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What is Pneumonia? - NEET PG Medicine

Feb 15, 2023

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Pneumocystis jirovecii 

Organism Specific Approach for Pneumonia

Rx of Atypical Pneumonia: Macrolides.

Treatment Strategy For C.A.P

For Inpatient Management

What is Pneumonia - NEET PG Medicine

Pneumonia is a common respiratory illness and a leading cause of morbidity and mortality worldwide, especially in young children and elderly individuals. It is a common presentation in clinical practice, and medical professionals need to be familiar with its management, including the use of antibiotics, and supportive care.

Read this blog for a quick overview of this important medicine topic for NEET PG exam Preparation.

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  • Commonest cause for community acquired pneumonia is Pneumococcus
  • Pneumonia in AIDS +ive patient, low CD4 count of <200 cells / cu.mm 
  • Opportunistic infection in AIDS +ive patient is Pneumocystis jirovecii 
  • Case 1: AIDS positive truck driver with pneumonia and low CD4 count. He is having bronchial breathing and lobar consolidation
    • Lobar consolidation and bronchial breathing are absent in pneumocystis jirovecii,
    • If bronchial breathing and Lobar consolidation are given in question, the answer is Pneumococcus. Because the leading cause of Pneumonia in AIDS positive patients is Pneumococcus.
    • Low CD4 count is s/o pneumocystis jirovecii but not confirmatory.
    • Conformation of Pneumocystis jiroveci is done by Bronchoalveolar Lavage stained with gomori methenamine silver stain and black cysts of Pneumocystis jiroveci are seen.
    • The word pneumocystis means the cysts causing pneumatocele in Lungs.
  • Below X-ray shows Lobar consolidation in Left upper lobe.
Pneumocystis jirovecii 
  • Below X-ray shows Lobar consolidation in the right middle zone.
Pneumocystis jirovecii 
Important information

MC organism for acute bacterial meningitis in adult and pediatric population is Pneumococcus 

Also Read: Myocardial Infarction - Neet PG Medicine

Pneumocystis jirovecii 

  • Pneumocystis jirovecii causes interstitial pneumonia.
  • Chest is clear initially, later develops diffuse rales
  • Chest X-ray: Bilaterally symmetrical perihilar reticular interstitial changes are seen 
  • HRCT chest: Diffuse ground glass opacities 
  • LDH increases.
  • Increase A -a gradient.
  • Confirmatory test: BAL stained with gomori methenamine silver stain which demonstrates the cysts.
  • Rx: TMP - SMX (DOC for treatment and prevention)
  • Other drugs: Pentamidine, Clindamycin, Primaquine, Atovaquone, steroids.
Important information

In covid -19 pneumonia HRCT shows ground glass opacities & D-Dimer increases.

Confirmatory test for covid-19: RTPCR.

Steroids used in both covid-19 and Pneumocystis Jiroveci causing interstitial pneumonia.
Important Information

Commonest cause of pneumonia in AIDS positive patient is Pneumococcus not Pneumocystis jivovecio

Organism Specific Approach for Pneumonia

  • Alcoholism= S. pneumonia, Klebsiella Pneumoniae, oral anaerobes.
    • Klebsiella pneumonia in alcoholics causes Necrotizing Pneumonia that results in a feature of red currant Jelly sputum.
    • Oral anaerobes in alcoholics cause Necrotizing Pneumonia that results in lung abscess. Chest X-ray showing air fluid level S/O Lung abscess
    • Impaired airway defence seen in alcohol/drug intoxication, dementia, stroke, etc., cause of pneumonia is Oral anaerobes
    • Rx of oral anaerobes causing Pneumonia is clindamycin
Important information

1. Red currant Jelly stool in 9-month baby S/O intussusception
2. Multiple air fluid level in X-ray abdomen S/O Intestinal obstruction
  • COPD: H. influenzae
  • Lung abscess:  oral Anaerobes? Primary.
    • CA-MRSA ? Secondary to setting of foreign body, Tumor, Infection.
  • Hotel stay / cruise : Legionella Pneumophila. (due to inhalation of water droplets)
  • Infected Humans: SARS - COV 2
  • Birds: H. capsulatum, C.pittaci
  • Rabbits: F. tularensis. 
    • Tularemia is caused by the bacterium Francisella tularensis. 
    • Hunter after killing a rabbit develops Eschar/ ulcer and regional lymph node swelling.
    • Ulceroglandular fever: The most common form of tularemia and usually occurs following a tick bite or after handing of an infected animal. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
  • Sheep: Coxiella Brunetti / Q fever
    • Coxiella Brunetti cause atypical pneumonia and Endocarditis as well.

Rx of Atypical Pneumonia: Macrolides.

Clinical feature Points 
Confusion (defined as a Mental Test Score of ≤8, or disorientation in person, place, or time )1
Uremia: BUN >7 mmol/L ( ~19 mg / dL)1
Respiratory rate: ≥30 breaths / minute1
Blood pressure: systolic <90 mm Hg or diastolic ≤60 mm Hg1
Age ≥65 years1
Total points 
  • BUN = UREA/2.14 
  • E.g., BUN= 10, UREA = BUN x 2.14 = 10 x 2.14 = 21.4 mg/dl 
  • Urea = BUN x 0.35
  • E.g., BUN= 10, Urea = 10 x 0.35 = 3.5 mmol/L
Treatment options based on CURB -65 Score 
ScoreGroupTreatment Options
0Group 1; mortality low (1.5%)Low risk; consider home treatment 
1-2Group 2; mortality intermediate (9.2%)Consider hospital-supervised treatment (either short – stay inpatient or hospital – supervised outpatient)
3Group 3; mortality high (22%)Manage in hospital as severe pneumonia; consider admission to 
  • For group 1: OPD management is done
  • For group 2: IPD management is done. E,g., 70 yrs old patient with elevated BUN RX: IV Augmentin with macrolides
  • For group 3: ICU management is done
  • If only age is >/= 65 and rest are normal. Treatment is based on health condition of patient the treating doctor can decide the type of management.
  • If age along with another deranged parameter is given. Then admit patient and give parenteral antibiotics

Also Read: EPILEPSY AND Electroencephalography (EEG) : NEET PG Medicine

Treatment Strategy For C.A.P

  • For outpatient management

Treatment strategy: C.A.P: outpatient

No comorbidity 

  1. Amoxicillin + macrolidedoxycycline
  2. Doxycycline 
  3. Macrolide (if local prevalence of pneumococcal Resistance <25%)

Comorbidity or Rcvd A/b in lost 3 months 

  1. amoxicillinClavulanate+ macrolide or doxycycline 
  2. Levofloxacin, moxifloxacin, Gemifloxacin (light machine gcm Respiratory fluoroquinolones)

For Inpatient Management

  • Beta lactam+ macrolide or respiratory fluroquinolones (levofloxacin, moxifloxacin, Gemifloxacin)
  • If recent hospitalization/ respiratory isolation
    • Add coverage for MRSA: Vancomycin/ linezolid & for pseudomonas: Piperacillin-Tazobactum

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