স্পেশাল বিসিএস (স্বাস্থ্য) - লং কোর্স

Hospital-acquired pneumonia (HAP) is defined as an episode of pneumonia that presents at least 48 hours after admission to hospital and was not incubating at the time of admission. It is the second most common healthcare-associated infection (HAI) after surgical-site infections and the leading cause of HAI-associated death. Older patients are particularly at risk, as are patients in intensive care units. The term ventilator-associated pneumonia (VAP) is used to describe pneumonia that develops in a person who is mechanically ventilated.

Infections are usually due to a mixture of anaerobes and aerobes in common with the typical flora encountered in the mouth and upper respiratory tract. Isolates of Prevotella melaninogenica, Fusobacterium necrophorum, anaerobic or microaerophilic cocci and Bacteroides fragili may be identified. When suppurative pneumonia or a pulmonary abscess

occurs in a previously healthy lung, the most likely infecting organisms  are Staph. aureus or K. pneumoniae. Actinomyces spp. cause chronic suppurative pulmonary infections, which may be associated with poor dental hygiene.

Focal unilateral airspace opacication favours bacterial infection,mycobacteria or Nocardia.

Bilateral opacication favours P. jirovecii pneumonia, fungi, viruses and unusual bacteria, e.g. Nocardia

cavitation may be seen with N. asteroides, mycobacteria and fungi  the presence of a ‘halo sign’ (a zone of intermediate attenuation between the nodule and the lung parenchyma) may suggest aspergillosis or other invasive fungal infection  pleural effusions suggest pyogenic bacterial infections and are uncommon in P. jirovecii pneumonia.

Miliary TB

Blood-borne dissemination gives rise to miliary TB, which may present acutely but more frequently is characterised by 2–3 weeks of fever, night sweats, anorexia, weight loss and a dry cough. Hepatosplenomegaly may develop and the presence of a headache may indicate coexistent tuberculous meningitis. Auscultation of the chest is frequently normal but

in more advanced disease widespread crackles are evident. Fundoscopy may show choroidal tubercles. The classical appearances on chest X-ray are of ne 1–2 mm lesions (‘millet seed’) distributed throughout the lung elds, although occasionally the appearances are coarser. Anaemia and leucopenia refect bone marrow involvement

Acute eosinophilic pneumonia is an acute febrile illness (of less than 5 days’ duration), characterised by diffuse pulmonary infilltrates and hypoxic respiratory failure.

,