Pneumonia

Definition: 

  • Inflammation of the lungs affecting the lung air sacs (Alveoli) usually caused by an infection.

Epidemiology:

  •  
  • Affects 450 million a year.

  • Community acquired Pneumonia (CAP) in adults is 5.16 to 6.11 cases per 1000 persons per year.

  • Out of the top 10 killers in the world, pneumonia is the only infection. 

Types:

  • Community Acquired pneumonia (CAP):

  • Typical (Lobar consolidation on CXR).

  • Atypical (Diffuse reticulonodular infiltrates).

  • Hospital Acquired pneumonia (HAP):

  • Develops at least 48-72 hours after admission.

 

 

Study guide:

Causes:

Signs and symptoms:


Typical CAP: 

  • Fever

  • Productive cough

  • Chest pain

  • Dyspnea

  • Tachycardia, tachypnea


Atypical CAP: 

  • Headache

  • Dry cough

  • Fever

  • Pulse-temperature dissociation (normal pulse with high fever)

Diagnosis:

Chest X-ray:

  • Best initial test.

  • Only way to differ pneumonia from acute bronchitis (same presentation).

Sputum culture: 

  • Most accurate test for pneumonia.

  •  Has to be done before treatment.

 Specific organism tests:

  • Legionella -> Urine Ag.

  • Mycoplasma -> Cold Agglutination.

  • Pneumocystis-> Bronchoalveolar lavage (BAL).​

Treatment:

the biggest decision to make is to whether admit the patient or not.
The decision is made based on the severity of the disease not the etiology.

Outpatient treatment (CAP): 

  • Younger than 60 years -> Macrolides is the first line treatment.

    • Floroquinolones is the alternative.

  • Older patients or with comorbidities -> Floroquinolones.

In-patient (CAP):

  • Floroquinolones alone or Macrolide + third generation cephalosporin.

Treatment of HAP (Any of the following 3): 

  1. Cephalosprin that covers pseudomonas.

  2. Carbepenems.

  3. Piperacillin/Tazobactam.

  • Note: Macrolides are not used.

CURB65= Admission (>2)

  • Confusion

  • Uremia

  • Respiratory

  • distress

  •  Low BP

  • Age>65 

Complications:

  • Pleural effusion.

  • Empyema.

  • Both respond most rapidly to chest tube or thoracostomy.
     

Vaccination:

  • Indications for pneumococcal vaccine:

  • Everyone above the age of 65 Y/O (single dose).

  • If the 1st dose was before the age of 65 or immunocompromised, give a booster dose after 5 years from the 1st dose.

  • Pre-existing pulmonary disease.

  • Cochlear implants.

  • CSF leaks.

  • Alcoholics.

  • Smokers.

References:

  1. Agabegi, Steven S, Elizabeth D Agabegi, and Adam C Ring. Step-Up To Medicine. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2013. Print.

  2. Fischer, Conrad. Master The Boards. Print.

  3. Sattar, Husain A. Fundamentals Of Pathology. Chicago: Pathoma.com, 2011. Print.

  4. Pneumonia, Hospital-Acquired. 'Hospital-Acquired Pneumonia - Pulmonary Disorders'. MSD Manual Professional Edition. N.p., 2015. Web. 3 Nov. 2015.

  5. Med-ed.virginia.edu,. 'Chest Radiology'. N.p., 2015. Web. 3 Nov. 2015. (Figure1). 

First author: Abdullah AlAsaad                                                                    
 
Second author: Lama AlLuhaidan                                                                           

Reviewed by: Roaa Amer
                               Haifa Al Issa

Format Editor: Adel Yasky

​- Read by: Bareen Humoud


​- Directed by: Rana Alzahrani
 

- Audio production: Bayan Alzomaili

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