Question 1 of 10

    Aspiration Pneumonia (Aspiration Pneumonias)

    Aspiration pneumonia (2)[1]

    Aspiration pneumonia is a bronchopneumonia resulting from the inhalation or inappropriate passage of foreign solid or liquid material into the respiratory tract.

    This disease originates from the following process: infectious.

    Presentation

    Aspiration pneumonia and pneumonitis presents from mildly ill to critically ill along with the signs and symptoms of septic shock and respiratory failure.

    Physical Examination: The findings of the physical examination depend on the severity of the disease and the presence of complications. Aspiration pneumonia shows the following signs: fever, tachypnea, tachycardia, decrease in breath sounds, rales, hyporexia, and/or hypotension.

    Host Factors: The decreased ability to protect the airway of the host results from previous cerebro-vascular accident (CVA), esophageal diseases, esophageal web, or if the patient is chronically fed by feeding tube.

    Chemical pneumonia

    The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis.

    Bacterial pneumonia

    The clinical presentation of bacterial aspiration pneumonia includes nonspecific symptoms such as headache or nausea/vomiting, and weight loss. Fever, absence of rigors, chest pain, chills and cough with sputum are some of the other symptoms manifested by the patients [7].

    Jaw & Teeth
    Dental Caries
    • Meticulous oral hygiene and treatment of dental caries and periodontal disease may reduce bacterial colonization. 29 Patients without teeth may have a reduced risk of aspiration pneumonia because of decreased colonization. 35 In addition, various antiseptic[consultantlive.com]
    Periodontitis
    • 20-30mL of gastric contents with pH 2.5 Can lead to aspiration pneumonia due to pulmonary defense mechanism injury Aspiration pneumonia Alveolar space infection secondary to inhalation of pathogenic material from oropharynx Increased in patients with periodontal[wikem.org]
    • Also, clinicians should consider the possibility of periodontal infection in all residents who have fevers.[ltlmagazine.com]
    • Other: tracheo-oesophageal fistula, ventilator-associated pneumonia, periodontal disease, gastro-oesophageal reflux [ 4 ] , post-gastrectomy, tracheostomy.[patient.info]
    • On physical examination, findings may include periodontal disease (primarily noted as gingivitis), bad breath, fever, bronchial breath sounds and rales over a consolidated posterior area.[emedicine.medscape.com]
    • Meticulous oral hygiene and treatment of dental caries and periodontal disease may reduce bacterial colonization. 29 Patients without teeth may have a reduced risk of aspiration pneumonia because of decreased colonization. 35 In addition, various antiseptic[consultantlive.com]
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  • Entire body system
    Fever
    • Treatment Dengue Fever Dengue fever is contracted from the bite of a striped Aedes aegypti mosquito.[medicinenet.com]
    • Rest until you no longer have a fever, chest pain, or shortness of breath.[summitmedicalgroup.com]
    • 20% of community-acquired pneumonia in elderly, majority of nursing home-acquired pneumonia Microbiology Community acquired: Pneumococcus, staph, H flu, enterobacter Hospital acquired: Pseudomonas, gram-negatives Clinical Features Aspiration pneumonia Fever[wikem.org]
    • Fever and rigors may be present.[emedicine.medscape.com]
    • There's usually a high fever, sometimes going up to 40.9 C (105 F).[chealth.canoe.ca]
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  • neurologic
    Altered Mental Status
    • It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex.[patientslikeme.com]
    • ASPIRATION Patients with an altered mental status are at high risk for aspiration.[emsworld.com]
    • mental status Aspiration pneumonitis Cough Tachypnea Bloody sputum Respiratory distress Differential Diagnosis Shortness of breath Emergent Pulmonary Airway obstruction Anaphylaxis Aspiration Asthma Cor pulmonale Inhalation exposure Noncardiogenic pulmonary[wikem.org]
    • In general, any condition that leads to altered mental status or decreased level of consciousness, depressed upper airway reflexes, increased gastric volume, or delayed gastric emptying can result in aspiration.[consultantlive.com]
    • mental status Hypoxemia Hypotension (in septic shock) Chemical pneumonitis Patients with chemical pneumonitis may present with an acute onset or abrupt development of symptoms within a few minutes to two hours of the aspiration event, as well as respiratory[emedicine.medscape.com]
    Confusion
    • Learn the correct uses of these two commonly confused homophones.[dictionary.reference.com]
    • You are confused or cannot think clearly.[allinahealth.org]
    • Signs and Symptoms of Aspiration Pneumonia There are several signs and symptoms associated with aspiration pneumonia, yet not all victims will show signs of every symptom: Confusion and disorientation Fever Wheezing and/or noisy breathing Shortness of[medmalfirm.com]
    • Other possible symptoms include: shortness of breath shivering chills headache delirium (confusion) severe bad breath muscle pain weakness chest pain, especially when breathing deeply blue lips and nail beds from lack of oxygen in the blood Viral pneumonias[chealth.canoe.ca]
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  • respiratoric
    Bronchial Breath Sounds
    • On physical examination, findings may include periodontal disease (primarily noted as gingivitis), bad breath, fever, bronchial breath sounds and rales over a consolidated posterior area.[emedicine.medscape.com]
    Cough
    • Cough (Chronic Cough) Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic Group B Strep Group B strep are bacteria called Streptococcus agalactiae that may sometimes cause infections both[medicinenet.com]
    • Poor pulmonary clearance and weak cough .[carterswallowingcenter.com]
    • People with COPD do have strong coughs, but as their immune system weakens with age, it becomes less able to fight off infection.[healthcommunities.com]
    • Cough up lung secretions as much as possible.[summitmedicalgroup.com]
    • Symptoms often include fever and cough of relatively rapid onset.[en.wikipedia.org]
    Dyspnea
    • SIGNS AND SYMPTOMS Dyspnea may be experienced during activity (dyspnea on exertion), at rest or as paroxysmal nocturnal dyspnea Tachycardia and tachypnea Jugular venous distention (late and more indicative of right-side heart failure) Lung sounds including[emsworld.com]
    • Symptoms include cough and dyspnea.[merckmanuals.com]
    • Clinically it is manifested by an increase in the rate and depth of respiration at all degrees of severity up to dyspnea.[medical-dictionary.thefreedictionary.com]
    • […] community-acquired pneumonia in elderly, majority of nursing home-acquired pneumonia Microbiology Community acquired: Pneumococcus, staph, H flu, enterobacter Hospital acquired: Pseudomonas, gram-negatives Clinical Features Aspiration pneumonia Fever Dyspnea[wikem.org]
    • . - WJ DePaso - Clinics in chest medicine, 1991 - ncbi.nlm.nih.gov Acute dyspnea in the office - RJ Zoorob, JS Campbell - American family physician, 2003 - meac.ufc.br A five-year study of severe community-acquired pneumonia with emphasis on prognosis[symptoma.com]
    Hemoptysis
    • Signs and symptoms can include: Chest pain, which may be pleuritic Cough that may be productive with hemoptysis Wheezing Altered mental status and syncope Signs of shock, including diaphoresis, tachycardia, tachypnea and hypotension History or suspicion[emsworld.com]
    • Clinical, Radiologic, and Laboratory Features Often times the patient experiences low grade fever, anorexia, significant weight loss, a productive cough, hemoptysis, chest pain and dyspnea (onset very gradual).[atsu.edu]
    • Common symptoms [ edit ] Coughing which produces greenish or yellow sputum A high fever , accompanied by sweating, chills and shivering Sharp, stabbing chest pains Rapid, shallow, often-painful breathing Less-common symptoms [ edit ] Coughing up blood ( hemoptysis[en.wikipedia.org]
    Hoarseness
    • […] may include any of the following: Body odor Carpal tunnel syndrome Decreased muscle strength ( weakness ) Decreased peripheral vision Easy fatigue Excessive height (when excess growth hormone production begins in childhood) Excessive sweating Headache Hoarseness[aspirus.org]
    • Pneumonia There are several signs and symptoms associated with aspiration pneumonia, yet not all victims will show signs of every symptom: Confusion and disorientation Fever Wheezing and/or noisy breathing Shortness of breath Difficulties with swallowing Hoarse[medmalfirm.com]
    • Suggested Reading on Pneumonia by Our Doctors Related Diseases & Conditions 67 articles Tonsillitis Tonsillitis is a contagious infection with symptoms such as: Bad breath Snoring Congestion Headache Hoarseness Laryngitis Coughing Human Immunodeficiency[medicinenet.com]
    • Cough, which may or may not bring up mucus Trouble swallowing Fever Shortness of breath, rapid breathing, or noisy breathing Chest pain Confusion, unclear thinking, or changes in alertness Voice changes such as gurgling and hoarseness Loss of appetite[allinahealth.org]
    • […] pink or frothy Bluish skin around your mouth or your fingertips Trouble swallowing Shortness of breath, rapid breathing, or noisy breathing Chest pain or a rapid heartbeat Confusion, fatigue, or changes in alertness Voice changes such as gurgling and hoarseness[drugs.com]
    Painful Cough
    • The most common symptoms are Bluish tint of the skin Chest pain Coughing Fatigue Fever Gurgling Shortness of breath Wheezing Talk with your physician immediately if you notice any of these symptoms.[dummies.com]
    • Coughing up foul-smelling, greenish or dark phlegm (sputum), or phlegm that contains pus or blood Fatigue Fever Shortness of breath Wheezing Breath odor Excessive sweating Problems swallowing Exams and Tests A physical examination may reveal: Bluish[mountsinai.org]
    Productive Cough
    • […] community-acquired pneumonia in elderly, majority of nursing home-acquired pneumonia Microbiology Community acquired: Pneumococcus, staph, H flu, enterobacter Hospital acquired: Pseudomonas, gram-negatives Clinical Features Aspiration pneumonia Fever Dyspnea Productive[wikem.org]
    • cough · Imaging findings o Conventional chest radiography is usually all that is needed to make the diagnosis o Fleeting infiltrate (lasts less than one or two days) if bland and non-infected § Chemical pneumonitis may appear almost instantly while aspiration[learningradiology.com]
    • Patients may have signs and symptoms similar to those of community-acquired pneumonia, including productive cough, fever, shortness of breath, and hypoxia.[consultantlive.com]
    • Clinical, Radiologic, and Laboratory Features Often times the patient experiences low grade fever, anorexia, significant weight loss, a productive cough, hemoptysis, chest pain and dyspnea (onset very gradual).[atsu.edu]
    Pulmonary Disorder
    • Mendelson's syndrome [ 2 ] refers to the inflammatory pulmonary disorder caused by aspiration of gastric content, more aptly called chemical pneumonitis.[cid.oxfordjournals.org]
    Purulent Sputum
    • It produces fever, leukocytosis, purulent sputum, and an infiltrate visible on a radiograph.[cid.oxfordjournals.org]
    • Patients have a cough, fever, purulent sputum, and radiographic evidence of infiltrate.[atsu.edu]
    • The patient may also describe the following: Cough with purulent sputum Fever or chills Malaise, myalgias Rigors may be present of absent Shortness of breath, dyspnea on exertion Pleuritic chest pain Putrid expectoration (a clue to anaerobic bacterial[emedicine.medscape.com]
    Rales
    • A few rales were heard in both lung fields.[jama.jamanetwork.com]
    • Dyspnea may be experienced during activity (dyspnea on exertion), at rest or as paroxysmal nocturnal dyspnea Tachycardia and tachypnea Jugular venous distention (late and more indicative of right-side heart failure) Lung sounds including wheezes and rales[emsworld.com]
    • There is profound toxemia, cough, gurgling or squeaky rales, and usually an attendant pleurisy producing a friction rub.[medical-dictionary.thefreedictionary.com]
    • Findings on physical examination may include tachypnea, tachycardia, fever, rales, wheezing, and possibly cyanosis.[emedicine.medscape.com]
    Sleep Apnea
    • apnea Widened fingers or toes, with swelling, redness, and pain Other symptoms that may occur with this disease: Colon polyps Excess hair growth in females ( hirsutism ) Type 2 diabetes Weight gain (unintentional) Exams and Tests The health care provider[aspirus.org]
    Sputum Production
    • Tell your doctor if you have any of these: Increased cough Increased sputum production Fever Decreased energy Chest pain Change in mental status Trouble breathing Weight loss Diagnosis Your doctor will ask about your symptoms and medical history.[lifescript.com]
    • 2,3,5,15 Antibiotics may be administered to patients with aspiration pneumonitis who are considered at high risk for bacterial colonization of oropharyngeal and gastric contents and who fail to improve within 48 hours. 2 The presence of fever, increased sputum[consultantlive.com]
    Tachypnea
    • Tachycardia altered mental status Aspiration pneumonitis Cough Tachypnea Bloody sputum Respiratory distress Differential Diagnosis Shortness of breath Emergent Pulmonary Airway obstruction Anaphylaxis Aspiration Asthma Cor pulmonale Inhalation exposure[wikem.org]
    • Signs and symptoms can include: Chest pain, which may be pleuritic Cough that may be productive with hemoptysis Wheezing Altered mental status and syncope Signs of shock, including diaphoresis, tachycardia, tachypnea and hypotension History or suspicion[emsworld.com]
    • Notable findings on initial examination (before intubation) were shock (arterial blood pressure 80/50 mm Hg, despite adequate fluid resuscitation), tachycardia (pulse rate 110 beats/min), tachypnea (respiratory rate 34 respirations/min), low peripheral[wwwnc.cdc.gov]
    • Symptoms and Signs Symptoms and signs include Cough Fever Dyspnea Chest discomfort Chemical pneumonitis caused by gastric contents causes acute dyspnea with cough that is sometimes productive of pink frothy sputum, tachypnea, tachycardia, fever, diffuse[merckmanuals.com]
    • […] by the inhalation or inappropriate passage of highly acidic gastric content–food, gastric acid, vomitus-into the respiratory tract, a clinical event most common in the comatose; after the insult, there is progressive respiratory depression, hypoxia, tachypnea[medical-dictionary.thefreedictionary.com]
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  • gastrointestinal
    Choking
    • They can teach you or your family how you can get the nutrition you need while limiting the risk of choking.[summitmedicalgroup.com]
    • […] aspiration of foreign material over a prolonged time o Zenker’s diverticulum o Achalasia o TE fistula o Neuromuscular diseases o Chronic reflux o Lipoid pneumonia § Mineral oil (used as a laxative) § Oily nose drops (not used anymore) · Clinical findings o Choking[learningradiology.com]
    • Common symptoms include coughing or choking during feeding or recurrent vomiting.[ct.gov]
    Loss of Appetite
    • Symptoms of aspiration pneumonia include difficulty breathing, difficulty swallowing, coughing, rapid breathing, an increased heart rate, loss of appetite and lethargy.[healthypets.mercola.com]
    • An altered mood, vomiting, loss of appetite , and regurgitation may also be present, depending on the underlying reasons for this condition.[petmd.com]
    • […] of appetite Diagnosis of Aspiration Pneumonia in Dogs A thorough physical examination with auscultation of the chest (listening to the chest through a stethoscope) and palpation of the abdomen are very helpful in detecting changes that could indicate[petplace.com]
    • […] of appetite Coughing, with or without phlegm Your Legal Rights Since the elderly population has an increased risk of developing aspiration pneumonia, many victims and loved ones might not understand that they have legal recourse and write it off as a[medmalfirm.com]
    • Cough, which may or may not bring up mucus Trouble swallowing Fever Shortness of breath, rapid breathing, or noisy breathing Chest pain Confusion, unclear thinking, or changes in alertness Voice changes such as gurgling and hoarseness Loss of appetite[allinahealth.org]
    Nausea
    • One night in Florida he awoke with flu-like symptoms, experiencing nausea and vomiting and gasping for air.[leader.pubs.asha.org]
    • Symptoms Nausea and vomiting - adults Nausea is feeling an urge to vomit.[scripps.org]
    • Presentation Nonspecific symptoms - eg, fever, headache, nausea, vomiting, anorexia, myalgia, weight loss.[patient.info]
    • […] cough Confusion or changes in mental awareness (in adults age 65 and older) Cough, which may produce phlegm Fatigue Fever, sweating and shaking chills Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) Nausea[mayoclinic.org]
    • Preoperative fasting may result in missed doses of oral medications, dry mouth, thirst, increased postoperative nausea and vomiting, and hypovolemia. 3 The use of pharmacotherapy to reduce gastric secretion volume and acidity has also been suggested.[consultantlive.com]
    Vomiting
    • Try: Inducing Vomiting in Dogs and Cats: Rules and Risks[embracepetinsurance.com]
    • It's not the act of vomiting that directly causes aspiration pneumonia.[healthypets.mercola.com]
    • This most commonly occurs with disorders that cause regurgitation or vomiting.[petplace.com]
    • I didn't see her vomit or find any vomit but I smelled vomit on her.[vetary.com]
    • Likewise, a vomiting dog may be particularly unlucky and inhale some of his own vomit into his lungs.[petful.com]
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  • cardiovascular
    Cyanosis
    • Symptoms and Types Symptoms of aspiration pneumonia include breathing difficulties, swallowing difficulties, coughing, fever, discharge from the nasal passages , rapid breathing, increased heart rate, a bluish tinge to the skin (cyanosis), and a possible[petmd.com]
    • […] than the esophagus, especially during force feeding or tube feeding Vomiting, especially chronic vomiting What to Watch For Signs of aspiration pneumonia in dogs may include: Coughing Respiratory distress, with rapid breathing and a high heart rate Cyanosis[petplace.com]
    • Coughing, shortness of breath, hypoxia, and cyanosis subsequently may develop.[consultantlive.com]
    • Findings on physical examination may include tachypnea, tachycardia, fever, rales, wheezing, and possibly cyanosis.[emedicine.medscape.com]
    • They were unable to get a better picture, however, because she was having such difficulty breathing and showing signs of cyanosis that they needed to keep her in the oxygen tank and doctors were afraid that stress would be fatal.[vetary.com]
    Tachycardia
    • Clinical findings Progressive respiratory depression, hypoxia, tachypnoea and tachycardia; the tracheobronchial tree “sweats” a thin frothy fluid.[medical-dictionary.thefreedictionary.com]
    • […] elderly, majority of nursing home-acquired pneumonia Microbiology Community acquired: Pneumococcus, staph, H flu, enterobacter Hospital acquired: Pseudomonas, gram-negatives Clinical Features Aspiration pneumonia Fever Dyspnea Productive cough Tachypnea Tachycardia[wikem.org]
    • Signs and symptoms can include: Chest pain, which may be pleuritic Cough that may be productive with hemoptysis Wheezing Altered mental status and syncope Signs of shock, including diaphoresis, tachycardia, tachypnea and hypotension History or suspicion[emsworld.com]
    • Notable findings on initial examination (before intubation) were shock (arterial blood pressure 80/50 mm Hg, despite adequate fluid resuscitation), tachycardia (pulse rate 110 beats/min), tachypnea (respiratory rate 34 respirations/min), low peripheral[wwwnc.cdc.gov]
    • Symptoms and Signs Symptoms and signs include Cough Fever Dyspnea Chest discomfort Chemical pneumonitis caused by gastric contents causes acute dyspnea with cough that is sometimes productive of pink frothy sputum, tachypnea, tachycardia, fever, diffuse[merckmanuals.com]
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  • psychiatrical
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  • Workup

    From the data obtained from the radiographic evidence of an infiltrate, the diagnosis of aspiration pneumonia can be ascertained. The exact location of the infiltrate is determined by the chest radiograph. Laboratory studies are guided by the symptoms and clinical presentation of the patients.

    • CBC with Differential: This test reveals the levels of white blood cells (WBCs). In bacterial and chemical pneumonia, there is an increase in the levels of neutrophils, and thrombocytosis
    • Chest Radiography: This test helps to ascertain the exact location of the aspiration pneumonia. 
    • CT Scanning: Though this test is not needed in all the types of aspiration pneumonia, the technique can help to characterize pleural effusions. It helps to differentiate between the pulmonary and pleural abnormalities.
    • Ultrasonography also helps to locate the exact position of the pleura effusions.
    • Bronchoscopy: This procedure is indicated in patients with chemical pneumonia when the foreign material is suspected.

    Test Results

    Pulmonary Function Test
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  • Laboratory

    Serum
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  • Microbiology
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  • Pleura
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  • Imaging

    X-ray
    Pulmonary Infiltrate
    • This practice is believed to lead to the selection of more resistant organisms. [20] In addition, those patients with recent aspiration, fever, and leukocytosis should not be treated even in the presence of a pulmonary infiltrate due to the risk of development[emedicine.medscape.com]
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  • Treatment

    Antibiotics: In aspiration pneumonia, antibiotics form the first line in the management procedure. The important points to consider while administering antibiotics in patients with aspiration pneumonia are as follows:

    • If the pneumonitis fails to resolve within 48 hours, antibiotics must be administered.
    • Patients with small-bowel obstruction must receive antibiotics.
    • Patients who are on antacids must be considered for antibiotic therapy since there is an increase in the chances of gastric colonization.
    • The choice of antibiotics range ceftriaxone plus azithromycin, levofloxacin, or moxifloxacin, Piperacillin/tazobactam and imipenem or cilastatin along with vancomycin.
    • Other antibiotics that can be used to manage the condition include a third-generation cephalosporin with a macrolide or a fluoroquinolone alone [8].

    Managing Chemical Aspiration Pneumonia: Important step for the management of chemical pneumonia is maintaining the airways of the secretions by tracheal suctioning and oxygen supplementation. The routine use of corticosteroid must be avoided.

    Prognosis

    Prognosis of the bacterial and chemical pneumonia depends on the underlying diseases or complications as well as host status. If the bacterial pneumonia is not treated, it can lead to severe complications such as lung abscess and bronchopleural fistula. Longer period of hospitalization is associated with nosocomial pneumonia [6].

    Complications

    The common complications of aspiration pneumonia are lung abscess, shock, bacteremia, and respiratory failure.

    Complications

    Acute Respiratory Distress Syndrome
    • Disease Acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood....[scripps.org]
    • respiratory distress syndrome (ARDS).[emedicine.medscape.com]
    • We report a case of acute respiratory distress syndrome (ARDS) and septic shock caused by H. parahaemolyticus .[wwwnc.cdc.gov]
    • This syndrome may resolve spontaneously, usually within a few days, or may progress to acute respiratory distress syndrome.[merckmanuals.com]
    • However, aspiration may cause: Chemical pneumonitis: chemical irritation of the lungs, which may progress to acute respiratory distress syndrome and/or bacterial infection.[patient.info]
    Atelectasis
    • As noted above, bronchoscopy may be useful and may be considered if radiographic evidence of endobronchial debris or atelectasis is present.[consultantlive.com]
    • Gastric acid causes a chemical burn of the airways and lungs, leading to rapid bronchoconstriction, atelectasis, edema, and alveolar hemorrhage.[merckmanuals.com]
    • […] most common in the comatose; after the insult, there is progressive respiratory depression, hypoxia, tachypnea, and tachycardia; the tracheobronchial tree 'sweats' thin frothy fluid; lung parenchyma is acutely inflamed, hemorrhagic and edematous with atelectasis[medical-dictionary.thefreedictionary.com]
    • Coughing, wheezing, and dyspnea occur with atelectasis seen on X-ray of the chest.[atsu.edu]
    Bacterial Pneumonia
    • Complications of bacterial pneumonia include parapneumonic effusion, empyema, lung abscess, and superinfection.[emedicine.medscape.com]
    • Bacterial pneumonia, on the other hand, has a sub-acute onset, with symptoms occurring after a couple days to weeks after the aspiration event. [nursinghomesabuseblog.com]
    • Bacterial pneumonia is most often caused by the bacteria Streptococcus pneumoniae (pneumococcus).[chealth.canoe.ca]
    • Chemical pneumonitis, bacterial pneumonia, or airway obstruction can occur.[merckmanuals.com]
    • Bacterial pneumonia and lung abscess.[m.medlineplus.gov]
    Empyema
    • The mortality rate for aspiration pneumonia complicated by empyema is approximately 20%.[emedicine.medscape.com]
    • Treatment and prognosis Complications The major complication associated with aspiration is pulmonary infection: segmental or lobar pneumonia bronchopneumonia lung abscess empyema Other causes of airspace opacity need to be considered 3 : pulmonary oedema[radiopaedia.org]
    • Empyema of the gallbladder due to Haemophilus parahaemolyticus , with a brief review of its role as a pathogen.[wwwnc.cdc.gov]
    • […] and Enterobacteriaceae · Hospital-acquired infections tend to be caused by Pseudomonas and other gram-negative organisms § Anaerobic infections commonly necrotize, so cavities may be present · Broncho-pleural fistulae and para-pneumonic effusions or empyema[learningradiology.com]
    • Empyema (see Etiology ) also occasionally complicates aspiration.[merckmanuals.com]
    Hyperventilation
    • […] with Respiratory Effort Guillain-Barre syndrome Multiple sclerosis Myasthenia Gravis Lambert-Eaton Syndrome Organophosphate toxicity Stroke (Main) Tick paralysis Non-Emergent ALS Ascites Uncorrected ASD Congenital heart disease COPD exacerbation Fever Hyperventilation[wikem.org]
    Hypoxia
    • As the condition progresses, fluid moves into the alveoli, worsening the gas exchange and resulting in worsening hypoxia.[emsworld.com]
    • Clinical findings Progressive respiratory depression, hypoxia, tachypnoea and tachycardia; the tracheobronchial tree “sweats” a thin frothy fluid.[medical-dictionary.thefreedictionary.com]
    • Coughing, shortness of breath, hypoxia, and cyanosis subsequently may develop.[consultantlive.com]
    • In most cases (60%), the symptoms of dyspnea, cough, hypoxia, and low-grade fever resolve over 2-4 days.[clincalc.com]
    • Severe infection may lead to hypoxia and septic shock.[patient.info]
    Lung Abscess
    • For aspiration-related lung abscess, chest x-ray may show a cavitary lesion.[merckmanuals.com]
    • abscess - M Allewelt, P Schüler, PL Bölcskei - Clinical microbiology , 2004 - Wiley Online Library Medien Referenzen Aspiration pneumonia (2) , CC BY-SA 3.0 In anderen Sprachen English Deutsch Selbsttest[symptoma.com]
    • Metronidazole may need to be added if there is evidence of complications - eg, lung abscess.[patient.info]
    • Bacterial pneumonia and lung abscess.[m.medlineplus.gov]
    • Two common complications are associated with aspiration pneumonia: Lung abscess: A lung abscess is a pus-filled cavity in the lungs that causes severe pain and difficulty breathing.[dummies.com]
    Pulmonary Embolism
    • embolism Pulmonary hypertension Tension pneumothorax Idiopathic pulmonary fibrosis acute exacerbation Cardiac Cardiac tamponade Cardiogenic pulmonary edema (CHF) Myocardial Infarction Pericarditis Other Associated with Normal/ Respiratory Effort Abdominal[wikem.org]
    • . - UM MacFadyen, GM Hendry, H Simpson - Archives of disease in , 1983 - adc.bmj.com Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment. - K Garg, H Sieler, CH Welsh - American Journal[symptoma.com]
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  • Etiology

    Three different types of materials cause three different types of aspiration pneumonia. They are as follows:

    • Chemical pneumonia: Aspiration of the gastric acid cause chemical pneumonia (infectious form) or pneumonitis (or chemical injury).
    • Bacterial pneumonia: When the aspiration of bacteria from oral areas causes pneumonia, it is called bacterial pneumonia. Sometimes there is aspiration of some foreign bodies which may predispose patients with this type of pneumonia.
    • Exogenous lipoid pneumonia: Aspiration of the oil causes this rare form of pneumonia.

