内科学英文课件：Pneumonia.ppt

Pneumonia,Definition, Pneumonia is an acute infection of the parenchyma (实质)and interstitial (间质) of the lung, 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 people.,Classification,Classification of anatomyClassification of pathogenClassification of acquired environmentClassification of the disease course,.Classification by pathogen,Pathogen classification is the most useful to treat 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 coli(3) Anaerobic bacteria,Atypical pneumonia,Including Legionnaies pneumonia（军团菌）,Mycoplasmal pneumonia（支原体） ,chlamydia pneumonia（衣原体）.,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, respiratory 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 or 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（医院获得性肺炎）Health-care associated pneumonia,HCAP (健康护理相关性肺炎）Immunocompromised host pneumonia,(ICHP)(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(5W) and physical examinationX-ray examinationPathogen identification,Pathogen identification,Sputum: More than 25 white blood cells (WBCs) and less than 10 epithelial cells.Nasotracheal suctioningBAL(支气管肺泡盥洗), ETA(经人工气道内吸引), PSB(防污染样本毛刷), LA(经胸壁穿刺肺吸引)Blood culture or pleural effusion cultureSerologic testing (immunological testing)Molecular Techniques,Differentiation,Pulmonary tuberculosisLung cancerAcute lung abecessPulmonary embolismNoninfectious pulmonary infiltration,evaluate the degree of the pneumonia,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 diagnostic 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,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 empiric therapy to target therapy,CAP (社区获得性肺炎）,CAP refers to pneumonia acquired outside 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)MRSA,Clinical manifestation,The onset is accuteRespiratory symptomsExtrapulmonary symptoms,signs,Respiratory rateConsolidation signsMoist ralesheart rate,Laboratory examination,WBCCRPPCTX-ray featuresChest CT,X-ray features,Diagnosis,Clinical diagnosisPathogen diagnosisEvaluate the severity degree of pneumonia,Clinical diagnosis,1. X-ray features2. Clinical features: fever 3. Clinical features: cough with sputum4. Signs: consolidation signs and moist rales5. WBC1+25; Except other respiratory diseases,The diagnostic standard of sever pneumonia,CURB-65Altered mental statusUreamia: BUN7mmol/LRespiratory rate30/minBlood pressure90/60mmHgAge65year,Therapy,Antiinfectious therapy (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 fluoroquinolone,Empiric therapy (2),Outpatient65 years old or having comorbid diseases Common 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-lactamase inhibitorThe second generation cephalosporin or combination of a。