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Pneumonia

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Pneumonia

MO lain penyebab CAP adalah :Haemophilus influenzaeStreptococcus pneumoniaeMoraxella catarrhalisStaphylococcus aureusKlebsiella pneumoniaePseudomonas aeruginosaLegionella pneumophilaDefinition Pneumonia dalam arti umum adalah peradangan parenkim paru yang disebabkan oleh MO (bakteri, virus, jamur, parasit) namun pneumonia juga dapat disebavkan oleh bahan kimia ataupun karena paparan fisik seperti suhu atau radiasi. Peradangan prenkim paru yang disebabkan oleh penyebab selain MO (fisik, kimia, alergi) sering disebut sebagai pneumonitis.Classification Klasifikasi pneumonia dapat berdasarkan;Anatomi EtiologiGejala klinikLingkungan Berdasarkan anatomi :SegmenLobus: bronkus dan bronkiolus sering disebut bronkopneumoniaMenurut gejala kliniknyaPneumonia klasik : batuk produktifPneumonia atipik : batuk non-produktif, terjadi pada jaringan interstisial, jadi tidak menimbulkan eksudat

Menurut lingkungan kejadian :Community acquired pneumoniaHospital acquired pneumoniaImmunocompromised pneumonia

Predisposing conditions

Extremes of age Chronic diseases Congestive heart failureCOPD Diabetes Congenital or acquired immune deficienciesDecreased or absent splenic function Sickle cell disease Post-splenectomy

Robbins & Cotran Pathologic Basis of Disease - 8th Ed 2010Etiologinya adalah bakteri streptococus pneumoniaeAkut, disertai menggigil dan diikuti demam yang tinggiPada foto thoraks ditemukan konsolidasiSputum purulent dan berwarna seperti karat besiPada preparat apusan sputum, dengan pewarnaan gram sering dijumpai diplokokus gram positif dengan leukosit polimorfonuklearHaemophilus influenzae is a pleomorphic, gram-negative organism that is a major cause of life-threatening acute lower respiratory tract infections and meningitis in young children. In adults it is a very common cause of community-acquired acute pneumonia. This bacterium is a ubiquitous colonizer of the pharynx, where it exists in two forms: encapsulated (5%) and unencapsulated (95%). Typically, the encapsulated form dominates the unencapsulated forms by secreting an antibiotic called haemocin that kills the unencapsulated H. influenzae. Although there are six serotypes of the encapsulated form (types a to f), type b, which has a polyribosephosphate capsule, used to be the most frequent cause of severe invasive disease. With routine use of H. influenzae conjugate vaccines, the incidence of disease caused by the b serotype has declined significantly. By contrast, infections with nonencapsulated forms are increasing. Also called nontypeable forms, they spread along the surface of the upper respiratory tract and produce otitis media (infection of the middle ear), sinusitis, and bronchopneumonia.

Streptococcus pneumoniae/pneumococcus, The most common cause of community-acquired acute pneumonia. The presence of numerous neutrophils containing the typical gram-positive, lancet-shaped diplococci supports the diagnosis of pneumococcal pneumonia, but it must be remembered that S. pneumoniae is a part of the endogenous flora in 20% of adultsTherefore false-positive results may be obtained. Isolation of pneumococcifrom blood cultures is more specific but less sensitive (in the early phase of illness, only 20% to 30% of patients have positive blood cultures). Pneumococcal vaccines containing capsular polysaccharides from the common serotypes are used in patients at high risk.

This occurs when protective processes fail to prevent inhaled or blood-borne microbes reaching and colonising the lungs. The following are some predisposing factors.Distribution of infected tissue in: A. Bronchopneumonia. B. Lobar pneumonia.

Bronchopneumonia. Gross section of lung showing patches of consolidation (arrows)

Lobar pneumoniagray hepatization, gross photograph. The lower lobe is uniformly consolidatedRobbins and Cotran Pathologic Basis of Disease Eighth Edition

Impaired coughing.

The effectiveness of coughing as an aid to the removal of infected mucus may be reduced when the individual is unconscious or by damage to:sensory nerve endings in the walls of the respiratory passagesthe cough reflex centre in the medulla oblongatanerves to the respiratory passages, lungs and muscles of respirationthe diaphragm and intercostal muscle

17 hospital- acquired pneumonia

Acute medicine,a practical guide to the management of medical emergencies. 4th ed.