Biological Sciences
Bacterial Pneumonia
Bacterial pneumonia is a type of lung infection caused by bacteria, leading to inflammation and fluid accumulation in the air sacs of the lungs. Common symptoms include cough, fever, difficulty breathing, and chest pain. Treatment typically involves antibiotics to target the specific bacteria causing the infection, and in severe cases, hospitalization may be necessary for supportive care.
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12 Key excerpts on "Bacterial Pneumonia"
eBook - PDF- Mark S. Parker, Melissa L. Rosado-de-Christenson, Gerald F. Abbott(Authors)
- 2012(Publication Date)
- Thieme(Publisher)
Section v Pulmonary Infections and Aspiration Pneumonia 263 ovErvIEw oF CoMMon Bacterial PneumoniaS Bacterial Pneumonia is an inflammatory process that usually affects the distal air spaces (e.g., respiratory bronchioles, alveolar ducts, and alveoli) but may also involve the trachea, bronchi, and larynx. Primary bac-terial pneumonia can be caused by inhalation of aerosolized organisms (e.g., M. tuberculosis, L. pneumoph-ila ) or can result from aspiration of contaminated oropharyngeal secretions . Secondary Bacterial Pneumonia results from hematogenous dissemination of infection from one organ to another—for example, endocarditis leading to staphylococcal lung abscesses. The upper respiratory tract is the source of both most community-acquired and nosocomial pneumonias . The most common causes of community-acquired pneumonia in non-hospitalized patients include M. pneumoniae, C. pneumoniae , and various viruses ( Table V.1 ). Those organisms causing more severe illness, often requiring hospitalization, include S. pneumoniae, S, aureus, H. influenza, M. pneumoniae, C. pneumoniae, L. pneumophila, Klebsiella pneumoniae , and the influenza virus ( Table V.1 ). Nosocomial pneumonias are most often associated with methicillin-resistant S. aureus (MRSA), P. aeruginosa , enteric Gram-negative bacilli, anaerobes, and A. baumannii ( Table V.1 ). Potential risk factors for nosocomial pneumonia include advanced age, immunosuppression, altered states of consciousness or neurologic insults predisposing to aspiration, and colonization and contamination of respiratory and other medical equip-ment, which is especially prevalent in many ICUs. Many patients with underlying chronic diseases, especially chronic lung diseases, and other particular risk factors or behaviors, are also prone to Bacterial Pneumonias often associated with specific organisms.
eBook - PDF- Derek J. Chadwick, Jamie A. Goode, Derek J. Chadwick, Jamie A. Goode(Authors)
- 2007(Publication Date)
- Wiley(Publisher)
M. tuberculosis is a common cause of pneumonia in the developing world and is one of the leading causes of death worldwide; however it is an uncommon cause of pneumonia in the developed world, probably because of better hygiene and effective strategies for anti-tuberculous therapy. Immunization in the developed world against H. influenzae type b (Watt et al 2003) and S. pneu-moniae (Lucero et al 2004) has virtually eliminated the former and has decreased the prevalence of the latter. However, infections with these agents are still preva-lent in the developing world, and even after pneumococcal immunization, are caused by serotypes not contained in the vaccine. Bacterial Pneumonia is often (but not always) lobar, but the aetiology usually cannot be established, as culture of the throat does not reveal the pathogen. The only ways to establish the aetiology is by blood culture (which may be positive in up to 25% of cases of pneumococcal pneumonia), by paracentesis of pleural effusions or by transcutaneous lung punc-ture. The latter procedure is rarely used, having been replaced by bronchoscopy or open lung biopsy. These latter procedures are reserved for the most serious cases and are rarely performed. Hospital-acquired pneumonia can be caused by the same agents as those from the community, but the list of other pathogens is very broad (Lynch 2001). 46 SPEERT Hospitalized patients are exposed to a wide range of potentially infectious agents from other patients, and their capacity to resist infection with agents of lower intrin-sic virulence is often diminished. For instance, respiratory pathogens may be spread by droplet or aerosol if proper infection control practices are not followed. Patients who are mechanically ventilated via an endotracheal tube are at greatly enhanced risk for Bacterial Pneumonia (Shaw 2005).
eBook - ePub- Lourdes R. Laraya-Cuasay, Walter T. Hughes, Jr.(Authors)
- 2019(Publication Date)
- CRC Press(Publisher)
Chapter 11Bacterial Pneumonia OF INFANTS AND CHILDREN Fred F. BarrettTable of Contents
- I. Introduction
- II. Etiology
- III. Pathogenesis
- IV. Clinical Features
- A. Pneumococcal Pneumonia
- B. Hemophilus Influenzae Pneumonia
- C. Staphylococcal Pneumonia
- D. Miscellaneous Etiologic Agents
- V. Diagnosis
- VI. Radiographic Features
- VII. Treatment
- VIII. Complications
- IX. Course and Prognosis
- References
I. Introduction
Bacterial Pneumonia is an inflammatory process of the lung which may involve interstitial tissue and/or pleura at some point in its evolution but by definition always progresses to alveolar consolidation with inflammatory cells and bacteria.1II. Etiology
Hospitalization for lower respiratory infection has declined in the U.S. in recent years due to a variety of factors including the advent of antibiotics, earlier treatment of respiratory infections, and access to medical care by an increasing proportion of the pediatric population. However, bacterial lower respiratory infection continues to account for a significant number of hospital admissions. In the 3 year period 1982 to 1984, etiologically confirmed Bacterial Pneumonia accounted for 0.2/100 admissions to LeBonheur Children’s Medical Center in Memphis, Tennessee. The frequency of bacteria as etiologic agents of lower respiratory infection varies from 10 to 50% depending upon the method of patient selection, age range of the study population, and the type of diagnostic procedures employed.2 ,3In studies of large pediatric populations employing a wide range of viral and bacteriologic diagnostic techniques, an etiologic agent was established in approximately 50% of patients with lower respiratory infection and bacteria accounted for 10 to 15% of cases.4 Viruses predominate over the entire pediatric age range, but are especially prominent during the first 6 months of life. The highest frequency of Bacterial Pneumonia (10 to 15%) is seen in the age group 6 months through 4 years. In studies in which patients were highly selected and in which invasive diagnostic procedures (needle lung aspirate and thoracentesis) as well as blood cultures were employed, a bacterial diagnosis was established in from 30 to 50% of cases.2 ,3 ,5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 and 13
eBook - PDF- Deepak M. Kamat(Author)
- 2017(Publication Date)
- American Academy of Pediatrics(Publisher)
P 876 Pneumonia DEFINITION ■ ■ Community-acquired pneumonia (CAP) is acquired outside the hospital environment. ■ ■ Nosocomial pneumonia is acquired in the hospital environment. ■ ■ The World Health Organization has defined pneumonia on the basis of clinical findings because chest radiology is not readily accessible in many parts of the world. ■ ■ The pathology of pneumonia is described as lobar, bronchopneumonia, interstitial, or miliary. SIGNS AND SYMPTOMS Signs and Symptoms That Suggest the Diagnosis ■ ■ The microbiologic diagnosis of pneumonia is difficult to prove in many cases without extensive investigation. • It is helpful to be aware of which organisms are in the community at the time. ■ ■ The age of the child will suggest the most likely cause ( Table 1 ). ■ ■ Infant to school age (1–4 years). • After 1 month of age, cough is the most common presentation. • Fever. ■ — Significant fever is usually present in Bacterial Pneumonia. ■ — In viral or atypical infections fever may be low grade. ■ — However, height of fever is a poor indicator of etiology. • Respiratory syncytial virus (RSV) is the most common pathogen. ■ — In children >2 years, RSV does not cause lower respiratory tract infection except in immunocompromised (especially transplant) patients. • Parainfluenza type 3 occurs year-round, with peaks in the spring. • Types 1 and 2 are typically seen in the fall. ■ ■ 5 years of age to adolescence. • The most common presentation is cough and fever, which is very nonspecific. • The appearance of the child will aid in arriving at the diagnosis of pneumonia. ■ — Signs of respiratory distress, including retractions and nasal flaring ■ — Abnormal auscultation Bacterial ■ ■ Pneumococcal pneumonia • May be preceded by a mild upper respiratory infection (URI). • Examination of the chest may not be abnormal in the infant and young child.
