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].

• Fever

  Other symptoms that occur in isolation or in association are cough, fever, breathlessness, and wheezing [4, 5]. [ajronline.org]

  However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. [ncbi.nlm.nih.gov]

  Pneumonia is suggested by fever (or hypothermia in the elderly), dyspnea, pleuritic chest pain, and cough productive of purulent mucus. These patients are generally toxic and have fevers above 39°C, tachycardia, and tachypnea. [pulmonologyadvisor.com]

  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]

  Both aspiration pneumonia and pneumonitis can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural [web.archive.org]

• Pain

  Add a translation Maltese Uġigħ faringolarinġali Sogħla1 English Pharyngolaryngeal pain Cough1 Last Update: 2017-04-26 Usage Frequency: 1 Quality: Maltese Sulluzzu, Uġigħ faringolarinġali, Disfonija English Hiccups, Pharyngolaryngeal pain, Dysphonia Last [mymemory.translated.net]

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  […] in older adults -- Addressing dyspnea in older adults -- Managing joint pain in older adults -- Managing back pain in older adults -- Determining the appropriate use of exercise for older adults -- Defining adequate nutrition for older adults -- Helping [worldcat.org]

  Clinical Manifestations of Aspiration Pneumonia RHONCI & Crackles over Affected Area (lower lobe) -Most common signs-cough, fever, chills, dyspnea, tachypnea, and pleuritic chest pain (pain on inspirations) (Pedi-retractions, nasal flaring, accessory [quizlet.com]

  The alveoli fill with fluid or pus, causing pain and difficulty breathing. Inhaling foods or liquids is of particular concern for infants and toddlers, as well as people over 65 years old. [nm.org]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  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]

  […] not alert (unconscious or semi-conscious) after a stroke or brain injury Problems with swallowing Symptoms may include any of the following: Chest pain Coughing up foul-smelling, greenish or dark phlegm (sputum), or phlegm that contains pus or blood Fatigue [medlineplus.gov]

• Hypoxemia

  Aspiration pneumonia is a form of ARDS resulting from an acid injury of the lung and is primarily a problem of arterial hypoxemia requiring adequate oxygen therapy. All other modes of therapy have not been shown to alter survival in man. [ncbi.nlm.nih.gov]

  […] can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural friction rub Altered mental status Hypoxemia [web.archive.org]

  Patients can be discharged from the hospital after clinical improvement and stability (eg, no fever, no leucocytosis, resolution of hypoxemia) and radiographic improvement (eg, decreased infiltrate or cavity size, no pleural effusion). [emedicine.com]

• Epilepsy

  Epilepsy. Coma. Critical illnesses and debilitated patients. Gastroesophageal reflux disease (GERD). Iatrogenic – anesthesia (general), bronchoscopy, endoscopy (upper gastrointestinal), intubation (nasogastric or endotracheal). tracheostomy. [healthhype.com]

  Folios 46-67: Essay on the most important diseases of China, continued fever, remittent fever, intermittent fever, ephemeral fever, small pox, measles, scarlatina, epilepsy, insanity, coup de soleil, bronchitis pleuritis and pneumonia, pthisis, dysentery [discovery.nationalarchives.gov.uk]

• Cough

  The most common symptom is Cough The cough produces sputum (thick or discolored mucus). The sputum soon smells foul. [merckmanuals.com]

  In that case, most of the time you’ll be able to prevent this by coughing. Those who have impaired coughing ability, however, may not be able to. [healthline.com]

• Dyspnea

  However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. [ncbi.nlm.nih.gov]

  View larger version (105K) Fig. 3A —Aspiration of tooth to right main bronchus in 43-year-old man with dyspnea and fever. [ajronline.org]

  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]

• Tachypnea

  However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. [ncbi.nlm.nih.gov]

  Chemical pneumonia The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis. [symptoma.com]

  The neutrophils, the offending organism, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation, leading to clinical manifestations of hypoxia (e.g., tachypnea, dyspnea, tachycardia). [quizlet.com]

