{"id":8410,"date":"2012-05-05T22:29:00","date_gmt":"2012-05-05T22:29:00","guid":{"rendered":"http:\/\/www.similima.com\/?p=8410"},"modified":"2021-10-22T05:04:25","modified_gmt":"2021-10-22T05:04:25","slug":"pneumonia-and-homoeopathy","status":"publish","type":"post","link":"https:\/\/www.homeobook.com\/pneumonia-and-homoeopathy\/","title":{"rendered":"Pneumonia and Homoeopathy"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong>Dr Beenadas<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Presenting complaints<\/strong><\/p>\n<p>Cough 6 days, coughs continually for a long time.<br \/>\nProductive, white sputum. Throat irritation precedes coughing.<br \/>\nNausea + + +.<br \/>\nHeadache, chest pain and pain around umbilicus with cough.<br \/>\nCough &lt; by slightest exertion, talking tight clothing,<br \/>\n&lt; by cold damp weather etc.<br \/>\nDifficulty in breathing \u2013 1 week. &lt; by coughing.<br \/>\nHoarseness \u2013 since 3 days.<strong style=\"text-align: justify;\">\u00a0<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>History of presenting complaints<br \/>\n<\/strong>Presenting complaints started 12 days after an exposure to cold damp climate during his travel to Palghat, Coimbatore etc. Then he took some Ayurvedic Medicine, single dose on the first day itself. thereafter cough becomes productive and associated with weakness of body. Increased cough, fever and dyspnoea\u00a0 occurred two days after medicine intake. Vomited mucus once and nausea still remains. Four days back noticed edema of both legs which lasted for one\u00a0 day, during his travel. Patient feels irritable and tendency to run out of\u00a0 bed if hears voice and prefers to lye still in bed as movement brings cough.<\/p>\n<p style=\"text-align: justify;\"><strong>History of previous complaints<\/strong><\/p>\n<ol>\n<li>History of anterior wall myocardial infarction 2 years back with dyslipidemia.<\/li>\n<li>History of hemorrhoids 4 years back.<\/li>\n<li>History of angina 6 months back, admitted here and got relief.<\/li>\n<li>No history of asthma or bronchitis.<\/li>\n<\/ol>\n<p style=\"text-align: justify;\"><strong>Family history<\/strong><\/p>\n<ul>\n<li>Father \u2013 died of heart failure.<\/li>\n<li>Mother \u2013 died.<\/li>\n<li>Has one sister and 2elder brothers. Sister died of renal &amp; cardiac complaint and one brother suicided.<\/li>\n<li>No family history of asthma and allergic disease.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Personal history<\/strong><\/p>\n<ul>\n<li>Place of birth \u2013 Karaparamba.<\/li>\n<li>Educational status \u2013 SSLC<\/li>\n<li>Religion \u2013 Hindu.<\/li>\n<li>Occupational status \u2013 Musician.<\/li>\n<li>Marital status \u2013 not married.<\/li>\n<li>Habit and Hobbies \u2013<\/li>\n<li>Non-vegit, addicted to tea, had smoking habit \u2013 stopped 2years back,<\/li>\n<li>Was alcoholic, now stopped 2 years back.<\/li>\n<li>Domestic relations \u2013 poor.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Physical features<\/strong><\/p>\n<p style=\"text-align: justify;\">(a)\u00a0Generals<\/p>\n<p style=\"text-align: justify;\">Functionals :-<\/p>\n<ul>\n<li>Appetite \u2013 decreased, prefers cold.<\/li>\n<li>Thirst \u2013 normal, prefers hot tea.<\/li>\n<li>Sleep \u2013 reduced, due to cough.<\/li>\n<li>Dreams of horrible animals \u2013 dragon- attacking him. Frightful dreams.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Eliminations :-<\/p>\n<ul>\n<li>Stool \u2013 constipated.<\/li>\n<li>Urine \u2013 normal<\/li>\n<li>Sweat \u2013 normal<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">(b) Response to<\/p>\n<ul>\n<li>&lt; &#8211; Night;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0can\u2019t tolerate air or fanning;<\/li>\n<li>Chilly patient;\u00a0\u00a0\u00a0\u00a0 desires covering<\/li>\n<li>&lt; cold climate;\u00a0\u00a0\u00a0\u00a0 complaints &lt; by bathing.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">\u00a0<strong>Psychic features<br \/>\n<\/strong>Wants to be quiet. Tendency to run out of bed. Imagines he is semiconscious and talks to imaginary person. Horrible dreams make him frightful and then praying.