Staphylococcal Pneumonia
It may be a primary respiratory infection or secondary to staphylococcal focus anywhere in the body. It is responsible for 5% of all pneumonias. Primary lesion in lung usually occurs as complication to influenza, otherwise it is common. It may occur in cystic fibrosis of lung as the cyst contains phydroxy-phenyl-acetic acid which increases the growth of these organisms. Haematogenous source may be seen in cases with septic thrombophlebitis, infective endocarditis or from infected intravascular device. The organism is Staphylococcus pyogenes. Onset is insidious and the temperature is remittent in type.
The lesion may be a lobar or segmental one indistinguishable from pneumococcal lesion but there may be formation of parenchymal necrosis resulting in multiple lung abscesses with thin walls (25%) . Empyema may develop in 5% of cases.
Treatment is difficult because the organisms are very frequently resistant to most of the antibiotics. Penicillinase resistant agent, e.g., Nafcillin is preferred treatment. It is better to have a culture of sputum with drug sensitivity test. Treatment is to be continued for at least 2 weeks. Longer treatment is better as it prevents relapse.
Friedlander’s Pneumonia
It usually occurs above 40 years of age. Organism is Klebsiella pneumoniae and this type of pneumonia is rare. It occurs in less than 1% of all pneumonias.
There is massive consolidation most commonly affecting the upper lobes along with other lobe or lobes. Profound toxaemia is present. Large amount of mucoid expectoration occurs which may have a chocolate colour. Alcoholics, diabetics and old debilitated subjects often develop this pneumonia. Resolution is extremely rare and often there is fibrosis, bronchiectasis or abscess formation. So, it is often confused with tuberculosis. Cephalosporin is usually preferred. In severe cases it should be added with Gentamycin, Tobramycin or Amikacin. The disease is fatal in 40%-60% of untreated cases but with adequate treatment the fatality rate is about 30%.
Tuberculous Pneumonia
See Pulmonary tuberculosis
Primary Atypical Pneumonia (Mycoplasma pneumonia)
The main causative organism is Mycoplasma pneumonia which is the only definite mycoplasmal disease in man. This infection occurs endemically and may spread in the family through respiratory secretions. It may outburst in military barracks and schools. Tracheo-bronchitis is more common than pneumonia together with pharyngitis. Skin rash, erythema nodosum, encephalitis, myelitis, neuropathy, etc. may also develop.
Onset is gradual. Low grade fever, weakness, lassitude, headache, myalgia and cough are present. Cough is the dominant symptom which increases gradually and may sometimes come in paroxysm. Sputum is scanty and sometimes blood tinged. Chest signs are minimal and variable. X-ray finding is disproportionately greater than the clinical signs.
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