Pneumonia Secondary to Sepsis
Pneumonia is an infection of the lower respiratory tract, which occurs when the lung’s or the systemic defense mechanism is impaired (Spratto & Woods, 2012). Sepsis is an infection caused by bacteria, virus, or fungus (Sundar, et al., 2013). Pneumonia secondary to sepsis is, thus, an infection of the lower respiratory tract as a result of septicemia or a localized infection of the lungs or bronchioles. This is commonly seen in community-acquired pneumonia which is predisposed by the lack of proper aseptic techniques by the community members (Severino, et al.2014).
Etiology
Pneumonia secondary to sepsis is caused by bacterial, viral, or fungal micro-organisms. Typically acquired pneumonia secondary to sepsis is entirely due to bacterial infections while the atypically acquired is caused by viral or fungal infections (Stearns-Kurosawa, et al., 2011). Bacterial microorganisms responsible for this type of pneumonia are Streptococcus pneumonia. which is the most common cause of this disease (Parker, et al., 2015). Others are Haemophilus influenza, Klebsiella pneumonia, Moraxella catarrhal, and Pseudomonas aeruginosa. Depending on the source of the microorganisms, the various forms of the disease can be community acquired nosocomial and aspiration pneumonia (Sundar, et al., 2013).
Morphological Patterns
There are two morphological patterns associated with pneumonia secondary to sepsis. First, lobar pneumonia is on the morphological patterns of the disease and occurs when pneumonia typically affects the lung lobes (Sundar, et al., 2013). Infections, which are predominantly affecting the lung lobes without infecting the bronchioles results in lobar pneumonia (Severino, et al.2014). Second, Bronchopneumonia is the morphological pattern of the disease in which both the lobes and the bronchioles and bronchi are affected. This is caused by highly virulent bacteria resulting in diffuse infection of the lower respiratory tract (Stearns-Kurosawa, et al., 2011).
Pathophysiology
Predisposing factors to the development of pneumonia are decreased cough reflex resulting in aspiration, decreased phagocytic functions of macrophages, defects in innate and humoral immune response, and diminished mucociliary functions, accumulation of secretions within the respiratory tract and congestion (Sundar, et al., 2013; Parker, et al., 2015). Infectious agents get into the lung parenchyma by either through the respiratory tract or the hematogenous spread (Stearns-Kurosawa, et al., 2011). Overgrowth of the micro-organisms occurs on the parenchyma of the lungs before they invade the alveolar membrane of the lungs. Recognition of the pathogens by Toll-Like Receptors results in innate immunity response to eliminate the microorganisms. These cells include macrophages, neutrophils, and Jak-STAT signaling molecules (Parker, et al., 2015).
Invasion by highly virulent microbes such as Staphylococcus aureus provokes an intense inflammatory response dominated by neutrophils and macrophages (Stearns-Kurosawa, et al., 2011). The virulent factors of these micro-organisms in that they produce toxic materials such as staphylococcal enterotoxin B and toxic shock syndrome toxin, which further results in systemic inflammation causing tissue damage (Parker, et al., 2015). Depending on the quantity and virulence of the pathogens, the body immunity can successfully eliminate them, or the pathogen can colonize and cause infections (Sundar, et al., 2013).
Diagnosis and Clinical Manifestation
Diagnosis of pneumonia can be done by sputum culture, Chest X-ray, nasal swabs, urine, and blood glucose, and antigen laboratory examination of blood (Sundar, et al., 2013). Symptoms include a cough with phlegm production, chest pain when breathing, shortness of breath, chills and fever (Parker, et al., 2015).
Plan of Care
The prioritized plan of care involves condition required therapy for the respiratory failure. Since pneumonia presents with obstructive respiration, there is a need to ensure that the patient is under oxygen therapy to prevent hypoxemia and hypercapnia from occurring. Blood PO2 and PCO2 levels should be maintained at normal values before initiation of treatment (Wanli, et al., 2016). Maintenance of oxygen therapy and administration of aerosol inhalation is important.
Assessment and diagnosis of the condition. This is done by taking a detailed history of the patient to ascertain the cause and type of pneumonia. According to Wanli et al.(2016) identification of the particular cause will facilitate accurate management of the condition. Once diagnosed, the severity of the condition is accessed as this would aid in the identification of the line of drugs to be used (Sundar, et al., 2013). The plan of care recurrent pneumonia caused by a highly virulent microbe would be different from managing aspiration pneumonia (Stearns-Kurosawa, et al., 2011).
Managing the disease and symptoms. Managing the disease would involve administration of anti-infective therapy to the patient. Wanli et al.’s (2016) article explains that depending on the cause of pneumonia, antibacterial, antiviral or antifungal medication to the patient so that progression of the disease is limited. Management of symptoms presented by the patient is also done. Reducing fever, cough, and abdominal distention (Sundar, et al., 2013).
In summary, pneumonia secondary to sepsis is a common form of Obstructive Pulmonary Diseases presenting in both children and adults. The disease is caused by various bacterial, viral, and fungal microorganisms, which cause infection and damage the body tissues. The disease can be fully managed, and complete eradication of the causative agent does not cause reinfection.
References
Parker, D., Ryan, C. L., Alonzo, F., Torres, V. J., Planet, P. J., & Prince, A. S. (2015). CD4+ T Cells Promote the Pathogenesis of Staphylococcus aureus Pneumonia. Journal of Infectious Diseases, 211(5), 835-845. https://dx.doi.org/10.1093/infdis/jiu525
Severino, P., Silva, E., Baggio-Zappia, G. L., Brunialti, M. C., Nucci, L. A., Rigato Jr., O., & … Salomao, R. (2014). Patterns of Gene Expression in Peripheral Blood Mononuclear Cells and Outcomes from Patients with Sepsis Secondary to Community Acquired Pneumonia. Plos ONE, 9(3), 1. doi:10.1371/journal.pone.0091886
Spratto, G., & Woods, A. L. (2012). Delmar nurse’s drug handbook. Albany, NY: Delmar.
Stearns-Kurosawa, D. J., Osuchowski, M. F., Valentine, C., Kurosawa, S., & Remick, D. G. (2011). The Pathogenesis of Sepsis. Annual Review of Pathology, 6, 19–48. http://doi.org/10.1146/annurev-pathol-011110-130327
Sundar, K. M., & Sires, M. (2013). Sepsis induced immunosuppression: Implications for secondary infections and complications. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 17(3), 162–169. http://doi.org/10.4103/0972-5229.117054
Wanli, l., Xinjiang, a., Mingyu, f., & Chunli, l. (2016). Emergency treatment and nursing of children with severe pneumonia complicated by heart failure and respiratory failure: 10 case reports. Experimental & Therapeutic Medicine, 12(4), 2145-2149. doi:10.3892/etm.2016.3558