<\/p>\n<p style=\"text-align: justify;\"><strong>Regionals<\/strong><\/p>\n<ul>\n<li>Head :- Headache only during coughing.<\/li>\n<li>Vertigo :- while standing.<\/li>\n<li>Teeth :- sore feeling in teeth.<\/li>\n<li>Throat:- irritation in throat leading to cough.<\/li>\n<li>Stomach :- pain around umbilicus during cough.<\/li>\n<li>Expectoration :-whitish or yellowish.<\/li>\n<li>Skin:- blackish discoloration on the back with pealing of skin after bathing.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Physical examination<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Generals:-\u00a0<\/strong><\/p>\n<ul>\n<li>Built :- poor ;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Complexion :- dark<\/li>\n<li>Wasting of muscles present.<\/li>\n<li>Pulse rate :- 113mt ;\u00a0\u00a0\u00a0\u00a0 R.R \u2013 36mt<\/li>\n<li>Temperature :- 104F;\u00a0\u00a0\u00a0\u00a0 B.P :- 11078 mm of Mg.<\/li>\n<li>Not anemic, no pallor, no clubbing, no edema<\/li>\n<li>No lymphadenopathy, not icteric.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Systemic:-\u00a0<\/strong><\/p>\n<p style=\"text-align: justify;\">Respiratory system<\/p>\n<ul>\n<li>Inspection:-<\/li>\n<li>Upper respiratory tract \u2013 NAD.<\/li>\n<li>No movement of accessory muscles of respiration.<\/li>\n<li>Shape of chest :- bilaterally symmetrical<\/li>\n<li>No chest deformities like pigeon chest, Harrison\u2019s sulci, rickety rosary.<\/li>\n<li>No congenital disorders of vertebral coloumn like kyphoscoliosis, pectus excavatum.<\/li>\n<li>No drooping of shoulders; no dilated veins on chest.<\/li>\n<li>Apex beat:- visible at left 5<sup>th<\/sup> intercostals 12\u201d medial to midclavicular line.<\/li>\n<li>Type of breathing :- abdominal.<\/li>\n<li>No marks of puncture, incision or scars over chest wall.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Palpation:-<\/p>\n<ul>\n<li>Trachea :- central in position.<\/li>\n<li>Apex beat felt at left IC space 12\u201d medial to midclavicular line.<\/li>\n<li>Tenderness of right side of chest \u2013present.<\/li>\n<li>Chest expansion-Decreased.(2-3cm)<\/li>\n<li>Vocal fremitus \u2013 increased on right side.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Percussion:-<\/p>\n<ul>\n<li>Left lobe \u2013 resonant.<\/li>\n<li>Right lobe \u2013 dull<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Auscultation:-<\/p>\n<ul>\n<li>Breath sounds \u2013 bronchial.<\/li>\n<li>Added sounds \u2013 bl crepitation, more on right side.<\/li>\n<li>Vocal fremitus \u2013 increased on right side.<\/li>\n<li>Brobchophony and whispering pectoriloquy \u2013 noted over right side.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Investigations:-<\/strong><\/p>\n<p style=\"text-align: justify;\">13-7-07.<\/p>\n<ul>\n<li>Blood \u2013\u00a0ESR :- 22mm of Hg<\/li>\n<li>Hb\u00a0\u00a0\u00a0 :-13.3g%<\/li>\n<li>WBC :- 4.8&#215;10 \/dl<\/li>\n<li>DC \u2013 L36: N52; mixed \u2013 11.1%<\/li>\n<li>CXR \u2013\u00a0 Opacity noted on upper lobe of right lung.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Provisional diagnosis :<\/strong> Pneumonia.<\/p>\n<p style=\"text-align: justify;\"><strong>Diagnosis of patient<\/strong><\/p>\n<p style=\"text-align: justify;\">Totality of symptoms\u00a0 :-<\/p>\n<p style=\"text-align: justify;\">Disease<\/p>\n<ul style=\"text-align: justify;\">\n<li>Cough With White Sputum<\/li>\n<li>Chest Pain With Cough<\/li>\n<li>Cough &lt; Physical Exertion, Cold Weather<\/li>\n<li>Dyspnoea &lt; Coughing<\/li>\n<li>Hoarseness And Irritation In Throat<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Patient<\/p>\n<ul style=\"text-align: justify;\">\n<li>Prefers Hot Drinks<\/li>\n<li>Chilly Patient+ + + ,Cannot Tolerate Fanning.<\/li>\n<li>Complaints &lt; By Bathing<\/li>\n<li>Tendency To Run Out.<\/li>\n<li>Horrible and frightful dreams.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Miasmatic Expressions <\/strong><\/p>\n<p style=\"text-align: justify;\">Psora:-<\/p>\n<ul>\n<li>Chest pain and pain around umbilicus with cough.<\/li>\n<li>Cough &lt; cold warm weather.