复旦大学临床医学专业：《内科学》课程教学资源（课件讲义，双语版）肺炎（胡必杰）

Respiratory Diseases Pneumonia Dr. Bijie Hu(胡必杰) Zhongshan Hospital of Fudan University Shanghai 2021/2/23 Dr HU Bijie

2021/2/23 Dr.HU Bijie 1 Respiratory Diseases Pneumonia Dr. Bijie HU（胡必杰） Zhongshan Hospital of Fudan University Shanghai

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200 180 mortality(per10 000 160 140 120 100 80 60 20 ◆◆,今 0 1900191019201930194019501960197019801990 Mortality Trends with Pneumonia from 1900 to 1990 in USA 2021/2/23 Dr HU Bijie Semin respir Infect 9(3): 140-52, 1994

2021/2/23 Dr.HU Bijie 3 Semin Respir Infect 9(3):140-52，1994 mortality (per10 000) Mortality Trends with Pneumonia from 1900 to 1990 in USA 0 20 40 60 80 100 120 140 160 180 200 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990

Leading infectious killers Millions of deaths, worldwide, all ages, 1998 Over age fiv Under age five 25 23 22 2.0 1.5 1.5 1.1 10 0.5 Acute AIDS Diarhoeal Malaria Measls respiratory infections (including h TehN b rudd amang ad6 dh pneumon ia and w宝xWT1D influenza)

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Mortality Forecast by WHO 1990 2020 Cardiovascular disease Cerebrovascular diseases Lower respiratory infections Diarrhea Perinatal disease COPD Tuberculosis Morbilli Gastric cancer Traffic accidents H Lung cancer suicide Editorial. Lancet. 1997.349:1263 2021/2/23 Dr HU Bijie

2021/2/23 Dr.HU Bijie 5 1990 2020 Cardiovascular disease Cerebrovascular diseases Lower respiratory infections Diarrhea Perinatal disease COPD Tuberculosis Morbilli Traffic accidents Lung cancer Gastric cancer HIV suicide Editorial, Lancet, 1997, 349: 1263. Mortality Forecast by WHO

Epidemiology 6th leading cause of death in U.S Number one among the infectious diseases 5.6 million patients annually in US Incidence 5-10/1,000/year Mortality in OPd patients 1-5%, but Inpatients 25%, ICU 50-60%0 2021/2/23 Dr HU Bijie

2021/2/23 Dr.HU Bijie 6 Epidemiology • 6th leading cause of death in U.S. • Number one Among the infectious diseases • 5.6 million patients annually in US • Incidence 5~10/1,000/year • Mortality in OPD patients 1-5 %, but Inpatients 25%, ICU 50-60%

Classification of respiratory tract infections Upper respiratory tract infection Definition Otitis media Coryza/col Epiglottis Pneumonia is the inflammation of lower Airway infections Acute bronchitis respiratory tracts including Acute exacerbation of chronic bronchitis alveoli. interstitial tissues Cystic fibrosis and broncioles by the Parenchymal infections Pneumonia microorganisms, chemical Lung abscess irritations or by an immunological process 2021/2/23 Dr HU Bijie Empyema

2021/2/23 Dr.HU Bijie 7 Definition • Pneumonia is the inflammation of lower respiratory tracts including alveoli, interstitial tissues, and broncioles by the microorganisms, chemical irritations or by an immunological process

Classifications Terminology Mild. moderate. severe Lobar vs interstitial Infections vS noninfections Bacterial, viral, fungal, parasitic Primary vs Secondary ⑤P;0 Community Acquired Pneumonia Nosocomial pneumonia Ventilator Associated pneumionia Typical vs Atypical Immune compromised vs. Normalimmunity 2021/2/23 D

2021/2/23 Dr.HU Bijie 8 Classifications & Terminology • Mild, moderate, severe • Lobar vs interstitial • Infections vs. noninfections • Bacterial, viral, fungal, parasitic • Primary vs. Secondary • Community Acquired Pneumonia Nosocomial Pneumonia Ventilator Associated Pneumionia • Typical vs. Atypical • Immune compromised vs. Normal immunity

Key Bacterial Pathogens of CAP A Global Meta-Analysis Other 12% S. pneumoniae 48P Legionella 66% M. pneumoniae 7% H. influenzae Study cohorts: N= 127 12% Total patients: N= 33,148 Total patients reporting 2021/2/23 Dr HU Bijie data: N=6866 Fine MJ et al. JAMA 1996: 275(2): 134-41

2021/2/23 Dr.HU Bijie 9 Key Bacterial Pathogens of CAP: A Global Meta-Analysis Fine MJ et al. JAMA 1996; 275(2):134-41. • Study cohorts: N = 127 • Total patients: N = 33,148 • Total patients reporting data: N = 6866 S. pneumoniae 66% Other 12% Legionella spp. 4% M. pneumoniae 7% H. influenzae 12%

Causative pathogens in 5,961 adults admitted to hospital with CAP identified in 26 prospective studies from 10 European countries s pneumoniae c pneumoniae Mycoplasma pneumoniae Legionella sp H influenzae G-neg enterobacteria C psittaci Coxiella burnetii Staph aureus M catarrhalis Other 2021/223 0510。15202530 C Bijie Woodhead M. Chest 1998: 183S-187S

2021/2/23 Dr.HU Bijie 10 Causative pathogens in 5,961 adults admitted to hospital with CAP identified in 26 prospective studies from 10 European countries 0 5 1 0 1 5 2 0 2 5 3 0 S pneumoniae C pneumoniae Viral Mycoplasma pneumoniae Legionella sp H influenzae G-neg enterobacteria C psittacii Coxiella burnetii Staph aureus M catarrhalis Other Woodhead M. Chest 1998;183S-187S