00:00
The other issues that you can
get with pneumonia,
are other complications. We’ve mentioned severe
hypoxia, we’ve mentioned septic shock, and
I’ve also mentioned ARDS. These are physiological
complications that occur with severe pneumonia.
00:15
In addition, you have renal impairment- again,
I have discussed that already. But, there
are other complications. Patients in hospital
are at risk of a deep vein thrombosis.
00:25
so they might develop a deep vein thrombosis.
Atrial fibrillation is a common complication
of acute pneumonia, and that will settle whereas
the patient gets better. Another important
thing is acute cardiac ischemia and that occurs
in patients who are being stressed, and pneumonia
is a great physiological stress for the body,
and therefore, if somebody has underlying
ischemic heart disease then that could have
precipitated a myocardial infarction or angina,
or decompensation if they've got cardiac
ventricular impairment.
01:01
So the important complications of pneumonia
are not to miss are infective ones and this
largely comes down to pleural effusions. Parapneumonic
effusions, there are small effusions that
occur in patients with pneumonia, and are
not infected, are present in about a third
of patients and these will resolve as the
patient gets better. However, in a minority
of patients about 7% , 5 or 10% that effusion
will become infected and become a complex
parapneumonic effusion, and eventually that
moves on to form an empyema. So this X ray
shows somebody presenting with left lower
lobe pneumonia, but now you can see that the
C-reactive protein was very high on the day
of the admission, about 330, 7 days later
after treatment, it had gotten better, but
then a couple days later they redeveloped
a fever, and the CRP has jumped back up to
over 140. And the chest X ray here shows some
left-sided shadowing pneumonia, but also you
can see there is some plural shadowing going
up to the left-hand side of the chest, and
this reflects an infected pleural effusion.
02:04
You can see that on the chest X ray, and that
diagnosis would be empyema, and these situations,
a complication of community acquired pneumonia.
Other infective complications are actually
pretty rare but you can get are lung abscesses,
little more likely in alcoholics or those
who've aspirated, and it’s actually more
likely with certain bacteria, Staphylococcus
aureus, Klebsiella, and anaerobes. You can
also get spread of infection from
the lung to other parts of the body. This is pretty
rare, but occasionally you get peritonitis,
arthritis, endocarditis as a complication
of pneumonia. What is actually quite common,
in somebody who's been in hospital and treated
for pneumonia, and the infection's initially
gotten better then has deteriorated with an
increasing fever again, is that they may have
an underlying associated cellulitis. So initial
antibiotics given in pneumonia will be intravenous,
and where the intravenous cannula has been
placed, there is relatively high chance that
they can develop a cellulitis during their
hospital stay.
03:03
And antibiotic therapy can cause clostridia
difficile diarrhea, a super infection of the
gut, a Clostridia difficile and that is actually
quite a common complication of patients receiving
antibiotics in hospital, and can be quite
dangerous.