<\/li>\n<li>\u00a0Hoarseness of voice.<\/li>\n<li>Imagines as semiconscious and tendency to run out.<\/li>\n<li>Horrible frightful dreams.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Sycotic.<\/p>\n<ul>\n<li>Pneumonia with consolidation of lungs.<\/li>\n<li>Sycotic pneumonia and bronchitis, cough and cold &lt; in humid moist atmosphere.<\/li>\n<li>Tachycardiya.<\/li>\n<li>Syphilitic-<\/li>\n<li>Feels worse at night.<\/li>\n<li>Cough paroxysmal<\/li>\n<li>Dyspnoea &lt; lying down.<strong style=\"text-align: justify;\">\u00a0<\/strong><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Evaluation of symptoms <\/strong><\/p>\n<ul>\n<li>Stomach &#8211; desire tea<\/li>\n<li>Generality \u2013 cold in general &#8211; &lt;<\/li>\n<li>Generality \u2013 heat vital, lack of<\/li>\n<li>Respiration \u2013 difficult, cough with.<\/li>\n<li>Respiration \u2013 difficult exertion after.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong> Medicines given <\/strong><\/p>\n<ul>\n<li>11-7-07\u00a0\u00a0\u00a0 &#8211; Ipecac 3x \/2d<\/li>\n<li>12-7-07\u00a0\u00a0\u00a0 &#8211; Ipecac30\/2d<\/li>\n<li>13-7-07\u00a0\u00a0\u00a0 &#8211; Bell200\/1d<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong><span style=\"text-decoration: underline;\">PNEUMONIA<br \/>\n<\/span><\/strong>Pneumonia is the infection of alveoli, distal airways and inerstitium of lung that is manifested by\u00a0 increased weight of the lungs, replacement of normal lung\u2019s sponginess by consolidation and alveoli filled with WBC , RBC and fibrin.<\/p>\n<p style=\"text-align: justify;\"><strong>Definition :- (clinician)<br \/>\n<\/strong>Pneumonia is\u00a0 constellation of symptoms and signs \u2013 fever, chill, cough, pleuritic chest pain, sputum production, hyper or hyperthermia, increased respiratory rate, dullness to percussion, bronchial breathing, egophony, crackles, wheezes, pleural friction rub with at least one opacity on chest X-Ray.<strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Host defenses protecting lungs<br \/>\n<\/strong>Nasal turbinate and sharp angular turn from the naso and anterior oropharynx into posterior pharynx acts as baffles where inhaled particulate matter can impact. Ciliated cells overlying mucus layer\u00a0 of trachea, bronchi and terminal bronchioles move a mucus layer which float. Mucus consists of complex glycoproteins called mucins that trap micro-organisms.<\/p>\n<p style=\"text-align: justify;\">The entry into lower respiratory tract is protected by glottis and is cleared by coughing defense include macrophages, fibronectin, lysozymes\u00a0 lactoferrin, Ig G, defensins, cathelicidins, collectins and complement. Surfactant is bactericidal to certain pathogens and along with Ig G and fibrinectin, can oponise bacteria.<\/p>\n<p style=\"text-align: justify;\"><strong> FACTORS IN PATHOGENISIS<br \/>\n<\/strong>Routes of infection :- gross aspiration, micro aspiration, haematogenous spread from a distal infected site and direct spread from a contiguous infected site.<\/p>\n<p style=\"text-align: justify;\">Microbial factors :- Micro organism develop a verity of mechanism to counteract host defense.<\/p>\n<p style=\"text-align: justify;\">Eg:- Chlamydia pneumonia produce \u2013 ciliostatic factor;<\/p>\n<p style=\"text-align: justify;\">Mycoplasma pneumonia\u00a0\u00a0\u00a0\u00a0\u00a0 &#8211;\u00a0\u00a0\u00a0\u00a0\u00a0 shear off cilia;<\/p>\n<p style=\"text-align: justify;\">S.pneumonia&amp; N.meningitidis \u2013 proteases.<\/p>\n<p style=\"text-align: justify;\">Host factors:-Hypogammaglobulinemia, defects in phagocytosis or ciliary function, neutropaenia, functional or anatomical asplenia or a reduction in CD4 &amp; T lymphocytes count are all host defense deficits.<\/p>\n<p style=\"text-align: justify;\">Anatomical defects:- obstructed bronchus, bronchiectasis or sequestration of pulmonary segment etc lead to recurrent pneumonia or failure of pneumonia to resolve.<\/p>\n<p style=\"text-align: justify;\"><strong>Pathophysiology<br \/>\n<\/strong>Vital capacity, lung compliance, functional residual capacity and total lung capacity\u00a0 are below normal.