Aspiration pneumonia bacterial infection: Difference between revisions
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{{Pneumonia}} | [[Image:Streptococcus pneumoniae.jpg|right|200px]] | ||
__NOTOC__ | |||
{{Infobox Disease | | |||
Name = Pneumonia | | |||
Image = | | |||
Caption = | | |||
DiseasesDB = 10166 | | |||
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}} | | |||
ICD9 = {{ICD9|480}}-{{ICD9|486}}, {{ICD9|770.0}} | | |||
ICDO = | | |||
OMIM = | | |||
MedlinePlus = | | |||
MeshName = Pneumonia | | |||
MeshNumber = C08.381.677 | | |||
}} | |||
{{Aspiration pneumonia bacterial infection}} | |||
'''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | |||
'''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] | |||
==[[Pneumonia overview|Overview]]== | |||
==[[Pneumonia historical perspective|Historical Perspective]]== | |||
==[[Pneumonia pathophysiology|Pathophysiology]]== | |||
==[[Pneumonia causes|Causes]]== | |||
:'''Specific causes:''' [[bacterial pneumonia|Bacterial]] | [[fungal pneumonia|Fungal]] | [[parasitic pneumonia|Parasitic]] | [[viral pneumonia|Viral]] | |||
:'''Classification scheme:''' [[Community-acquired pneumonia]] | [[Hospital-acquired pneumonia|Health-care associated pneumonia]] | |||
:'''Other types:''' [[Severe acute respiratory syndrome]] | [[Bronchiolitis obliterans organizing pneumonia]] | [[Eosinophilic pneumonia]] | [[Aspiration pneumonia]] ([[Chemical pneumonitis]] | [[Aspiration pneumonia bacterial infection]] | [[Airway obstruction]]) | |||
==[[Pneumonia differential diagnosis|Differentiating Pneumonia from other Diseases]]== | |||
==[[Pneumonia epidemiology and demographics|Epidemiology and Demographics]]== | |||
==[[Pneumonia risk factors|Risk factors]]== | |||
==[[Pneumonia 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]] | |||
==Diagnosis== | |||
[[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]] | |||
==Treatment== | |||
[[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:Pulmonology]] | |||
[[Category:Infectious disease]] | |||
[[Category:Pneumonia|Pneumonia]] | |||
[[Category:Emergency medicine]] | |||
{{WH}} | |||
{{WS}}{{Pneumonia}} | |||
'''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] | '''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] | ||
==Overview== | ==Overview== | ||
Revision as of 19:05, 8 September 2012
| Pneumonia | ||
| ICD-10 | J12, J13, J14, J15, J16, J17, J18, P23 | |
|---|---|---|
| ICD-9 | 480-486, 770.0 | |
| DiseasesDB | 10166 | |
| MeSH | C08.381.677 | |
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Aspiration pneumonia bacterial infection Microchapters |
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Differentiating Aspiration pneumonia bacterial infection from other Diseases |
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Diagnosis |
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Treatment |
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Aspiration pneumonia bacterial infection On the Web |
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American Roentgen Ray Society Images of Aspiration pneumonia bacterial infection |
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Directions to Hospitals Treating Aspiration pneumonia bacterial infection |
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Risk calculators and risk factors for Aspiration pneumonia bacterial infection |
For patient information click here
Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]; Philip Marcus, M.D., M.P.H.[3]
Overview
Historical Perspective
Pathophysiology
Causes
- Specific causes: Bacterial | Fungal | Parasitic | Viral
- Classification scheme: Community-acquired pneumonia | Health-care associated pneumonia
- Other types: Severe acute respiratory syndrome | Bronchiolitis obliterans organizing pneumonia | Eosinophilic pneumonia | Aspiration pneumonia (Chemical pneumonitis | Aspiration pneumonia bacterial infection | Airway obstruction)
Differentiating Pneumonia from other Diseases
Epidemiology and Demographics
Risk factors
Natural History, Complications and Prognosis
Prognosis predictor scores: CURB-65 | Pneumonia severity index | Criteria for severe community acquired pneumonia
Diagnosis
Diagnostic criteria | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray
Treatment
Site of care decision | Medical Therapy | Other treatments consideration | Prevention | Management of non-responding pneumonia
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Pneumonia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Aspiration pneumonia bacterial infection On the Web |
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American Roentgen Ray Society Images of Aspiration pneumonia bacterial infection |
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Risk calculators and risk factors for Aspiration pneumonia bacterial infection |
Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [5]
Overview
Aspiration pneumonia caused by bacterial infection is the commonest subtype of aspiration pneumonia. The other subtypes being chemical pneumonia, and airway obstructions.
Causes
- Normal flora of upper airways, gingival cavity or stomach.
- Caused by less virulent bacteria, such as aerobic or microaerophilic streptococci (commonest) and anaerobes (second common cause) such as
Diagnosis
History and symptoms
The manifestation depends on:
- The bacteria involved
- Time since aspiration to diagnosis
- Immune status of the host
Symptoms in aerobic microbes
- Abrupt or Indolent course
- Productive cough
- Fever
- Absence of chills and rigors
- Dyspnea
- Anorexia, weight loss
- Anemia
Lab diagnosis
Sputum culture
- Expectorated sputum is not used as an diagnostic tools as contamination by the normal flora of the mouth and airways is inevitable.
- Specimen obtained via bronchoscopy may be suitable but limited studies are available to prove this.
Symptoms in anaerobic microbes
Clinical features, which are characteristic of aspiration pneumonia involving anaerobic bacteria, include:
- Indolent course
- Presence of risk factors: altered sensorium (anesthesia, alcohol, drug, trauma, dysphagia, dental caries)
- Putrid sputum
- Absence of chills and rigors
Chest X Ray
- Lung abscess
- Empyema
- 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
Natural History, Complications and Prognosis
- Lung abscess
- Necrotizing pneumonia
- Empyema
- Bronchopleural fistula
Risk factors
- Poor dental hygiene is a risk factor
- Patients with good dental hygiene and edentulous are less predisposed
Treatment
Medical therapy
Antibiotics
- Treatment of choice clindamycin
- Doses 600 mg Q8hourly, followed by 300 mg Q6hourly, or 450 mg tid
- Advantage of clindamycin :
- Cheap
- Less incidences of superimposed MRSA
- 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).
- 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