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| [[Image:Streptococcus pneumoniae.jpg|right|200px]]
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| __NOTOC__ | | __NOTOC__ |
| {{Infobox Disease |
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| Name = Pneumonia |
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| Image = |
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| Caption = |
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| DiseasesDB = 10166 |
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| ICD10 = {{ICD10|J|12||j|09}}, {{ICD10|J|13||j|09}}, {{ICD10|J|14||j|09}}, {{ICD10|J|15||j|09}}, {{ICD10|J|16||j|09}}, {{ICD10|J|17||j|09}}, {{ICD10|J|18||j|09}}, {{ICD10|P|23||p|20}} |
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| ICD9 = {{ICD9|480}}-{{ICD9|486}}, {{ICD9|770.0}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| MeshName = Pneumonia |
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| MeshNumber = C08.381.677 |
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| }}
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| {{Aspiration pneumonia bacterial infection}} | | {{Aspiration pneumonia bacterial infection}} |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org]; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com]
| | {{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com] |
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| ==[[Pneumonia overview|Overview]]==
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| ==[[Pneumonia historical perspective|Historical Perspective]]==
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| ==[[Pneumonia pathophysiology|Pathophysiology]]== | | ==[[Aspiration pneumonia bacterial infection overview|Overview]]== |
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| ==[[Pneumonia causes|Causes]]== | | ==[[Aspiration pneumonia bacterial infection pathophysiology|Pathophysiology]]== |
| :'''Specific causes:''' [[bacterial pneumonia|Bacterial]] | [[fungal pneumonia|Fungal]] | [[parasitic pneumonia|Parasitic]] | [[viral pneumonia|Viral]]
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| :'''Classification scheme:''' [[Community-acquired pneumonia]] | [[Hospital-acquired pneumonia|Health-care associated pneumonia]]
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| :'''Other types:''' [[Severe acute respiratory syndrome]] | [[Bronchiolitis obliterans organizing pneumonia]] | [[Eosinophilic pneumonia]] | [[Aspiration pneumonia]] ([[Chemical pneumonitis]] | [[Aspiration pneumonia bacterial infection]] | [[Airway obstruction]])
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| ==[[Pneumonia differential diagnosis|Differentiating Pneumonia from other Diseases]]== | | ==[[Aspiration pneumonia bacterial infection causes|Causes]]== |
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| ==[[Pneumonia epidemiology and demographics|Epidemiology and Demographics]]== | | ==[[Aspiration pneumonia bacterial infection differential diagnosis|Differentiating Aspiration pneumonia bacterial infection from other Diseases]]== |
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| ==[[Pneumonia risk factors|Risk factors]]== | | ==[[Aspiration pneumonia bacterial infection risk factors|Risk factors]]== |
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| ==[[Pneumonia natural history, complications, and prognosis|Natural History, Complications and Prognosis]]== | | ==[[Aspiration pneumonia bacterial infection natural history, complications, and prognosis|Natural History, Complications and Prognosis]]== |
| '''Prognosis predictor scores:''' [[CURB-65]] | [[Pneumonia severity index]] | [[Pneumonia medical therapy#Criteria for severe community acquired pneumonia|Criteria for severe community acquired pneumonia]]
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[Aspiration pneumonia bacterial infection history and symptoms| History and Symptoms]] | [[Aspiration pneumonia bacterial infection physical examination | Physical Examination]] | [[Aspiration pneumonia bacterial infection chest x ray|Chest X Ray]] | [[Aspiration pneumonia bacterial infection ct scan | CT scan ]] |
| [[Pneumonia diagnostic criteria | Diagnostic criteria]] | [[Pneumonia history and symptoms| History and Symptoms]] | [[Pneumonia physical examination | Physical Examination]] | [[Pneumonia laboratory studies |Laboratory Findings]] | [[Pneumonia chest x ray|Chest X Ray]] | |
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| ==Treatment== | | ==Treatment== |
| | | [[Aspiration pneumonia bacterial infection medical therapy|Medical Therapy]] |
| [[Pneumonia medical therapy#Pneumonia site of care decision|Site of care decision]] | [[Pneumonia medical therapy|Medical Therapy]] | [[Pneumonia medical therapy#Other treatments consideration|Other treatments consideration]] | [[Pneumonia prevention|Prevention]] | [[Pneumonia medical therapy#Management of non-responding pneumonia|Management of non-responding pneumonia]] | |
| [[Category:Diseaase]] | | [[Category:Diseaase]] |
| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
| [[Category:Infectious disease]]
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| [[Category:Pneumonia|Pneumonia]] | | [[Category:Aspiration pneumonia bacterial infection|Aspiration pneumonia bacterial infection]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
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| {{WH}}
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| {{WS}}{{Pneumonia}}
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| '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org]
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| ==Overview==
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| [[Aspiration pneumonia]] caused by bacterial infection is the commonest subtype of [[aspiration pneumonia]]. The other subtypes being [[chemical pneumonia]], and airway obstructions.