<\/p>\n<p style=\"text-align: justify;\"><strong>Pathology<br \/>\n<\/strong>This is manifested as 4 general patterns \u2013 1) Lobar Pneumonia 2) Broncho Pneumonia 3) Interstitial Pneumonia 4) Miliary Pneumonia.<\/p>\n<p style=\"text-align: justify;\"><strong>1.Lobar pneumonia<br \/>\n<\/strong>Classically involves an entire lung lobe relatively homogeneously, although in some patient a small portion of the lobe may be unaffected or at an earlier stage of involvement. Four\u00a0 stage of lobar pneumonia may exists simultaneously in the\u00a0 same lung.<\/p>\n<p style=\"text-align: justify;\">1) First stage \u2013 Stage of Congestion :-occurs during the first 24 hours and is characterized grossly\u00a0 by redness and a doughy consistency\u00a0 and microscopically by vascular congestion and alveolar edema. Many bacteria are present and are swept by the rapid expansion of edema fluid throughout the lobe via the Pores of Kohn. Only a few neutrophils are seen at this stage.<\/p>\n<p style=\"text-align: justify;\">2) 2<sup>nd<\/sup> stage \u2013 Stage of Red Hepatization.:- This term is because of the color of the lung and the similarity of its airless, noncrepitant firmness to the consistency of liver \u2013 is characterized microscopically by the presence of many erythrocytes, neutrophills, desquamated epithelial cells and fibrin in the alveolar spaces.<\/p>\n<p style=\"text-align: justify;\">3) 3<sup>rd<\/sup> stage \u2013 Stage of Grey Hepatization :- The ling is dry, friable and grey-brown to yellow as a consequence of a persistent fibrinopurulent exudates, a progressive disintegration of RBC and the variable presence of hemosiderin. The exudates contains macrophages, neutrophills and seldom bacteria.<\/p>\n<p style=\"text-align: justify;\">\u00a02<sup>nd<\/sup> &amp; 3<sup>rd<\/sup> stage lasts for 2-3 days each, with a 2-6 day duration\u00a0of maximal consolidation.<\/p>\n<p style=\"text-align: justify;\">4) 4<sup>th<\/sup> stage &#8211; Stage of Resolution :- characterized by erythocytic digestion of alveolar exudates, resorptin, phagositosis or coughing\u00a0 op of residual debris and restoration of the pulmonary architecture. Fibrinous inflammation may extent to\u00a0 and across the plural space, causing a rub heard by auscultation, and may lead to resolution or to organization and plural adhesions.<\/p>\n<p style=\"text-align: justify;\"><strong>11.Bronchopnumonia<br \/>\n<\/strong>A\u00a0 patchy consolidation involving\u00a0 one or several lobes, usually involves the dependent lower and posterior portions of the lung \u2013 a pattern attributable to the distribution of aspirated oropharyngeal contents by gravity. The consolidated area are poorly demarcated; in some cases there is an abrupt delimitation of the pneumonia at interlobular septa. The neutrophilic exudates is centered in bronchi and bronchioles with centrifugal spread to adjacent alveoli and diminishing cellular exudates. Often there is pulmonary edema in the periphery of the lesion.<\/p>\n<p style=\"text-align: justify;\"><strong>111. Interstitial pneumonia.<br \/>\n<\/strong>Is defined by histopathologic identification of an inflammatory process predominantly involving the interstitium, including the alveolar walls and the connective tissues around the bronchovascular tree. The inflammation may be patchy or diffuse. The alveolar septa contain an inflammation of lymphocytes, macrophages and plasma cells. The alveoli contains protein rich hyaline membrane similar to that found in ARDS may line the alveolar space. Bacterial super infection of viral pneumonia also produce a mixed patter of interstitial and alveolar air space inflammation.<\/p>\n<p style=\"text-align: justify;\"><strong>1V. Miliary Pnumonia<\/strong>.<br \/>\nNumerous discrete lesions resulting from the spread\u00a0 of the pathogen to the lungs via the bloodstream. The varying degree of immunocompramise manifests as variation in the tissue reaction.