eBook - PDFChest Radiology: A Resident's Manual
A Resident's Manual
- Johannes Kirchner(Author)
- 2011(Publication Date)
- Thieme(Publisher)
3.2 Classification of the pneumonias. The pneumonias can be classified according to pathologic, epidemiologic, and radiologic criteria. As these criteria overlap, the terminology can be rather confusing. Notes on Pathology and Epidemiology Like tracheitis, bronchitis, and bronchiolitis, the pneumonias are also infectious diseases (caused by bacteria, mycoplasmata, viruses, and other pathogens) involving the pulmonary parenchyma. Pneu-monias manifest themselves with exudates in the interstitium and alveolar space. In addition to the pathoanatomic classification in primarily alveolar and interstitial forms, pneumonias can also be classified according to clinical and epidemiologic criteria or accord-ing to the spectrum of pathogens ( Fig. 3.2 ). Classification of pneumonias. The advances in modern chemo-therapy and antibiotic treatment have reduced the mortality of in-fectious pulmonary diseases in the generations since the Second World War. However, they have not led to a lower incidence of bronchitis or pneumonia. Accordingly, the annual incidence of new cases of pneumonia in Germany is 200 000, of which 100 000 re-present hospital-acquired infections. The following classification should be observed with respect to the spectrum of pathogens: Community-acquired versus hospital-acquired (nosocomial) Secondary versus primary Presence versus absence of an underlying disorder In cases of community-acquired pneumonia without an underlying disorder, even today pathogens include mainly pneumococci and Haemophilus . In 50% of all cases the etiology remains unclear. Hospi-tal-acquired pneumonia occurs in up to 70% of all intensive care patients. These infections have a mortality of 10 – 20%. The most common pathogens include: Pseudomonas Staphylococcus aureus Enterobacter Viral pneumonias account for a share of less than 20%. 3 Pneumonia 102 Fig. 3.4 Bronchopneumonia. The patient is a 75-year-old man with a long history of COPD.
eBook - PDF- Michael Galanski(Author)
- 2010(Publication Date)
- Thieme(Publisher)
Definition ............................................................................................ Pneumonia acquired in normal, daily life. Epidemiology Diagnostic microbiologic evaluation is carried out in less than 30% of cases of community-acquired pneumonia; the pathogen can be positively identified in only 5% of cases · Pneumococci ( Streptococcus pneumoniae ), Mycoplasma pneu-moniae, Haemophilus influenzae, Chlamydia pneumoniae , and viruses (adenovi-rus, respiratory syncytial virus) are the most common pathogens; less common pathogens include Legionella pneumophila, Staphylococcus aureus, Klebsiella pneumoniae · Protozoans and fungi are practically never the cause · The spec-trum of pathogens varies depending on seasonal, geographic, socioeconomic, and intrinsic factors (age, comorbidity). Etiology, pathophysiology, pathogenesis These depend on the pathogen. Pneumococci, Klebsiella, Legionella , and Myco-plasma typically cause lobar consolidation. Haemophilus influenzae and staphylo-cocci cause bronchopneumonic infiltrates, and viruses and mycoplasmas cause interstitial or mixed interstitial-alveolar infiltrates. Imaging Signs ............................................................................................ Modality of choice Radiographs · CT is indicated only where findings are equivocal or there is clini-cal suspicion but no radiographic correlate. Radiographic findings Homogeneous, nonsegmental area of opacification with a pleural interface and alveolar and/or lobar infiltrates · Ill-defined focal heterogeneous opacities in a segmental configuration with bronchopneumonic infiltrates. CT findings Findings are similar to radiography · CT is more sensitive in detecting associated findings (multifocal manifestation, pleuritis, liquefaction). Pathognomonic findings See “ Radiographic findings. ” Clinical Aspects ............................................................................................
eBook - PDFInfectious Diseases
An evidence based approach
- Vikas Mishra(Author)
- 2019(Publication Date)
- Delve Publishing(Publisher)
Diagn Microbiol Infect Dis. 2008;60(3):255–61. 11. Johansson N, Kalin M, Tiveljung-Lindell A, Giske CG, Hedlund J. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010;50(2):202–9. 12. Luchsinger V, Ruiz M, Zunino E, Martinez MA, Machado C, Piedra Etiology of Community-Acquired Pneumonia and Diagnostic Yields of... 381 PA, et al. Community-acquired pneumonia in Chile: the clinical relevance in the detection of viruses and atypical bacteria. Thorax. 2013;68(11):1000–6. 13. Sangil A, Calbo E, Robles A, Benet S, Viladot ME, Pascual V, et al. Aetiology of community-acquired pneumonia among adults in an H1N1 pandemic year: the role of respiratory viruses. Eur J Clin Microbiol Infect Dis. 2012;31(10):2765–72. 14. Huijskens EG, van Erkel AJ, Palmen FM, Buiting AG, Kluytmans JA, Rossen JW. Viral and bacterial aetiology of community-acquired pneumonia in adults. Influenza Other Respi Viruses. 2013;7(4):567– 73. 15. van Gageldonk-Lafeber AB, Wever PC, van der Lubben IM, de Jager CP, Meijer A, de Vries MC, et al. The aetiology of community-acquired pneumonia and implications for patient management. Neth J Med. 2013;71(8):418–25. 16. Templeton KE, Scheltinga SA, van den Eeden WC, Graffelman AW, van den Broek PJ, Claas EC. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis. 2005;41(3):345–51. 17. Pavia AT. What is the role of respiratory viruses in community-acquired pneumonia?: What is the best therapy for influenza and other viral causes of community-acquired pneumonia? Infect Dis Clin North Am. 2013;27(1):157–75. 18. File Jr TM. New diagnostic tests for pneumonia: what is their role in clinical practice? Clin Chest Med. 2011;32(3):417–30. 19. Kirkpatrick MB, Bass Jr JB. Quantitative bacterial cultures of bronchoalveolar lavage fluids and protected brush catheter specimens from normal subjects.
eBook - PDF- (Author)
- 2014(Publication Date)
- European Respiratory Society(Publisher)
Conclusion Pneumococcal pneumonia is an infrequent but severe consequence of frequent bacterial exposure. Immune defence is usually effective at containing carriage but struggles in the face of full blown 55 CHAPTER 4: PATHOPHYSIOLOGY OF PNEUMOCOCCAL PNEUMONIA infection. Modern scientific methods have generated information likely to lead to new vaccines and treatments. Acknowledgements We would like to acknowledge A. Kadioglu (Institute of Infection and Global Health, University of Liverpool, Liverpool, UK) for taking the time to critically appraise this manuscript. Support Statement D.G. Wootton is a fellow of the UK National Institute of Health Research (NIHR) supported by a Doctoral Research Fellowship. S.J. Aston has received a report grant from the Wellcome Trust (grant 099962). Statement of Interest None declared. References 1. White B, Robinson ES, Barnes LA, eds. The Biology of Pneumococcus. The Bacteriological, Biochemical, and Immunological Characters and Activities of Diplococcus pneumoniae . New York, The Commonwealth Fund, 1938. 2. van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet 2009; 374: 1543–1556. 3. Kadioglu A, Weiser JN, Paton JC, et al. The role of Streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nat Rev Microbiol 2008; 6: 288–301. 4. Gritzfeld JF, Wright AD, Collins AM, et al. Experimental human pneumococcal carriage. J Vis Exp 2013; 15: pi, 50115. 5. Wu HY, Virolainen A, Mathews B, et al. Establishment of a Streptococcus pneumoniae nasopharyngeal colonization model in adult mice. Microb Pathog 1997; 23: 127–137. 6. Ogunniyi AD, LeMessurier KS, Graham RMA, et al. Contributions of pneumolysin, pneumococcal surface protein A (PspA), and PspC to pathogenicity of Streptococcus pneumoniae D39 in a mouse model. Infect Immun 2007; 75: 1843–1851. 7. Bogaert D, de Groot R, Hermans PW. Streptococcus pneumoniae colonisation: the key to pneumococcal disease.
