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PneumoniaAka: Bacterial Pneumonia, Atypical Pneumonia, Community-Acquired Pneumonia, CAP

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  1. See Also
    1. Viral Pneumonia
    2. Pneumonia in the Elderly
  2. Definition: Community Acquired Pneumonia (CAP)
    1. Lower respiratory tract infection
    2. Develops in non-hospitalized patient
    3. May be bacterial, viral, fungal or parasitic
    4. May be present despite normal Chest XRay
  3. Epidemiology: Community acquired pneumonia
    1. Adults: 346 Israeli patients admitted for pneumonia
      1. Pneumococcal Pneumonia (43%)
      2. Mycoplasma pneumonia (29%)
      3. Chlamydia pneumoniae (18%)
      4. Legionella pneumonia (16%)
    2. References
      1. Lieberman (1996) Chest 109:1243
  4. Causes: Community Acquired Pneumonia
    1. See Pneumonia Causes
    2. Bacteria: Typical
      1. Streptococcus Pneumoniae
      2. Staphylococcus aureus
      3. Haemophilus Influenzae
      4. Moraxella catarrhalis
    3. Bacteria: Atypical
      1. Mycoplasma pneumoniae
      2. Legionella pneumonia
      3. Chlamydia Pneumonia
      4. Q Fever
      5. Psittacosis
    4. Virus
      1. Adenovirus
      2. Influenza A and B
      3. Parainfluenza
      4. Respiratory Syncytial Virus
    5. Fungus
      1. Blastomycosis
      2. Coccidioidomycosis
      3. Histoplasmosis
  5. Risk Factors
    1. Age over 65 years
    2. Recent antibiotics
    3. Immune compromised (e.g. HIV Infection)
    4. Respiratory illness (COPD, Asthma)
    5. Vascular disease (CHF, CVA)
    6. Diabetes Mellitus
    7. Chronic Liver Disease
    8. Chronic Kidney Disease
    9. Cancer
  6. Signs and Symptoms
    1. Bacterial Pneumonia
      1. Cough
        1. Productive of Purulent Sputum with typical bacteria
        2. Non-productive in atypical cases
      2. Sudden onset
      3. Fever and Chills
      4. Fatigue
      5. Ill appearing patient
      6. Pleuritic Chest Pain
      7. Dyspnea
      8. Tachypnea
      9. Tachycardia
    2. Viral Pneumonia
      1. Non-productive cough
      2. Gradual Onset with prodrome (malaise and Headache)
      3. Chest XRay more impressive than exam
      4. Onset in fall or winter
      5. Wheezing more common in viral causes
      6. Low grade temperature (<101.3 F)
    3. Mycoplasma pneumonia
      1. Constant, harsh, non-productive cough
      2. Wheezing may occur in Mycoplasma pneumonia
      3. Fever typically lasts longer than 3 days
      4. More common in age over 3 years
    4. Legionella
      1. Onset with myalgias and Headache
      2. Fever to 104 F for first few days
      3. Gastrointestinal symptoms predominate in up to 40%
      4. Cough is late onset, mild, often non-productive
  7. Exam (* denotes high correlation with bacterial CAP)
    1. General findings
      1. Ill appearing patient
      2. Dyspnea (*)
      3. Tachypnea
      4. Tachycardia
    2. Localized findings at involved lung region
      1. Rales
      2. Diminished breath sound
      3. Bronchial breath sounds (*)
      4. Dullness to percussion
      5. Tactile fremitus
      6. Egophony
  8. Diagnosis
    1. See Diehr Rule to Diagnose Pneumonia
  9. Labs
    1. General
      1. Lab Indications
        1. Moderate or severe community acquired pneumonia
        2. Patient with comorbid conditions
      2. Efficacy of Labs
        1. No value in non-severe community acquired pneumonia
        2. Theerthakarai (2001) Chest 119:181
    2. Sputum Examination
      1. Tests
        1. Sputum Gram Stain
        2. Sputum Culture
      2. Efficacy of Sputum exam
        1. Sputum has low diagnostic yield in CAP
        2. Not recommended in community acquired pneumonia
        3. Ewig (2002) Chest 121:1486
    3. Blood Culture
      1. Indications
        1. Not indicated unless severe disease
        2. Recommended by ATS in hospitalized CAP
      2. Efficacy
        1. Low sensitivity: Positive in only 5-10% of cases
        2. Does not predict severity or outcome
      3. References
        1. Campbell (2003) Chest 123:1142
    4. Specific Testing with reasonable efficacy
      1. Chlamydia pneumonia
        1. Rapid PCR (>30% Test Sensitivity)
      2. Influenza
        1. Rapid Influenza Test (Influenza DFA)
      3. Legionella pneumophila
        1. Rapid PCR of Sputum (80% Test Sensitivity)
        2. Urinary antigen (>50% Test Sensitivity)
      4. Mycoplasma pneumoniae
        1. Rapid PCR of Sputum (>30% Test Sensitivity)
  10. Radiology: Chest XRay
    1. Indications: All cases of suspected CAP
    2. Precautions: False negatives in early presentation
      1. Serial Chest XRays may be needed
      2. Does not exclude pneumonia in severe illness
        1. Positive in only 40% of acute pneumococcal CAP
    3. Interpretation
      1. Lobar infiltrate suggests typical bacterial CAP
      2. Diffuse, bilateral infiltrates suggests atypical CAP
  11. Differential Diagnosis
    1. See Pneumonia Causes
    2. See Cough Causes
    3. Acute Respiratory Distress Syndrome
    4. Severe Acute Respiratory Syndrome
    5. Churg-Strauss Syndrome
    6. Congestive Heart Failure
    7. Inflammatory Lung Disease
    8. Idiopathic Pulmonary Fibrosis
    9. Interstitial pneumonitis
    10. Pulmonary Embolism
    11. Lung Cancer
    12. Sarcoidosis
    13. Wegener's Granulomatosis
    14. Bronchiolitis Obliterans with Organizing Pneumonia
    15. Bioterrorism Agents
      1. Anthrax
      2. Plague
      3. Tularemia
      4. Q Fever
      5. Brucellosis
  12. Management
    1. See Pneumonia Management
    2. Convert to oral antibiotic within 72 hours if possible
    3. See Pneumonia Hospitalization Criteria
    4. See Pneumonia Hospitalization Criteria in the Elderly
  13. Prognosis: Predictors of increased mortality
    1. See Pneumonia Prognostic Factors in Older Patients
    2. Comorbid neurologic disease
    3. Renal disease
    4. Congestive Heart Failure
    5. Hypotension
    6. Tachypnea
    7. Hypothermia
  14. Prevention
    1. See Pneumonia Prevention in the Elderly
    2. See Influenza Vaccine
    3. See Pneumococcal Vaccine
  15. Resources
    1. Pneumonia Severity Index
      1. http://www.aafp.org/afp/20030815/tips/6.html
  16. References
    1. Bernstein (1999) Chest 115:9S
    2. Cunha (2001) Med Clin North Am 85(1):43
    3. Fine (1997) N Engl J Med 336:243
    4. Fine (1990) Am J Med 89:713
    5. Gleason (1997) JAMA 278:32
    6. Lutfiyya (2006) Am Fam Physician 73:442
    7. Marrie (2000) Clin Infect Dis 31(4):1066
    8. Metlay (2003) Ann Intern Med 138:109

