Community acquired Pneumonia manage and diagnosis

Essential info about community acquired pneumonia

1. COMMUNITYACQUIRED
PNEUMONIA(CAP)

2. OBJECTIVES
•Epidemiologyandpathophysiology
•Commonetiologicalagents
•Differentclassificationsof pneumonia
•ClinicalpresentationsofCAP
•Diagnosisand empiricaltreatmentofCAP

3. DEFINITION
•Pneumoniaisaninfectionthatleadsto
inflammation(consolidationandexudation)ofthe
parenchymaof thelung(thealveoli)
•Usuallyitpresentsasanacute,fulminantclinical
disease

4. •5-6cases per1000personsper
year
•Mortality23%
•Especiallyinolderpeople
Riskfactors
•Age<2 yrs,>65yrs
•Alcoholism
•Smoking
•AsthmaandCOPD
•Aspiration
•Dementia
•Priorinfluenza
•HIV
•Immunosuppression
•Institutionalization
•Recenthotel:Legionella
•Travel,pets,occupational
exposures-birds(C.
psittaci)

5. ETIOLOGICALAGENTS
Infectious:
•Bacterial
•Fungal
•Viral
•Parasitic
Non-infectious (pneumonitis):
•Chemical
•Allergenrelated

6. •Streppneumonia 48%
•Viral 23%
•Atypicalorgs(MP,LG,CP) 22%
•Haemophilusinfluenza 7%
•Moraxellacatharralis 2%
•Staphaureus 1.5%
•Gram–iveorgs 1.4%
•Anaerobes
INFECTIOUSAGENTSCAP

7. ATYPICALBATERIA
•Chlamydiapneumonia
•Mycoplasma
pneumonia
•Legionellaspp
•Psittacosis(Chlamydia
psittaci)
•Qfever(Coxiella
burnettii)
•Approximately15%ofallCAP
•Notdetectableongramstain
•Won’tgrowonstandardmedia
•Somedon’thave a bacterialcellwall
Isthisimportanttoremember?

8. PATHOGENESIS
Twofactorsinvolvedinthe
formationofpneumonia
−Pathogens
−Hostdefenses

9. DEFENSEMECHANISMOF
RESPIRATORYTRACT
•Filtrationanddepositionofenvironmental
pathogensintheupperairways
•Coughreflux
•Mucociliaryclearance
•Alveolarmacrophages
•Humoralandcellularimmunity
•Oxidativemetabolismofneutrophils

10. PATHOPHYSIOLOGY
1.Inhalationoraspiration ofpulmonarypathogenic
organismsintoalungsegmentorlobe.
2.Resultsfromsecondarybacteraemiafromadistant
source, suchasEscherichiacoliurinarytractinfection
and/orbacteraemia(lesscommonly).
3.Aspirationoforopharyngeal contents(multiple
pathogens).

11. NORMAL
PNEUMONIA

12. DIAGNOSTICCRITERIA

13. SYMPTOMS

14. PHYSICAL EXAMINATION
Str Pneumoniaeusually causes lobar pneumonia, affects only one part of the lung

15. INFILTRATIONS

16. PNEUMONIA STAGES

18. DIAGNOSTICTOOLS

21. DIFFERENTIALDIAGNOSIS

23. DIFFERENTIALDIAGNOSIS

24. CLASSIFICATION
•Pneumoniaclassifiedaccordingto:
1.Pathogen
•Bacterial (Typical / Atypical)
•Viral
•Fungal
•Parasite
2.Anatomy (eg Lobar, Diffused)
3.Acquiredenvironment (eg
Community, Hospital, Health Care,
Ventilator Acquired)

25. ISCLASSIFICATION
IMPORTANT?

28. CLASSIFICATIONBY
ACQUIREDENVIRONMENT
oCommunityacquiredpneumonia(CAP)
oHospitalacquiredpneumonia(HAP)
oNursinghomeacquiredpneumonia(NHAP)

29. TYPICALORNOT?

32. EMPIRICAL TREATMENT

33. ADMITORNOT? (CURB 65)

34. ANTIBIOTICRESISTANCE

35. ANTIBIOTICRESISTANCE

37. ANTIBIOTICRESISTANCE

38. COMPLICATIONS

39. A 55-year-old man presents to theemergency department
with a 3-day history of fever, productive cough, and night
sweats. He denies recent hospitalization and lives at home
with his wife and 2 dogs. He appears acutely ill, his heart
rate is 122 bpm, and his temperature is38.5 C. His
pulmonary exam is notable forcrackles at the right lung
base. What is the best next step in management?
A. 2-view chest radiograph
B. Procalcitonin level
C. CT scan of the chest
D. Sputum culture

40. A 19-year-old boy presents with a headache, fever, malaise,
shortness of breath, and a dry cough for the past three
weeks but acutely worsened last night. The patient is an
exchange student from India and spent the last 2 days in
different airports until he comes to Cyprus. Chest X-ray
shows diffuse bilateral infiltrates. Which of the following is a
most possible culprit microorganism?
•Gram-positive agents such asStreptococcus pneumoniae,
•Gram-negative agents such asHaemophilus influenzae
•Atypical agents such asLegionella, Mycoplasma,
Chlamydia pneumoniae,andChlamydia psittachi
•Viruses (rhinovirus, influenza, severe acute respiratory
syndrome coronavirus 2)