eBook - PDF- Andrew M. Churg, Jeffrey L. Myers, Henry D. Tazelaar, Joanne L. Wright(Authors)
- 2011(Publication Date)
- Thieme(Publisher)
These organisms are dis-tinctly bacterial, based on their 16S ribosomal subunit gene sequences, and are capable of extracellular replica-tion, although growth occurs slowly with a doubling time up to 20 times longer than the more conven-tional bacteria. Complex media is required for success-ful culture. 191 194 Thurlbeck’s Pathology of the Lung FIGURE 7 -23 Legionnaires’ disease. There is necrosis of the intraalveolar exudates, but the alveolar walls remain intact ( 750). FIGURE 7 -24 Legionnaires’ disease. Bac-teria are mainly intracellular (Dieterle’s silver stain, 2500). The organism attaches to ciliated respiratory epithelial cells via a specialized terminal filament that can be seen using electron microscopy in experimental models and occasionally in clinical material. 192 Replication occurs at this site, with the organism being shed in secretions as long as a week prior to development of symptoms. Mycoplasma pneumoniae infection is typically a disease of otherwise healthy adolescents and young adults, and is estimated to be a common pathogen in this population. 193 Approximately 20% of infections are asymptomatic. The majority of symptomatic infections are either mild upper respiratory tract infections or tracheobronchitis, but about 5 to 10% of infections result in pneumo-nia. 193,194 Contagion within families or closed populations is common, leading to miniepidemics. 193,195 – 198 Although M. pneumoniae tends to affect patients under the age of 40 years, 25% of cases are seen in older age groups, and there is some evidence that this population has a higher frequency of complicated infection. 191,198 M. pneumoniae has been estimated to cause 15% of cases of pneumonia in patients over 40 years of age, and may exacerbate symp-toms of underlying asthma or chronic obstructive lung disease.
eBook - PDFLife with the Pneumococcus
Notes from the Bedside, Laboratory, and Library
- Robert Austrian(Author)
- 2016(Publication Date)
One of the discussants of the 132 Life with the Pneumococcus earlier paper commented: I have only one remark to make: it seems to me a most valuable paper. I want to suggest that it ought to stimulate us in every way to try to find some means of preventing—if we cannot cure it. Age and Defense Mechanisms, with Special Reference to Pneumonia The reasons for the increased incidence of pneumonia which accompanies the latter decades of life have not been delineated clearly. The defenses of the normal lung against bacterial invasion are multiple and efficient, and bacteria inhaled in droplets small enough to reach the pulmonary alveoli of experi-mental animals are usually cleared without the development of significant pul-monary lesions.' 5 Only when the epithelial lining of the lower repiratory tract is altered by viral, chemical or physical injury or when pulmonary edema, local or general, develops is Bacterial Pneumonia likely to ensue. 16 It was rec-ognized more than a century ago 3 and confirmed in modern times' 7 that sig-nificant changes in the ventilatory apparatus take place with advancing age, changes which undoubtedly interfere with the cleansing of the respiratory tract and increase vulnerability to pulmonary infection. Aspiration of food and drink by the debilitated, especially when ingesting either in the supine position, may well be the initiating factor of pneumonia. 18 Much attention has been given to the effect of age on the host's defensive mechanisms against infection. Although alterations with age both of humoral and of cellular functions can be demonstrated, no single factor has emerged as the one responsible for either the increased morbidity or the mortality from infection in later life. 19-21 There is a clear need to study a large cohort of sub-jects over a period of several decades, and to attempt to relate quantitatively a number of host defenses to the clinical history of each subject.