  Both aspiration pneumonia and pneumonitis can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural [web.archive.org]

  Signs and symptoms Findings of aspiration may include one or several of the following: dyspnea, tachypnea, low oxygen saturation (O2 sat), putrid expectoration, malaise, and frequent coughing. [americannursetoday.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 Confusion The health care provider will listen for crackles [medlineplus.gov]

  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 The health care provider will listen for crackles [ufhealth.org]

  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 The health care provider will listen for crackles or abnormal [nlm.nih.gov]

• Hemoptysis

  Aspiration may be clinically silent, or patients may develop life-threatening hemoptysis as a result [1]. The diagnosis of foreign body aspiration may not be obvious when a patient does not remember an episode of aspiration. [ajronline.org]

  Pink-colored to red sputum (hemoptysis) Bluish tinge of the lips, fingers and/or toes (cyanosis) Causes Aspiration pneumonia is unlikely to arise in a healthy person who is conscious and has properly functioning gag and cough reflexes. [healthhype.com]

  Half of patients report expectoration of putrid sputum that may or may not be associated with hemoptysis. These patients appear chronically ill and have fevers generally below 39°C. [pulmonologyadvisor.com]

  Chapter 81: Delirium -- Chapter 82: Diarrhea -- Chapter 83: Disorders of the Eye -- Chapter 84: Dizziness and Vertigo -- Chapter 85: Dyspnea -- Chapter 86: Edema -- Chapter 87: Falls -- Chapter 88: Fever and Rash -- Chapter 89: Headache -- Chapter 90: Hemoptysis [worldcat.org]

• Vomiting

  A washout period should be considered when switching between ChE inhibitors to minimize the risk of vomiting and aspiration. [ncbi.nlm.nih.gov]

  Inhalation of vomit can occur when a person who vomits is not completely awake, as can happen after a seizure or a drug or alcohol overdose or when a person awakens from anesthesia. [merckmanuals.com]

  Overview Aspiration pneumonia is a complication of pulmonary aspiration, or the inhalation of food, liquid or vomit into the lungs. When the respiratory system is healthy and strong, pulmonary aspiration often clears up on its own. [nm.org]

• Gagging

  This includes gag reflex, coughing, ciliary movement, and immune mechanisms, all of which aid in removing infectious material from the lower airways. [web.archive.org]

  It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. Treatment is directed to the infectious agent or underlying cause. [patientslikeme.com]

  Aspiration of foreign materials can occur with disorders that affect normal swallowing, disorders of the esophagus, a decreased or absent gag reflex, dysphagia, dental problems, sedatives, anesthesia and coma. [hhs.texas.gov]

  Aspiration pneumonia is multifactorial [1] ; however, the most common predisposing factors for aspiration in adults are the following: Impaired airway protection mechanisms (loss of cough/gag reflex, unable to maintain airway, alcohol intake, depressed [emedicine.medscape.com]

• Choking

  This study aimed to determine the frequency of reporting of AP or choking as a cause of death on death certificates with mention of stroke in the United States as a proxy measure of the incidence of dying from AP or choking among patients with stroke. [ncbi.nlm.nih.gov]

  One of the most common problems is coughing or choking, when food goes down the "wrong way" and blocks your airway. This can lead to chest infections, such as aspiration pneumonia, which require urgent medical treatment. [nhs.uk]

• Nausea

  Cholinesterase (ChE) inhibitors approved for treatment of Alzheimer disease are associated with nausea and vomiting in a sizable percentage of patients, ranging from 5% to 31% in clinical trials. [ncbi.nlm.nih.gov]

  […] pneumonia is similar to that of community-acquired pneumonia and may include the following: Cough Fever or chills Malaise, myalgias Shortness of breath, dyspnea on exertion Pleuritic chest pain Putrid expectoration Nonspecific symptoms including headache, nausea [web.archive.org]

  Bacterial pneumonia The clinical presentation of bacterial aspiration pneumonia includes nonspecific symptoms such as headache or nausea/vomiting, and weight loss. [symptoma.com]

