 Today we are going to deal with pneumonia, pneumonia, various types of pneumonia and its management and communication. Coming to the definition of pneumonia, pneumonia is defined as acute respiratory illness with radiological permanent ray shadowing. Acute respiratory illness means either fever or shortness of breath or cough or chest pain. How does one get pneumonia? Our body has a protective mechanism that filters the bacteria or organism and keeps our lungs from becoming infected. But when our immune system is weak or organisms are very strong, body fails to filter these organisms or bacteria. That's how one get pneumonia. Pneumonia can be of community acquired, hospital acquired and ventilator associated pneumonia. Cap community acquired pneumonia. It occurs in community within 48 houses of hospital admission. Most common causative organism of community acquired pneumonia is streptococcus pneumonia. Streptococcus pneumonia itself is the most common causative organism of community acquired pneumonia resulting in hospital admission as well as ICU admission. Hospital acquired pneumonia. It occurs in hospitalized patient after 48 hours of hospital stay. Most common causative organism of hospital acquired pneumonia is gram-negative basalic. But when you ask which is the single most common causative organism of hospital acquired pneumonia, it is the gram-positive cocci, which is tap horus. Ventilator associated pneumonia. It occurs after 48 to 72 hours of mechanical ventilation. Most common causative organism of ventilator associated pneumonia is pseudo monast. Ventilator associated pneumonia is of two types that is early ventilator associated pneumonia and late ventilator associated pneumonia. Early ventilator associated pneumonia occurs within five days of mechanical ventilation whereas in the late it is more than five days of the mechanical ventilation. Streptococcus pneumonia is the most common causative organism for the early ventilator associated pneumonia. Other causative organisms is a hemophilus influenza. Late ventilator associated pneumonia causative organisms are pseudo monast, tap horus and acinetobacter. Pneumonia is of two types that is typical pneumonia and atypical pneumonia. Typical pneumonia it occurs within alveoli that is putum production will be there that is within the alveoli. But whereas in the atypical pneumonia the infection occurs in interstitium that is the space between two alveoli that is the interstitial infection. So in the typical pneumonia fever with productive cuff will be the clinical presentation whereas in the atypical pneumonia fever with dry cuff or scanty sputum. On blood R.E. in typical pneumonia predominant neutrophilic leucocytosis will be there whereas in the atypical pneumonia mild leucocytosis mild leucocytosis only. Sputum gram staining reveals organism in typical pneumonia whereas in the atypical pneumonia no organisms are revealed in sputum gram staining. Just x-ray features in typical pneumonia it is alveolar exudates in atypical pneumonia no alveolar exudate will be there will get interstitial pattern peribrombo vascular infiltrate will be there and bilateral hedgenus will be there. Most common causative organism of typical pneumonia is streptococcus pneumonia. Other organisms are tachyloids, plebsiola and pseudomonas. In atypical pneumonia most common causative organism is mycoplasma. Other organisms are legionella, chlamydia and viral. Most common causative organism of atypical pneumonia resulting in ICU admission is legionella. The typical pneumonia caused by streptococci, strepilococci and plebsiola we will compare it. Risk factors for this streptococci, typical pneumonia caused by streptococcal is smoking mainly by smoking and it is the most common pneumonia in diabetic militants and alcoholics. IB drug uses pneumonia. It is the strepilococci and it occurs as greater pneumonia in post-viral anus. Risk factors for the klepsiola are alcoholism and malnubration. Clinical features of streptococci, it's a characteristic sputum that is red trusty sputum in streptococci. In strepilococci it is mucocoralin sputum whereas in klepsiola it is red carangeli sputum. Just x-ray features of streptococci, it is the low bar consolidation that it involves only a lobe or a segment of lung. It is a localized involvement and it is the most common pattern in community acquired pneumonia. In strepilococci we get bronchon pneumonia. Bronchon pneumonia, it affects the lungs in patches around bronchi. We get bilateral patchy consolidations, can cause nematoseals, cavity and lung abscess. It is the most common pattern in hospital acquired pneumonia. What is nematoseals? It is the air-filled area with ill-defined walls whereas cavity is air-filled area with well-defined walls. Just x-ray features of klepsiola are right upper lung, right upper lobe consolidation with bulging fissure. It is the most common characteristic that is bulging fissure will be there. It can also cause nematoseal, cavity and lung abscess. Treatment for the streptococci, it is with beta-lactam and strepilococci. If it is methicillin-resistant staph aureus, treat it with vancomycin. And if it is vancomycin-resistant staph aureus, treat it with linizolidin. Klepsiola, treat it with beta-lactam plus aminoglycoside