa（原虫）,.Classification by anatomy,1.Lobar（大叶性）:#Involvement of an entire lobe2.Lobular（小叶性）:#Involvement of parts of the lobe only,segmental o

6、r of alveoli contiguous to bronchi（bronchopneumonia）.3.Interstitial（间质性）,Lobar pneumonia,Lobular pneumonia,Interstitial pneumonia,Classification by acquired environment,Community acquired pneumonia，CAP（社区获得性肺炎）Hospital acquired pneumonia，HAP，NP（医院获得性肺炎）Nursing home acquired pneumonia,NHAP（护理院获得性肺炎）I

7、mmunocompromised host pneumonia,（ICAP）（免疫宿主低下肺炎）,Diagnosis（诊断步骤）,Give a definite diagnosis of pneumoniaTo evaluate the degree of the pneumoniaTo definite the pathogen of the pneumonia,Diagnosis,History and physical examination（5W）X-ray examinationPathogen identification,Differentiation,Pulmonary tub

8、erculosisLung cancerAcute lung abecessPulmonary embolismNoninfectious pulmonary infiltration,Pathogen identification,Sputum:#More than 25 white blood cells（WBCs）and less than 10 epithelial cells.Nasotracheal suctioningBAL,ETA,PSB,LABlood culture or pleural effusion cultureSerologic testing（immunolog

9、ical testing）Molecular Techniques,The principal of therapy,Select antibioticsAccording to guideline,Therapy,The therapy should always follow confirmation of the diagnosis of pneumonia and should always be accompanied by a diligent effort to identify an etiologic agent.Empiric therapy,（4-8h）Combined

10、empiric therapy to target therapy,It is important to evaluate the severity degree of pneumonia,The critical management decision is whether the patient will require hospital admission.It is based on patient characteristics,comorbid illness,physical examinations,and basic laboratory findings.,The diag

11、nostic standard of sever pneumonia,Altered mental statusPa0230/min Blood pressure90/60mmHgChest X-ray shows that bilateral infiltration,multilobar infiltration and the infiltrations enlarge more than 50%within 48h.Renal function:#U20ml/h,and 80ml/4h,CAP（社区获得性肺炎）,CAP refers to pneumonia acquired outs

12、ide of hospitals or extended-care facilities.Streptococcus pneumoniae remains the most commonly identified pathogen.Other pathogens include Haemophilus influenzae,mycoplasma pneumoniae,Chlamydophilia pneumoniae,Moraxella catarrhalis and ects.Drug resistance streptococcus pneumoniae（DRSP）,Clinical ma

13、nifestation,The onset is accuteRespiratory symptomsExtrapulmonary symptoms,signs,Consolidation signsMoist ralesRespiratory rate or heart rate,Laboratory examination,WBCX-ray features,Diagnosis,Clinical diagnosisPathogen diagnosisEvaluate the severity degree of pneumonia,Therapy,Antiinfectious therap

14、y（Combined empiric therapy to target therapy）Supportive therapy,Empiric therapy（1）,Outpatient60 years old and no comorbid diseasesCommon pathogens:#S pneumoniaes,M pneumoniae,C pneumoniae,H influenzae and viruses,A new generation macrolideA beta-lactam:#the first generation cephlosporinA fluoroquino

15、lone,Empiric therapy（2）,Outpatient65 years old or having comorbid diseases or antibiotic therapy within last 3 monthsCommon pathogens:#S pneumoniae（drug-resistant）,M pneumoniae,C pneumoniae,H pneumoniae,H influenzae,Viruses,Gram-negative bacilli and S aureus,A fluoroquinoloneA beta-lactam/beta-lacta

16、mase inhibitorThe second generation cephalosporin or combination of a macrolide,Empiric therapy（3）,Inpatient:#Not severely ill.Common pathogen:#S pneumoniae,H influenzae,polymicrobial,Anaerobes,S aureus,C pneumoniae,Gram-negative bacilli.,The second or third generation cephalosporin plus A macrolideA beta-lactam/betalactamase inhibitor.A newer fluoroquinolone,Empiric therapy（4）,Inpatient severely illCommon pathogens:#S pneumoniae,Gram-negative bacilli,M pneumoniae,S aureus and viruses,The second or third