eBook - PDF- Mark S. Parker, Melissa L. Rosado-de-Christenson, Gerald F. Abbott(Authors)
- 2011(Publication Date)
- Thieme(Publisher)
Because alveolar air is replaced by exudate, there is little volume loss. Pneumococcal pneumonia is the prototype of lobar or airspace pneumonia. Clinical Findings Seventy percent of patients that develop pneumococcal pneumonia have had a recent upper respiratory tract infection. Additionally, pneumococcal pneumonia often complicates influenza. In fact, it is the most common Bacterial Pneumonia that occurs following infection with influenza. Patients with pneumococcal pneumonia often present with an abrupt onset of rigors, followed by fever, cough productive of rusty sputum, dyspnea, and pleuritic chest pain. Leukocytosis is usually present, but severe infection may be associated with white blood counts of less than 3000 cells/mm 3 . Metastatic infection (e.g., endocarditis, meningitis, arthritis), pericarditis, and rarely empyema may occur as complications of pneumococcal pneumonia. Pathology GROSS • Lobar consolidation MICROSCOPIC • Pulmonary infiltration by neutrophils • Inflammatory exudate surrounded by edema Imaging Findings RADIOGRAPHY • Homogeneous, nonsegmental, parenchymal consolidation typically involving one lobe, with a predilection for the lower lobes or posterior segments of the upper lobes ( Fig. 51A ) • Mass-like rounded consolidation (i.e., round pneumonia) ( Fig. 51B ) • Airspace disease abutting surrounding visceral pleura ( Fig. 51A ) • Frequent air bronchograms ( Figs. 51A and 51B ) • Rare cavitation • Minimal volume loss ( Figs. 51A and 51B ) • Pleural effusion common (60%); empyema is unusual Treatment • Antibiotic of choice: penicillin • Antibiotic of choice for penicillin-resistant strains (30% of isolates): vancomycin 51 STREPTOCOCCUS PNEUMONIAE PNEUMONIA 215 Figure 51B (1,2) PA (1) and lateral (2) chest radiographs of a 5-year-old child with round (pneumococcal) pneumonia reveal a homogeneous, ovoid opacity that partially obscures the left heart border and the T8–T10 vertebrae.
eBook - PDFNosocomial Pneumonia
Strategies for Management
- Jordi Rello(Author)
- 2008(Publication Date)
- Wiley-Interscience(Publisher)
Adapted from [16] Infections Bactrerial infections Common pyogenic bacteria Streptococcus pneumoniae Staphylococcus aureus Haemophilus influenzae Pseudomonas aeruginosa and Enterobacteriaceae Intracellualr bacteria Legionella pneomophilia Chlamydia and Mycoplasma pneumoniae Other bacteria Actinomyces israeli Nocardia spp. Pneumocystis jirovecii Invasive fungal Infections Molds Aspergillosis Emerging mycotic infections: trichosporosis, fusariosis, zygomycetes Yeasts Lung involvement during candidemia Endemic fungal infections Histoplasmosis, coccidioidomycosise, blastomycosis Viral infections (primary infections or reactivations) Seasonal respiratory viruses Influenzae, parainfluenzae, rhinovirus Respiratory syncytial virus Herpes virus Cytomegalovirus, herpes virus, zoster virus and HHV6 Other viruses: adenovirus Mycobacterial infections Tuberculosis and atypical mycobacteria INTRODUCTION 193 Noninfectious causes Cardiogenic pulmonary edema Capillary leak syndrome Lung infiltration Drug-induced toxicity Alveolar hemorrhage Transfusion-related acute lung injury Radiation-induced lung damage Alveolar proteinosis Diffuse alveolar damage Bronchiolitis Cryptogenic organized pneumonia Second malignancy strategy in cancer patients with pulmonary infiltrates [16]. Suggested diagnostic strate-gies cover an extensive spectrum ranging from empirical treatment without diagnostic investigation to diagnostic lung biopsy. However, most groups recommend diagnostic investigation. The main difference across strategies is whether fiberoptic bron-choscopy with bronchoalveolar lavage (FO − BAL) is performed (Table 11.2) [16]. Table 11.2 The diagnostic strategy without bronchoscopy in cancer patients with pulmonary infiltrates.
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