<\/p>\n<p style=\"text-align: justify;\"><strong>Pulmonary complications in pneumonia<br \/>\n<\/strong>Necrotizing pneumonia, formation of abscess, vascular invasion with infarction, cavitations and extension to the pleura\u00a0 with empyema or bronchopleural fistula.<strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Community accured pneumonia.(cap)\u00a0<\/strong><\/p>\n<ul>\n<li>Risk factors of CAP \u2013 alcoholism, asthma, immunosuppresion.<\/li>\n<li>Risk factors for Pneumococcal Pneumonia \u2013 Dementia seizures CCF, CVA, tobacco smoking, alcoholism,COPD.<\/li>\n<li>Risk factors for invasive invasive pneumococcal disease include \u2013 male gender, black race, chronic illness, current tobacco smoking and passive exposure to\u00a0 tobacco smoke, HIV infection.<\/li>\n<li>Risk factor for Legionnaire\u2019s disease include \u2013 male gender, current tobacco smoking, Diabetes mellitus, hematological malignancy, cancer, ESRD and HIV infection.<\/li>\n<li>Risk factor for Gram negative bacteria :- aspiration, previous hospital administration, previous antimicrobial treatment and broncetasis.<\/li>\n<li>Etiology :- Organism causing pneumonia may be identified from culture of blood, sputum, plural fluid, pulmonary tissues or endobronchial secretion.<\/li>\n<li>CAP include bacteria, fungi, viruses and parasite.<\/li>\n<li>Pathogens \u2013 S.pneumoniae, H.influenza, S.aureus, M.pneumonia, C. pneumonia, Moraxella catarrhalis, Leginella,aerobic Gram negative bacteria, influenza virus, adenovirus and respiratory syncytial virus.S.pneumonia account for 50% of CAP.<span style=\"text-align: justify;\">\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Clinical features.<br \/>\n<\/strong>Vary from mild to fulminent and fatal. Onset may be sudden, dramatic and insidious. Fever, cough (nonproductive\u00a0 or productive of purulent or rust colored sputum), pleuritic chest pain, chills or rigors, and shortness of breath are typical. Headache, nausea, vomiting, diarrhea, myalgia, arthralgia, fatigue, etc may also be present. Confusion may be important manifestation in elderly persons.<\/p>\n<p style=\"text-align: justify;\"><strong>Physical signs :-<\/strong>\u00a0 tachypnoea, dullness\u00a0 to percussion, increased tactile and vocal fremitus, egophony, whispering pectoriloquy, crackles and pleural friction rub.<\/p>\n<p style=\"text-align: justify;\">Single most useful clinical sign of severity of pneumonia is respiratory rate &gt; 30\/mt. mortality rate is highest for pneumonia due to P. aeruginora, them for klebsiella, E.coli, S.aureus and Acinetobacter.<\/p>\n<p style=\"text-align: justify;\">Worsening of co morbid conditions \u2013 DM, CCF, IHD and asthma.<\/p>\n<p style=\"text-align: justify;\"><strong> Complication.<\/strong><\/p>\n<ul>\n<li>Respiratory failure, CCF, shock, atrial dysarrhythmias, MI, GI bleeding and renal insufficiency.<\/li>\n<li>Most common\u00a0 immediate cause of death in pneumonia patient \u2013 respiratory failure, heart disease and infection.<\/li>\n<li>Associated with pneumonia related\u00a0 mortality include \u2013 dementia immunosuppression, active cancer, systolic hypotension, male gender, multilobar pulmonary infiltration.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong> Diagnosis<\/strong><\/p>\n<p style=\"text-align: justify;\">1)Chest X-Ray<\/p>\n<p style=\"text-align: justify;\">2) CT \u2013 detects pulmonary opacities in patient when chest X-Ray not show pneumonia or again chest X-Ray is repeated after 24-48 hours.<\/p>\n<p style=\"text-align: justify;\">3) Etiological Diagnosis :- blood culture, sputum strains and culture<\/p>\n<p style=\"text-align: justify;\">Detection of antigens of pulmonary pathogens in urine:-<\/p>\n<p style=\"text-align: justify;\">eg :- L.pneumophilia serogroup 1 antigen _ Legionnaire\u2019s disease.<\/p>\n<p style=\"text-align: justify;\">Bacterimic pneumococcal pneumonia \u2013 S.pneumonia.<\/p>\n<p style=\"text-align: justify;\">Serology \u2013 detection of IgM antibody or demonstration of a fourfold rise in titer of antibody.<\/p>\n<p style=\"text-align: justify;\">Eg:- serologic tests are complement fixation, indirect immunoflouresence, ELISA.