Pneumonia

Pneumonia is the infection of the lower respiratory tract. There are 2 main types; Community acquired pneumonia (CAP) and Health care associated pneumonia (HCAP)

EPIDEMIOLOGY
– approx 4 million adults in the US are diagnosed with CAP every year

ETIOLOGY
– Viral (most common, 85% cases)
– Common bacterial; S.pneumoniae, Hemophilus influenzae, Staph aureus, MRSA, Pseudomonas
– Other; TB, fungi, legionella

RISK FACTORS
– Age (>65yrs)
– Smoking, Alcohol use
– Asthma, COPD
– Previous h/o of pneumonia
– Immunosuppression
– Malnutrition

PATHOLOGY BASED ON RISK FACTORS
1. Alcohol – S.pneumoniae, Klebsiella, S aureus, Anaerobes
2. COPD – S.pneumoniae, H.influenzae, Moraxella
3. Diabetes – S.pneumoniae, S aureus
4. Sickle cell – S.pneumoniae
5. HIV – S.pneumoniae, Pneumocystis carinii, H.influenzae, Cryptococcus, TB

CLINICAL FEATURES
– Cough, fever, chills, pleuritic chest pain, sputum
– Fatigue, myalgia, headache
– Tachypnea
– Wheeze, crackles, pleural fub

LABORATORY
– CBC, Sputum stain
– Blood culture
– Chest xray, CT scan
– Procalcitonin (bacterial vs viral)
– Influenza swab
– Urinary antigen (Legionella)

CUBR-65
Confusion, Uremia, Blood pressure, Respiratory rate, 65+ yrs age
Score decides; outpatient vs inpatient management

TREATMENT
1. Amoxicillin – previously healthy, pre-school age children
2. Macrolides / Doxycycline – uncomplicated outpatient treatment
3. Levofloxacin – outpatient with risk factors / comorbidities
4. Fluroquinolone + Macrolide – inpatient treatment for CAP

FOLLOWUP
Repeat CXR in 4-6 weeks after discharge outpatient

References;
1. Mindy Smith MD. Pneumonia. Color Atlast of Family Medicine 2nd Edition.