    Though aspiration pneumonia includes chemical and bacterial pneumonia, their presentation, pathophysiology and treatment vary [2].

    Epidemiology

    The authentic data for chemical pneumonia is not known, some studies, however, suggest that around 5 to 15% of all the community acquired pneumonia (CAP) results from aspiration pneumonia. The 30-day mortality rate of the aspiration pneumonia was found to be around 21%.

    It has been estimated that 1 in every 10 patient hospitalized post drug-overdose were found to have aspiration pneumonitis.

    Nosocomial bacterial pneumonia is more common among males than females. Adults were found to be more frequently affected by this disease than the children. The predisposing factors are common among the elderly, making them susceptible to this disease [3].

    Sex distribution
    Age distribution

    Pathophysiology

    In patients who develop aspiration pneumonia, the infiltrate increases the risk of oropharyngeal aspiration. The risk is greatly increased in patients with the lower level of consciousness. The three most important determinants of the severity and extent of aspiration pneumonia are nature, and volume of the material aspirated, along with the host defenses.

    Chemical pneumonia: This aspiration leads to acute respiratory distress within one hour. The chances of development of this type of pneumonia depend on the levels of consciousness. Since the gastric fluid is acidic in nature, it results in chemical burns. Studies have revealed that if the pH of the aspirated fluid is less than 2.5 and volume aspirated is greater than 0.3 mL/kg of body weight, the chances of chemical pneumonia increase several fold.

    Bacterial pneumonia: In persons with impaired airway defense, there is an increased risk of bacterial pneumonia as the inherent mechanism of removing the bacteria is compromised. This type of pneumonia occurs both in community and hospital acquired pneumonia. Anaerobic and micro-aerophilic organisms are believed to play significant role in this disease

    Causative microorganisms: The common causative micro-organisms of community acquired aspiration pneumonia are: Streptococcus species (pneumoniae, aureus), Haemophilus influenzae, and Enterobacteriaceae. However, the hospital acquired pneumonia (especially intubated patients) is caused by gram-negative organisms such as Pseudomonas aeruginosa [4] [5].

    Prevention

    • Patients with swallowing dysfunction must opt for soft diet.
    • Lower risk is associated with patients who use the gastrostomy tubes along with mosapride citrate.
    • Patients with altered consciousness who are at the risk of aspiration pneumonia must be positioned in a semi-recumbent position [9] [10].

    Summary

    When the gastric contents or oropharyngeal contents seek passage to the lower airways, it is defined as aspiration.

    The passage of the foreign materials to the lungs may cause several syndromes depending on the nature, frequency, host factors and quantity of the material aspirated. Pneumonia that accompanies aspiration is called aspiration pneumonia [1].

    Patient Information

    Aspiration pneumonia is a serious disease and there are certain conditions that can worsen or increase the chances of complications such as alcoholism, drug overdose, stroke and seizures, trauma to head, dysphagia, esophageal neoplasm, gastroesophageal reflux disease, myasthenia gravis, Parkinson disease and dementia.

    Critical illness and use of mechanical devices also contribute to the disease. Hence, awareness of the condition in such patients is advisable.

    Self-assessment

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    References

    1. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. Mar 1 2001;344(9):665-71.
    2. Varkey B, Kutty K. Pulmonary aspiration syndromes. In: Kochar's Concise Textbook of Medicine.Baltimore, Md:. Lippincott Williams & Wilkins;1998:902-906.
    3. Lanspa MJ, Jones BE, Brown SM, Dean NC. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. Feb 2013;8(2):83-90. 
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