combined both. Now, coming to pseudomonas, occurs frequently as ventilator-associated pneumonia. It is the most common causative organism of pneumonia in bronchiectasis, cystic fibrosis, structural lung disease. Tamp aureus is also the causative organism for this condition but pseudomonas is the main causative organism. Clinical features include pivo with mucopurulence putum, it can cause lung abscess, cysticcery features are bilateral infiltrate, treatment with anti-seudomonal beta-lactam plus pleuroquinolones or aminoglycosides. You can treat it either with anti-seudomonal beta-lactam plus pleuroquinolone or aminoglycosides. Now, coming to acenitobacter, it occurs as ventilator-associated pneumonia. Initial treatment is with carbapenems if persistent treat it with colistium. Now, coming to atypical pneumonia caused by legionella and mycoplasma. Most common method of transmission in legionella is due to aspiration. More than auralization, it is due to aspiration and spread is through contaminated water. It's not from person to person. It's through contaminated water. Special features include associated pneumonia is associated with diarrhea. Other features are headache, confusion, hyponetremium, altered liver function test. As it is atypical pneumonia, Graham's training reveals no organisms. Poor response to beta-lactam. It occurs in all-dage and in immunocompromised patients. Occurrence of illness within 10 days discharged from hospital. Legionella incubation period is 5 to 10 days. Mycoplasma is the most common atypical pneumonia. It is otherwise known as walking pneumonia or eat an aged pneumonia. Extra pulmonary features include rash, erythema nodosum, encephalitis, bulian barrier syndrome, hemolytic anemia, myocarditis, pericarditis and arthritis. Mycoplasma contains no cell wall. If you cure pneumonia associated with diarrhea, then you should think about legionella. And pneumonia with hemolytic anemia, you should think about mycoplasma. How to diagnose? Diagnosis is made by serology or PCR, polymerase chain reaction. As it is poor response to beta-lactam, treatment is with pleurokinolons either with pleurokinolons or macrolite or tetracycline. Best treatment for legionella is levofluxacin and moxifluxacin. Azitromycin is the best treatment for mycoplasma. Pneumocystitis pneumonia. Pneumonia in the immunocompromised patient. Infection. This infection can occur in any but this is only in immunocompromised patient. It is the most common capacity fungal pneumonia in HIV. Risk factors include TDPO count less than 200 per ml in HIV and in organ transplant patients. Patient on long-term immunosuppressive treatment. Primary immunodeficiencies. Clinical features include either fever or dry coughs or shortness of breath. Initially chest x-rays is normal. Peritubular infiltrates will be there which leads to diffuse interstitial infiltrate. Pneumotoxyl pneumotorax can be seen. Diagnosis. Diagnosis is mainly by bronchoalveolar lavage rather than protein sputum. We go for bronchoalveolar lavage and visualize for cyst. Right gemstasein, gormon methamine savusin, immunofluorescence stain will use these stains for visualizing the cyst. Drug of choice include Cortramaxazole. Cortramaxazole is the drug of choice for propyl axis ulcer. Coming to the assessment of severity of pneumonia it is Curb 65. Curb C4 confusion. U4 urea greater than 7 millimole per litre R4 is free free rate more than 30 per minute B4 systolic blood pressure less than 90 mmHg Dastolic blood pressure less than 60 mmHg and 65 age more than 65. If the score is zero to one between zero to one then you need only OP treatment. Form treatment with antibiotic. If it is two, score is two. Hospitalize and treat. And if the score is three to five is between three to five then consider it as severe pneumonia and patient may require ICU admission. Empirical regimens for community-acquired pneumonia. OP treatment it is oral forms. If the patient is with no comorbidities you can treat either with macrolite or beta-lactam or tetracycline. Macrolite you you can use clarithromycin or azithromycin or doxycycline. Beta-lactam amoxicillin or moxclab amoxicillin clavulinate can be used. In IP treatment we use both oral and injectable forms but mainly injectable form. In non-ICU patient treat it either with beta-lactam plus macrolite or fluoroquinolones. In ICU patient treat it either with beta-lactam plus macrolite or beta-lactam plus fluoroquinolones. In ICU patient if pseudomonas is suspected treat it with anti-seudomonal beta-lactam plus fluoroquinolone or aminoblycosides plus azithromycin which is a macrolite. If community-acquired methicillin resistance tap or is suspected treat it either with beta-lactam plus macrolite plus vancomycin. And the second one is the most effective regimen which is beta-lactam plus fluoroquinolones plus linizolid with or without clindamycin. This is the treatment part. Coming to the complications of pneumonia. Most common complication it is a paranymonic effusion will be there. M. paeema retention of sputum causing low bar collapse, deep vein thrombosis and pulmonary embolism. Pneumothoraz particularly with staph ores, separative pneumonia or lung abscess. It may cause ARTS, renal failure, multi organ failure and ectopic abscess formation. Thank you.