  Presentation Nonspecific symptoms - eg, fever, headache, nausea, vomiting, anorexia, myalgia, weight loss. Cough. Dyspnoea. Pleuritic chest pain. Purulent sputum. [patient.info]

• Loss of Appetite

  Loss 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 [medmalfirm.com]

  […] thick yellow, green, brown or blood-stained mucus (phlegm) difficulty breathing – your breathing may be rapid and shallow, and you may feel breathless, even when resting rapid heartbeat high temperature feeling generally unwell sweating and shivering loss [nhs.uk]

• Periodontitis

  The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. [ncbi.nlm.nih.gov]

  Periodontal diseases play an evident role in the etiology of aspiration pneumonia due to their effect to alter the oral bacterial flora. [hungary.pure.elsevier.com]

  Moreover, the importance of using standard case definitions for periodontitis surveillance will be described, along with the development of the current CDC/AAP case definitions by the Workgroup of which Dr. [apollonia.fi]

  […] or anesthesia; or dysphagia ● Absence of rigors ● Failure to recover likely pulmonary pathogens with cultures of expectorated sputum ● Sputum that often has a putrid odor, which is considered diagnostic of anaerobic infection ● Concurrent evidence of periodontal [tistorysjloveu2.tistory.com]

• Dental Caries

  The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. [ncbi.nlm.nih.gov]

• Tachycardia

  Chemical pneumonia The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis. [symptoma.com]

  Both aspiration pneumonia and pneumonitis can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural [web.archive.org]

  The neutrophils, the offending organism, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation, leading to clinical manifestations of hypoxia (e.g., tachypnea, dyspnea, tachycardia). [quizlet.com]

  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]

  Signs may include tachycardia, tachypnoea, decreased breath sounds and dullness to percussion over areas of consolidation, pleural friction rub. Severe infection may lead to hypoxia and septic shock. [patient.info]

• Hypotension

  He then became hypotensive and required dopamine and fluid support. Brief bronchoscopy revealed food particles in the lower airways and bile-stained secretions. Intubation was notable for the large amount of secretions. [ncbi.nlm.nih.gov]

  Intubation, altered level of consciousness, and hypotension would justify an intensive care unit admission. [americannursetoday.com]

  […] present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural friction rub Altered mental status Hypoxemia Hypotension [web.archive.org]

  Aspiration pneumonia shows the following signs: fever, tachypnea, tachycardia, decrease in breath sounds, rales, hyporexia, and/or hypotension. [symptoma.com]

• Cyanosis

  In the absence of an obvious predisposition, the abrupt onset of a self-limited illness characterized by dyspnea, cyanosis, and low-grade fever associated with diffuse rales, hypoxemia, and alveolar infiltrates in dependent lobes should suggest aspiration [ncbi.nlm.nih.gov]

  Chemical pneumonia The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis. [symptoma.com]

  Pink-colored to red sputum (hemoptysis) Bluish tinge of the lips, fingers and/or toes (cyanosis) Causes Aspiration pneumonia is unlikely to arise in a healthy person who is conscious and has properly functioning gag and cough reflexes. [healthhype.com]

  […] aspiration pneumonia include: chest pain shortness of breath (dyspnea) wheezing fever cough, sometimes with yellow or greenish sputum (mixture of saliva and mucus) fatigue difficulty swallowing (dysphagia) profuse sweating bad breath a bluish skin color (cyanosis [verywellhealth.com]

  Witnessed aspiration was followed by respiratory distress and cyanosis within two hours. The women's X-rays showed infiltrates in one or both lower lobes. [nps.org.au]

• Arthralgia

  […] stabbing chest pains Rapid, shallow, often-painful breathing Less-common symptoms [ edit ] Coughing up blood ( hemoptysis ) Headaches, including migraines Loss of appetite Excessive fatigue Bluish skin ( cyanosis ) Nausea Vomiting Diarrhea Joint pain ( arthralgia [en.wikipedia.org]