<\/p>\n<p style=\"text-align: justify;\">Agent diagnosed are \u2013 M.pneumonias, C.pneumonias, Chlamydia psittaci, legionella, C.burnettii<\/p>\n<p style=\"text-align: justify;\">Polymer Chain Reaction :- detection of DNA (Legionella, M.pneumonia &amp; C.pneumonia) or RNA of microorganisms.<\/p>\n<p style=\"text-align: justify;\">Complication:-\u00a0Pleural effusion, Lung abscess, recurrent pneumonia.<\/p>\n<p style=\"text-align: justify;\"><strong>Aspiration pneumonia<br \/>\n<\/strong>It is due to introduction of foreign substance or objects into the lower respiratory tract. Areas involved are those that are most dependent in the supine position \u2013 posterior segment of upper lobe and superior segment of lower lobe.<\/p>\n<p style=\"text-align: justify;\">Etiology :- cause in elderly \u2013 Enterobacteriaceae, S.aureus, S.pneumoniae and H.influenza.<\/p>\n<p style=\"text-align: justify;\"><strong>Epidemiology:-<br \/>\n<\/strong>Gastric contents are aspirated into lungs with a consequent inflammatory response \u2013 due to aspiration of oropharyngeal flora into the lungs with consequent bacterial infection.<\/p>\n<p style=\"text-align: justify;\">Risk Factors :- altered level of consciousness , incompetent gastro esophageal junction, elevated intragastric pressure or volume and neuromuscular disease(glottis closures)<\/p>\n<p style=\"text-align: justify;\"><strong>Clinical Feature :-<br \/>\n<\/strong>Chemical pneumonitis which is severe, require assisted ventilation. PH of &lt;2.5 &amp; a gastric aspirate volume of &gt;0.3ml\/kg(20-25ml in adults) is need to develop aspiration pneumonia.<\/p>\n<p style=\"text-align: justify;\"><strong>Diagnosis:-<\/strong><\/p>\n<ul>\n<li>History of aspiration.<\/li>\n<li>Location of pneumonia \u2013 depends on position of patient when aspiration<\/li>\n<li>Ocurs. Eg \u2013 in recumbent position, opacity in posterior segment of right upper lobe.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Prevention :-<\/strong> oral hygiene.<strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Hospital acquired (nosocomical) pneumonia.<br \/>\n<\/strong>It is the pneumonia occurring at least 48 hours after hospital admission.<\/p>\n<p style=\"text-align: justify;\">Common in medical and surgical wards, in ICU patient undergoing\u00a0 mechanical ventilation. Tubes serves direct bacterial introduction into lower respiratory tract, prevents effective coughing to clear lower respiratory secretions, damage he tracheal epithelium and allows the accumulation of oropharyngeal secretions.<\/p>\n<p style=\"text-align: justify;\">Presence of nasotrachial or nasogastric tube increase risk of nosocomial sinusitis.<\/p>\n<p style=\"text-align: justify;\"><strong> Etiology:-<\/strong>Common cause \u2013 S.aureus (64%) then, enterobacteriaceae.<\/p>\n<p style=\"text-align: justify;\"><strong>Clinical features:-<\/strong>presence of a new or progressive infiltrate on CXR + at least 2 of the following \u2013 1) fever &gt;37.8*C 2) Leukocytosis &gt;10,000WBC\/L 3) purulent sputum.<\/p>\n<p style=\"text-align: justify;\">Other symptoms _ dyspnoea, hypoxemia &amp; chest pain.<\/p>\n<p style=\"text-align: justify;\"><strong>Diagnosis :-<\/strong> endotrachial aspiration or bronchoalveolar lavage.<\/p>\n<p style=\"text-align: justify;\">PSB( protected specimen brush) +ive if at least (10)3CFU(colony forming units) of bacteria \/ml<\/p>\n<p style=\"text-align: justify;\"><strong>Pneumonia Rubric \u2013<\/strong><strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Kent-<\/strong><\/p>\n<p style=\"text-align: justify;\">(1) Chest-hepatizaton of lungs-<\/p>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0 3 \u2013 phos,\u00a0 \u00a0 2 \u2013 Br, Cactus, Camph, Chel,Iod, Kali.carb, Kali.clor, Kali.iod, Lache,\u00a0 Lob, Lyco, Nux.vom, Sangu, Tubercu.<\/p>\n<p style=\"text-align: justify;\">(2) Chest \u2013 Inflammation \u2013 Lungs<\/p>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0 3 \u2013 Aco, Ant.tart, Ars, Bry, Car.veg, Chel, Hep, Lob, Lyco, Mer, Phos,\u00a0 \u00a0Puls, Rhus.tox, Senega, Sepia, Sul, Ver.vir<\/p>\n<p style=\"text-align: justify;\"><strong>Boerick<\/strong><\/p>\n<p style=\"text-align: justify;\">(1) Resp. system- Inflammation- 1) Bronchopneumonia<\/p>\n<p style=\"text-align: justify;\">2- Acon, Ant.tart, Ars.iod, Bry, Chel, Ipecac, Phos, Puls, Tub.