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What are the complications of pneumonia ?


What are the complications of pneumonia ?

المعلومة

1- Respiratory failure : Type 1 respiratory failure (PaO2 less than 8kPa) is relatively common . Treatment is with high-flow (60%) oxygen .
2- Hypotension : may be due to combination of dehydration and vasodilatation due to sepsis .
3- Atrial fibrillation : is quite common, particularly in the elderly. It usually resolves with the treatment of pneumonia.
4- Pleural effusion .
5- Empyema .
6- Lung abscess .
7- Septicemia : may occur as a result of bacterial spread from the lung parenchyma into the bloodstream.
8- Pericarditis and myocarditis .
9- Jaundince : It is usually cholestatic, and may be due to sepsis or secondary to antibiotic therapy (particularly flucloxacillin and co-amoxiclav)

المرجع

Oxford Hand Book of Clinical Medicine

by

What is Empyema?
how can we diagnose it?
how can we treat it?
DAM's picture
DAM



Empyema is pus in the pleural space, which can be as thin as serous fluid or so thick that it is impossible to aspirate even through a wide-bore needle.
Microscopically, neutrophil leukocytes are present in large nimbers.

Dx:It should be suspected in patients with pulmonary infection,e.g pneumonia, if there is persistence or recurrence of pyrexia despite the adminstration of a suitable antibiotic.(or: if a patient with a resolving pneumonia develops a recurrent fever)

The clinical features can be divided to Systemic and Local features:
1- Systemic features : pyrexia(usually high and remittent), rigors,sweating,malaise...polymorphonuclear leukocytosis and high CRP.
2- Local features:pleural pain,breathlessness,cough and sputum usually because of underlying lung disease, copious purulent sputum if empyema ruptures into a bronchus (bronchopleural fistula)and clinical signs of
fluid in the pleural space (pleural effusion).

Investigations:

1- Radiological examination:CXR(appearance of pleural effusion. when there is air with the pus a horizontal 'fluid level ' marks the interface between the liquid and air) , US (shows the position of the fluid, loculated or encysted empyema ....) and CT (shows the pleura and helps assessing the underlying lung parenchyma).

2- Aspiration of pus : confirms the presence of an empyema . The aspirated pleural fluid is typically yellow and turbid with a pH less than 7.2 , low glucose and high LDH.

Treatment :

1- It should be drained using a chest drain, preferably inserted under radiological guidance.
2- Antibiotics directed against the organism causing the empyema should be given for 2-4 weeks .
3- If the intercostal tube is not providing adequate drainage Surgical Intervention or Surgical Decortication of the lung is required.

A.M
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