• Seizure

  Patients with aspiration pneumonitis secondary to seizure, head trauma, or drug overdose should be inspected for signs related to these processes. [web.archive.org]

  English Only one recorded death has been published: after an overdose of 469 mg/kg, a 16-month old child developed an apnoeic episode with seizures and a fatal aspiration pneumonia. [mymemory.translated.net]

  For example, if aspiration is suspected when a person was unconscious or in the throes of a seizure, there may be a consolidation of fluid to the back part of the upper lung. [verywellhealth.com]

  This can occur in aspiration-prone patients, such as those who have frequent episodes of loss of consciousness (e.g., patients prone to seizures or who have alcoholism) or have disorders of the swallowing mechanisms (e.g., patients who have had cerebrovascular [academic.oup.com]

  Risk Factors Factors that may increase the chance of aspiration pneumonia: Decreased level of consciousness due to alcohol intake, seizures, stroke, or other conditions Impaired swallowing function due to poor teeth or a history of Parkinson disease, [winchesterhospital.org]

• Confusion

  They were more likely cared for in the intensive care unit (19% vs 13%, P = 0.002), had longer unadjusted hospital length of stay (9 vs 7 days, P CONCLUSIONS: Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are [ncbi.nlm.nih.gov]

  In logistic regression, the factors predicting aspiration pneumonia were Dementia (OR=44.37), Parkinson's disease (OR=18.63), stroke (OR=17.17), confusion (OR=8.62), hypoalbuminemia (OR=2.89). [dbpia.co.kr]

  You are confused or cannot think clearly. You have more trouble breathing, or your breathing seems faster than normal. When should I contact my healthcare provider? You have a fever. Your symptoms are not better after 2 or 3 days of treatment. [drugs.com]

• Altered Mental Status

  Additionally, altered mental status on emergency department arrival, white blood cell count, and increased exposure duration were independently associated with the development of aspiration pneumonia. Copyright © 2017 Elsevier Inc. [ncbi.nlm.nih.gov]

  It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. Treatment is directed to the infectious agent or underlying cause. [patientslikeme.com]

  It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. The bacteriology and presentation of aspiration pneumonia have changed over the past five decades. [bestpractice.bmj.com]

• Headache

  Aspiration pneumonia symptoms When it starts it'll probably feel like the worst case of flu you've ever had, with a high temperature, headache and aches and pains. [patient.info]

  […] aspiration pneumonia is similar to that of community-acquired pneumonia and may include the following: Cough Fever or chills Malaise, myalgias Shortness of breath, dyspnea on exertion Pleuritic chest pain Putrid expectoration Nonspecific symptoms including headache [web.archive.org]

  […] therapies for older adults -- Considering complementary & alternative medicines for older adults -- Managing misuse of alcohol & psychoactive prescription medications in older adults -- Assessing older adults for syncope following a fall -- Treating headaches [worldcat.org]

  Typically, viral pneumonia causes these symptoms: dry cough minimal sputum headache muscle pain weakness and fatigue moderate fever, up to about 39°C (102°F) chills shortness of breath blue lips and nail beds Making the Diagnosis When diagnosing pneumonia [chealth.canoe.ca]

  Bacterial pneumonia The clinical presentation of bacterial aspiration pneumonia includes nonspecific symptoms such as headache or nausea/vomiting, and weight loss. [symptoma.com]

• Agitation

  Increased impulsiveness or agitation 7. Use of medications such as psychotropic, neuroleptic, antidepressants, anticholinergic, or phenothiazine drugs 8. Hyperextended neck or contractures 9. [patientsafetyinstitute.ca]

  Pacemakers, Defibrillators, and Cardiac Resynchronization Devices in Hospital Medicine -- Section 2: Critical Care -- Chapter 137: Inpatient Cardiac Arrest and Cardiopulmonary Resuscitation -- Chapter 138: Acute Respiratory Failure -- Chapter 139: Pain, Agitation [worldcat.org]

  After 2 h, the solution was allowed to be cooled for 4 h with continuous agitation. Then the extract was removed from the apparatus, followed by paper filtration. [ncbi.nlm.nih.gov]

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.