<\/p>\n<p style=\"text-align: justify;\">1- Am.iod, Ant.ars, Ars, Bell, Bry, Iod, Kali.carb, Puls.<\/p>\n<p style=\"text-align: justify;\">(2) Croupous pneumonia-<\/p>\n<p style=\"text-align: justify;\">2- Acon, Ant.tart, Bell, Brom, Bry, Chel, Iod, Kali.carb, Lyco, Phos,\u00a0 Sangu, Sul, Ver.vir.<\/p>\n<p style=\"text-align: justify;\">1-\u00a0 Am.iod, Ars.iod, Arn, Campher, Car.veg, Gels, Hp.sul, Ip, Lache,\u00a0 Nat.sulph, Nit.ac, Op, Rtus.tox,Tub.<\/p>\n<p style=\"text-align: justify;\">(3) Stages of pneumonia- Congestive-<\/p>\n<p style=\"text-align: justify;\">\u00a02 -Acon, Fer.p, Iod, Sang, Ver.vir<\/p>\n<p style=\"text-align: justify;\">(4) Stage of Consolidation-<\/p>\n<p style=\"text-align: justify;\">2-Bry, Iod, Phos.<\/p>\n<p style=\"text-align: justify;\">(5) Stage of resolution-<\/p>\n<p style=\"text-align: justify;\">\u00a02-ant.tart, Hepar, Kali.iod, Phos, Sang, Sulp.<\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"text-decoration: underline;\">THERAPEUTICS<\/span><\/strong><strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>ACONITE-<\/strong> In pulmonary congestions, 1<sup>st<\/sup> stage of pneumonia. Symptoms are high fever, distinct chill, pulse- small, full, hard &amp; tense. History of exposure to cold winds. Skin hot, dry; hard teasing and painful dry cough. Expectoration is watery, serous and\u00a0 frothy, may blood tinged. Restless tossing about ,anxiety and fear of death.<\/p>\n<p style=\"text-align: justify;\"><strong>VER.VIR<\/strong>&#8211; Full, hard and rapid pulse, red streak through the centre of tongue. Indicated at commencement of pneumonia \u2013 violent congestion about chest preceding pneumonia. Great arterial excitement, dyspnoea, chest oppression and stomach symptoms of nausea and vomiting. High fever.<\/p>\n<p style=\"text-align: justify;\"><strong>FER.PHOS-<\/strong> 1<sup>st<\/sup> stage of inflammation before exudation takes place. Expectoration is thin watery and blood streaked. Violent congestion of lungs- whether at onset of disease or during its course. Thus it corresponds to secondary pneumonia in the aged and debilitated. High fever oppressed and hurried breathing and bloody expectoration. Little thirst.<\/p>\n<p style=\"text-align: justify;\"><strong>IODINE-<\/strong> 1<sup>st<\/sup> &amp; 2<sup>nd<\/sup> stage of pneumonia,croupous form. High fever and thirst less. Rapid tendency for hepatization. Cough and dyspnoea as if chest would not expand. Sputum blood streaked.Iod 1x-3x arrests process of hepatization if given.<\/p>\n<p style=\"text-align: justify;\"><strong>BRYONIA-<\/strong> Fever present ;sharp, stitching\u00a0 pleuritic pains. Cough is hard and dry. Sputum is scanty and rust colored. Tongue is dry. Patient wants to keep perfectly quiet. Right sided remedy. Pain in chest worse by motion, breathing and relieved by lying on right or painful side.\u00a0 For pneumonia complicated by pleurisy.<\/p>\n<p style=\"text-align: justify;\"><strong>PHOS-<\/strong>Follows Bry and is complimentary. Lungs are hepatized. Cough with pain under sternum; mucus rales, sputa is yellowish mucus with blood streaks or rust colored.<\/p>\n<p style=\"text-align: justify;\"><strong>HEPAR SULPH-<\/strong> After phos. as the exudates begins to soften. Cough after exposure to dry cold wind, rattling of mucus,&lt;by cold air or drinks. Cough when any part of body is uncovered. Patient has to sit up and bend back in\u00a0asthma.<\/p>\n<p style=\"text-align: justify;\"><strong>TUBERCULINUM-<\/strong> In lobular pneumonia rising as intercurrent from 6x-30x is important.<\/p>\n<p style=\"text-align: justify;\"><strong>SANGUNARIA-<\/strong> Fever, burning and fullness in the upper chest. Sharp, stitching pains on right side. Dry cough, dyspnoea\u00a0 and expectoration of rust color sputum. Circumscribed redness and burning heat of the cheeks esp. afternoon. Engorgement and congestion of lungs.