Pneumonia, Bacterial (C0004626)

Definition (MSH)Pneumonia caused by various species of bacteria. Bacterial pneumonia commonly results from bronchogenic spread of infection following microaspiration of secretions. The largest category of this disease arises from community-acquired pneumonias.
Definition (CSP)pneumonia caused by various species of bacteria; commonly results from bronchogenic spread of infection following microaspiration of secretions.
ConceptsDisease or Syndrome (T047)
ICD9482.9
EnglishBACT PNEUMONIA, Bacterial pneumonia, Bacterial Pneumonias, PNEUMONIA BACT
Spanishneumonía bactérica, neumonía bacteriana, neumonia bacteriana, neumonia bacterica
CreditsDerived from the NIH UMLS (Unified Medical Language System)


capsule (pharmacologic) (C0006935)

Definition (MSH)Hard or soft soluble containers used for the oral administration of medicine.
Definition (NCI)A solid pharmaceutical dosage form that contains medicinal agent within either a hard or soft soluble container or shell, usually used for the oral administration of medicine. The shells are made of a suitable form of gelatin or other substance. (NCI)
Definition (NCI)A solid oral dosage form consisting of a shell and a filling. The shell is composed of a single sealed enclosure, or two halves that fit together and which are sometimes sealed with a band. Capsule shells may be made from gelatin, starch, or cellulose, or other suitable materials, may be soft or hard, and are filled with solid or liquid ingredients that can be poured or squeezed.
Definition (NCI)A solid pharmaceutical dosage form that contains medicinal agent within either a hard or soft soluble container or shell, usually used for the oral administration of medicine. The shells are made of a suitable form of gelatin or other substance.
Definition (HL7V3.0)A solid dosage form in which the drug is enclosed within either a hard or soft soluble container or "shell" made from a suitable form of gelatin.
ConceptsBiomedical or Dental Material (T122)
EnglishCAP, Caps, Capsule, Capsule Dosage Form, Capsule Dose Form, Capsules, Drug capsule
Spanishcápsula, cápsula medicamentosa, capsula, capsula medicamentosa, fármaco en cápsula, farmaco en capsula, medicamento en cápsula, medicamento en capsula
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Pneumonia (C0032285)

Definition (MSH)Inflammation of the lungs.
Definition (CSP)inflammation of the lungs with consolidation and exudation.
Definition (NCI)(noo-MONE-ya) An inflammatory infection that occurs in the lung.
Definition (NCI)An acute, acute and chronic, or chronic inflammation focally or diffusely affecting the lung parenchyma, due to infections (viruses, fungi, mycoplasma, or bacteria), treatment (e.g. radiation), or exposure (inhalation) to chemicals. Symptoms include cough, shortness of breath, fevers, chills, chest pain, headache, sweating, and weakness.
ConceptsDisease or Syndrome (T047)
BasqueNEUMONIA
DanishLungebetaendelse
DutchPneumonie
EnglishLung Inflammation, Lung Inflammations, Pneumonia, Pneumonias, Pneumonitides, Pneumonitis, Pulmonary Inflammation, Pulmonary Inflammations
FinnishKEUHKOKUUME
FrenchPneumonie
GermanPneumonie
Hebrewdaleket reot
Hungarianpneumonia
ItalianPolmonite
NorwegianLUNGEBETENNELSE
PortuguesePneumonia
Spanishneumonía, Neumonia, neumonitis
SwedishLUNGINFLAMMATION/PNEUMONI
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Atypical pneumonia (C1412002)

ConceptsDisease or Syndrome (T047)
Englishatypical pneumonia
Spanishneumonía atípica, neumonia atipica
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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