• Atelectasis

  Aspiration of particulate matter causes airways obstruction and atelectasis. Most commonly there is a shifting mixed infiltrate in the lower lobes. [ncbi.nlm.nih.gov]

  Contrast-enhanced CT images show tooth aspirated to right main bronchus and associated atelectasis of right mid and lower lobes. [ajronline.org]

  A foreign body in the tracheobronchial tree and associated atelectasis or consolidation can be defined with relative ease on CT scans. [emedicine.medscape.com]

  […] antipyretics, fever, analgesics (chest pain), antiemtic (gerd,proton pump inhibitor) -Pleurisy (Inflammation of the tissues that line the lungs and chest cavity) -Pleural effusion (A buildup of fluid between the tissues that line the lungs and the chest) -Atelectasis [quizlet.com]

  Gastric acid causes a chemical burn of the airways and lungs, leading to rapid bronchoconstriction, atelectasis, edema, and alveolar hemorrhage. [merckmanuals.com]

• Pulmonary Infiltrate

  Aspiration pneumonia is defined as pulmonary infiltration caused by inhaled material, either solid or liquid, that is inherently toxic or that initiates a toxic response. [ncbi.nlm.nih.gov]

  In the past, the use of antibiotics shortly after aspiration in patients who develop a fever, leukocytosis, or a pulmonary infiltrate was discouraged.5 Empiric antibiotics were recommended only for patients who aspirate gastric contents and who have conditions [journalofhospitalmedicine.com]

  Aspiration pneumonia should be suspected in those patients with pulmonary infiltrates and a predisposing cause of aspiration (e.g., dysphagia or fall in consciousness Anaerobes should be suspected in the presence of periodontitis, putrid discharge, infection [link.springer.com]

• Pleural Rub

  A doctor listening to your chest with a stethoscope might hear that your breathing sounds muffled and that the covering of your lungs makes a sound when you breathe in and out (a pleural rub). [patient.info]

• Leukocytosis

  In both instances, the white blood cell count (WBC) will invariably be elevated, leading to leukocytosis. [verywellhealth.com]

  It produces fever, leukocytosis, purulent sputum, and an infiltrate visible on a radiograph. It is not an infectious but an inflammatory process, because the low gastric pH keeps the gastric contents sterile. [academic.oup.com]

  Lab tests may or may not reveal a leukocytosis. Patients typically demonstrate low oxygen saturation levels on pulse oximetry as well. Thoracic radiographs are the most important diagnostic tool for diagnosing aspiration pneumonia. [bluepearlvet.com]

  Investigations Blood count: neutrophil leukocytosis. Electrolytes and renal function: dehydration, electrolyte imbalance. Blood culture. Blood gases. [patient.info]

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 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.

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].

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].

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].

• 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].

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].

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.

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. 
4. Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest. Jan 1999;115(1):178-83. 
5. Mier L, Dreyfuss D, Darchy B, Lanore JJ, Djedaïni K, Weber P, et al. Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures. Intensive Care Med. 1993;19(5):279-84. 
6. 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.
7. Akritidis N, Gousis C, Dimos G, Paparounas K. Fever, cough, and bilateral lung infiltrates. Achalasia associated with aspiration pneumonia. Chest. Feb 2003;123(2):608-12.
8. Moore FA. Treatment of aspiration in intensive care unit patients. JPEN J Parenter Enteral Nutr. Nov-Dec 2002;26(6 Suppl):S69-74; discussion S74.
9. Vadeboncoeur TF, Davis DP, Ochs M, Poste JC, Hoyt DB, Vilke GM. The ability of paramedics to predict aspiration in patients undergoing prehospital rapid sequence intubation. J Emerg Med. Feb 2006;30(2):131-6. 
10. Loeb MB, Becker M, Eady A, Walker-Dilks C. Interventions to prevent aspiration pneumonia in older adults: a systematic review. J Am Geriatr Soc. Jul 2003;51(7):1018-22.