6. Breech of body barriers
• Cigarette smoking
• Viral infection
• Trauma to chest wall
• Pulmonary edema
• Alteration in the level of consciousness
– Stroke
– Seizures
– Sedation
– Alcohol abuse
– Even normal sleep
7. Mode of transmission
• Air born
• Aspiration of upper respiratory flora
• Metastatic seeding through blood
11. Pneumonia
History →
• Fever/Chills, cough, sob, chest pain
• Physical Exam → Varies based on age of child
Newborns
Patients do not cough → more commonly present
with tachypnea, retractions, grunting
Adults
• Auscultation of the lung fields may yield the
following:
– Crackles, wheezing, diminished breath sounds,
tubular breath sounds, or pleural friction rub
13. Ventilator associated pneumonia
(VAP)
• VAP refers to pneumonia that arises more than
48–72 hours after endotracheal intubation.
• Most concerning aspect of VAP is the high rate
of associated mortality.
• Risk factors :
– patient related (male sex, preexisting pulmonary
disease, or multiple organ system failure)
– treatment related (intubation or enteral feeding)
Modifiable risk factors for HAP are obvious
targets for improved management and
prophylaxis in several studies.
16. Pneumonia
Diagnosis →
Sputum Culture → usually not helpful → poor
correlation with lower respiratory pathogens
Tracheal aspirate: Quantitative culture
Broncho-alveolar levage→ most useful in
immunocompromised patients believed to have
unusual organisms or patients who are severely ill
Lung Aspirate → underused but can be very helpful
one series reports 52% positive cultures using this
approach
Blood & pleural fluid cultures positive in <20% cases
17. Sputum:
• One of the most common types of specimen
submitted to the laboratory for bacterial
examination.
• Difficult to obtain because of contamination with
saliva.
• Many of the bacteria which are known to cause
lower respiratory tract infections may be present
in the oropharynx as part of the normal flora
• The examination of a direct smear from the
specimen can be very helpful in diagnosing
respiratory infections and in determining the
usefulness of the information provided by the
culture.
22. Reporting
• The average number of each type of cell
per low power field in a representative
area of the smear is recorded.
• Less than 1 and up to 9 cells per field are
reported as “Few”
• 10 to 25 cells are reported as “Moderate”
• Any number in excess of 25 is reported as
“Numerous”