<\/p>\n<p style=\"text-align: justify;\"><strong>CHELIDONIUM<\/strong>&#8211; Bilious pneumonia is indication. Stitching pain under right scapula. Cough is loose, rattling and difficult expectoration.<\/p>\n<p style=\"text-align: justify;\"><strong>ANT.TART-<\/strong> Indicated at stage of resolution. Fine moist rales heard all over the hepatized portion of lungs. Oppression of breathing compels to sit. No expectoration. More suited in aged and in children.<\/p>\n<p style=\"text-align: justify;\"><strong>KALI.CARB<\/strong>&#8211; Sharp stitching pain in chest, worse by motion. Affect lower part of right lung. Dyspnoea and great mucus in chest. Indicated when Ant.tart &amp; Ip fails to raise the expectoration.<\/p>\n<p style=\"text-align: justify;\"><strong>SULPHUR-<\/strong> In any stage of pneumonia. Slow speech, dry tongue, weakness and faintness are characteristic.Dyspnoea &lt;12 &amp;2 at midnight causing patient to sit-up in bed. Psoric constitutions with tendency to develop into tuberculosis.<\/p>\n<p style=\"text-align: justify;\"><strong>LYCOPODIUM-<\/strong>Useful in delayed or partial resolution. Tightness across the chest, aching over lungs, great weakness. Threatens to run into acute phthisis.<\/p>\n<p style=\"text-align: justify;\"><strong>IPECAC-<\/strong> Cough incessant and violent with every breath. Chest seems full of phlegm. Bubbling rales. Constriction in chest with nausea. Hoarseness. cough dry and asthmatic. Rattling cough. Fever with nausea, thirst,<\/p>\n<p style=\"text-align: justify;\"><strong>CAL.C<\/strong> chilliness and shivering.<\/p>\n<p style=\"text-align: justify;\"><strong>CUPRUM.MET-<\/strong> Spasm and constriction of chest. Spasmodic asthma alternating with spasmodic vomiting. Cough better\u00a0 by drinking cold water. ARB- Chest very sensitive to touch, percussion or pressure. Suffocating spells. Painless hoarseness. cough exited by tickling in the throat and accompanied by vomiting.<\/p>\n<p style=\"text-align: justify;\"><strong>ARS.ALB<\/strong>&#8211; Respiration anxious, stertorous and wheezing. Oppression of chest on coughing, walking and on going upstairs. great anxiety. chest, shivering or great heat\u00a0 and burning in chest..<\/p>\n<p style=\"text-align: justify;\"><strong>CARBO.VEG-<\/strong> Cough &lt; in evening, going from a warm to cold place, in bed. Chilliness or coldness in Expectoration of green mucus or yellow pus or spitting of blood and burning pain in the chest.<\/p>\n<p style=\"text-align: justify;\"><strong>CAUSTICUM<\/strong>&#8211; Aphonia from weakness of muscles of larynx. Hawking up of abundant mucus. Cough excited by speech and cold. Cough relieved by swallow of cold water. Cough with involuntary passage of urine.<\/p>\n<p style=\"text-align: justify;\"><strong>NAT.SULPH-<\/strong> Sycotic pneumonia, lower lobe of right lung affected , with great soreness of chest. During cough patient has to sit up in bed and hold the chest with both hands.<\/p>\n<p style=\"text-align: justify;\"><strong>Dr.Beenadas<br \/>\n<\/strong>Lecturer, Department of MM<br \/>\nGovt. Homeopathic Medical College. Calicut<\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>Dr Beenadas Presenting complaints Cough 6 days, coughs continually for a long time. Productive, white sputum. Throat irritation precedes coughing. Nausea + + +. Headache, chest pain and pain around umbilicus with cough. Cough &lt; <a class=\"mh-excerpt-more\" href=\"https:\/\/www.homeobook.com\/pneumonia-and-homoeopathy\/\" title=\"Pneumonia and Homoeopathy\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":20608,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9925],"tags":[9933],"class_list":{"0":"post-8410","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-case-presentations","8":"tag-pneumonia-and-homoeopathy"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Pneumonia and Homoeopathy<\/title>\n<meta name=\"description\" content=\"Homoeopathic management of Pneumonia\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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