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| ==Causes==
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| * Normal flora of upper airways, gingival cavity or stomach.
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| * Caused by less virulent bacteria, such as aerobic or microaerophilic [[streptococci]] (commonest) and anaerobes (second common cause) such as
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| ** [[Peptostreptococcus]]
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| ** [[Fusobacterium nucleatum]]
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| ** [[Prevotella]]
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| ** [[Bacteroides]]
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| ==Diagnosis==
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| ==History and symptoms==
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| ===The manifestation depends on:===
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| * The bacteria involved
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| * Time since aspiration to diagnosis
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| * Immune status of the host
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| ===Symptoms in aerobic microbes===
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| * Abrupt or Indolent course
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| * Productive [[cough]]
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| * [[Fever]]
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| * Absence of [[chills]] and [[rigors]]
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| * [[Dyspnea]]
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| * [[Anorexia]], weight loss
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| * [[Anemia]]
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| ==Lab diagnosis==
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| ===Sputum culture===
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| * Expectorated sputum is not used as an diagnostic tools as contamination by the normal flora of the mouth and airways is inevitable.
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| * Specimen obtained via bronchoscopy may be suitable but limited studies are available to prove this.
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| ===Symptoms in anaerobic microbes===
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| Clinical features, which are characteristic of aspiration pneumonia involving anaerobic bacteria, include:
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| * Indolent course
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| * Presence of risk factors: altered sensorium (anesthesia, alcohol, drug, trauma, dysphagia, dental caries)
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| * Putrid sputum
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| * Absence of chills and rigors
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| ==Chest X Ray==
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| * Lung abscess
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| * Empyema
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| * Involvement of dependent pulmonary lobes i.e., upright position lower lobe, superior segment of lower lobes or posterior segment of upper lobes in recumbent position
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| ==Natural History, Complications and Prognosis==
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| * Lung abscess
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| * Necrotizing pneumonia
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| * Empyema
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| * Bronchopleural fistula
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| ==Risk factors==
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| * Poor dental hygiene is a risk factor
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| * Patients with good dental hygiene and edentulous are less predisposed
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| ==Treatment==
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| ===Medical therapy===
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| ====Antibiotics====
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| * Treatment of choice [[clindamycin]]
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| ** Doses 600 mg Q8hourly, followed by 300 mg Q6hourly, or 450 mg tid
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| ** Advantage of clindamycin :
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| *** Cheap
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| *** Less incidences of superimposed [[MRSA]]
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| * Other agents used: [[Ampicillin-sulbactam]] (1.5 g or 3 g twice daily), [[Imipenem]] ([[Invanz]] 500 mg BID), [[amoxicillin]]-[[clavulnate]] (875 mg orally bid), [[penicillin]] (1 to 2 million units IV Q6hourly) / amoxicillin (500 mg orally tid)+ [[metronidazole]] (500 mg orally or IV tid).
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| * Monotherapy with metronidazole is not preferred as high failure rates have been reported. This is because metronidazole is ineffective against some pathogens such as microaerophilic and aerobic streptococci
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| ==References== | | ==References== |
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| [[Category:Diseaase]] | | [[Category:Diseaase]] |
| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
| [[Category:Infectious disease]]
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| [[Category:Pneumonia|Pneumonia]] | | [[Category:Pneumonia|Pneumonia]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |