Aspiration pneumonia


Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs1 Symptoms often include fever and cough of relatively rapid onset1 Complications may include lung abscess1 Some include chemical pneumonitis as a subtype, which occurs from acidic but non-infectious stomach contents entering the lungs, while other do not12

Infection can be due to a variety of bacteria2 Risk factors include decreased level of consciousness, problems with swallowing, alcoholism, tube feeding, and poor oral health1 Diagnosis is typically based on the presenting history, symptoms, chest X-ray, and sputum culture12 Differentiating from other types of pneumonia may be difficult1

Treatment is typically with antibiotics such as clindamycin, meropenem, ampicillin/sulbactam, or moxifloxacin1 For those with only chemical pneumonitis antibiotics are not typically required2 Among people hospitalized with pneumonia, about 10% are due to aspiration1 It occurs more often in older people, especially those in nursing homes2 Both sexes are equally commonly affected2

Contents

  • 1 Causes
    • 11 Risk factors
    • 12 Implicated bacteria
  • 2 Location
  • 3 Diagnosis
  • 4 See also
  • 5 References
  • 6 External links

Causesedit

Aspiration pneumonia is often caused by a defective swallowing mechanism, often due to a neurological disease or as the result of an injury that directly impairs swallowing or interferes with consciousness Examples of the former are stroke, Parkinson's disease, and multiple sclerosis, and examples of the latter are some types of dementia, seizures, intoxication, and general anaesthesia For many types of surgical operations, patients are therefore instructed to take nothing by mouth nil per os, abbreviated as NPO for at least four hours before surgery

Risk factorsedit

  • Ethnicity
    • In the United States, African-Americans are hospitalized at a significantly higher rate than whites for aspiration pneumonia Asians have a lower risk of death, and the risk of death for African-Americans is not significantly different from whites Hispanics have a lower risk of death than non-Hispanics3
  • Age, male gender, poor dental hygiene, lung disease, swallowing difficulties, diabetes mellitus, severe dementia, malnutrition, Parkinson's disease, use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors45
  • Reduced functional status, residence in an institutional setting, prolonged hospitalization or surgical procedures, impaired consciousness, chronic swallowing disorders, mechanical airway interventions, immunocompromised, history of smoking, antibiotic therapy, advanced age, reduced pulmonary clearance, diminished cough reflex, disrupted normal mucosal barrier, impaired mucociliary clearance, alter cellular and humoral immunity, obstruction of the airways, and damaged lung tissue6

Whether aspiration pneumonia represents a true bacterial infection or a chemical inflammatory process remains the subject of significant controversy Both causes may be present with similar symptoms

Implicated bacteriaedit

When bacteria are implicated, they are usually aerobicverification needed:

  • Streptococcus pneumoniae7
  • Staphylococcus aureus7
  • Haemophilus influenzae7
  • Pseudomonas aeruginosa7

They may also be admixed with anaerobic bacteria oral flora:

  • Bacteroides7
  • Prevotella7
  • Fusobacterium7
  • Peptostreptococcus7

Locationedit

The location is often gravity dependent, and depends on the patient position Generally, the right middle and lower lung lobes are the most common sites affected, due to the larger caliber and more vertical orientation of the right mainstem bronchus Patients who aspirate while standing can have bilateral lower lung lobe infiltrates The right upper lobe is a common area of consolidation in alcoholics who aspirate in the prone position8

Diagnosisedit

Aspiration pneumonia in a ventilated person with a central line and nasogastric tube

Aspiration pneumonia is typically diagnosed by a combination of clinical circumstances a debilitated or neurologically impaired person, radiologic findings an infiltrate in the proper location, and sometimes with the help of microbiologic cultures Some cases of aspiration pneumonia are caused by aspiration of food particles or other particulate substances like pill fragments; these can be diagnosed by pathologists on lung biopsy specimens9

See alsoedit

  • Dysphagia
  • Meconium aspiration syndrome
  • Nosocomial pneumonia

Referencesedit

  1. ^ a b c d e f g h i j k l m n o p DiBardino, DM; Wunderink, RG February 2015 "Aspiration pneumonia: a review of modern trends" Journal of critical care 30 1: 40–8 PMID 25129577 doi:101016/jjcrc201407011 
  2. ^ a b c d e f g h i Ferri, Fred F 2017 Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1 Elsevier Health Sciences p 1006 ISBN 9780323529570 
  3. ^ Oliver, NM, Stukenborg, GJ, Wagner, DP, Harrell, FE, Kilbirdge, KL, Lyman, JA, Einbinder, J, & Connors, AF 2004 Ethnicity on In-Hospital Mortality from Aspiration Pneumonia Journal of the National Medical Association, 9611, 1462-1469
  4. ^ Scannapieco, FA, Mylotte, JM 1996 Relationship between periodontal disease and bacterial pneumonia Journal of Periodontal, 67, suppl 10, 1114-1122
  5. ^ van der Maarek-Wierink, CD, Vanobbergen, JN, Bronkhorst, EM, Schols, JM, & de Baat, C, 2011 Risk factors for aspiration pneumonia in frail older people: a systematic literature review Journal of American Medical Directors Association, 125, 344-354
  6. ^ Taylor, GW, Loesche, WJ, & Terpenning, MS 2000 Impact of Oral Diseases on Systemic Health in the Elderly: Diabetes Mellitus and Aspiration Pneumonia Journal of Public Health Dentistry, 604, 313-320
  7. ^ a b c d e f g h Table 13-7 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K; Fausto, Nelson Robbins Basic Pathology: With Student Consult Online Access Philadelphia: Saunders ISBN 1-4160-2973-7  8th edition
  8. ^ Anand Swaminathan, MD "eMedicinecom: Pneumonia, Aspiration"  Retrieved: 2007-01-20
  9. ^ Mukhopadhyay S, Katzenstein AL 2007 "Pulmonary disease due to aspiration of food and other particulate matter: a clinicopathologic study of 59 cases diagnosed on biopsy or resection specimens" American Journal of Surgical Pathology 31 5: 752–759 PMID 17460460 doi:101097/01pas000021341808009f9 

External linksedit

Classification
  • ICD-10: J690, P249
  • ICD-9-CM: 507,77018 99732
  • MeSH: D011015
External resources
  • MedlinePlus: 000121
  • eMedicine: emerg/464





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