{"id":874,"date":"2024-11-22T07:59:58","date_gmt":"2024-11-22T07:59:58","guid":{"rendered":"https:\/\/www.fmgesolutions.com\/New-Blog\/?p=874"},"modified":"2024-12-12T08:02:33","modified_gmt":"2024-12-12T08:02:33","slug":"pneumonia","status":"publish","type":"post","link":"https:\/\/www.fmgesolutions.com\/New-Blog\/pneumonia\/","title":{"rendered":"PNEUMONIA\u00a0"},"content":{"rendered":"\t\t
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Diagnosis of\npneumonia <\/span>requires two or more symptoms<\/b> of acute\nrespiratory infection plus <\/b>infiltrates\/ consolidation on chest x-ray or\nCT chest.<\/span><\/p>

It usually starts as sudden onset fever with\nproductive cough (purulent yellow- green sputum or hemoptysis), breathing\ndifficulty, night sweats, pleuritic chest pain. <\/span><\/p>

The most reliable auscultation finding is\nBronchial breathing with I:E ratio of 1:1 instead of conventional 1:2 ratio of\nvesicular breathing heard in normal lung fields.<\/span><\/p>

CRB -65 is used to decide the need for\nhospitalization in pneumonia. CURB-65 has a disadvantage that BUN report is not\navailable immediately on presentation. Both are discussed in detail below.<\/span><\/p>

Organism\nspecific approach to pneumonia <\/o:p><\/b><\/p>\n \n \n \n \n \n \n \n \n \n \n \n
\n

CATEGORY <\/b><\/o:p><\/b><\/p>\n <\/td>\n

\n

ETIOLOGY <\/b><\/o:p><\/b><\/p>\n <\/td>\n <\/tr>\n

\n

Atypical <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Mycoplasma, Legionella, Chlamydophila (Chlamydia)\n pneumoniae <\/span><\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

Nosocomial or heath care associated <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Staphylococcus,\n anaerobes<\/o:p><\/span><\/p>\n

Pseudomonas (Ventilator\n associated pneumonia<\/b> and intubated patients) <\/o:p><\/span><\/p>\n

 <\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

Immunocompromised <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Streptococcus pneumoniae (most common),\n Staphylococcus, Pneumocystis Jirovecii (HIV+ patient), mycobacteria <\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

Aspiration <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Anaerobes<\/o:p><\/span><\/p>\n

 <\/span><\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n

\n

Alcoholics\/IV drug <\/span><\/o:p><\/span><\/p>\n

users <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

S pneumoniae,\n Klebsiella, Staphylococcus <\/span><\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

CF <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Staphylococcus,\n Pseudomonas, Burkholderia, mycobacteria <\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

COPD <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Hemophilus influenzae, Moraxella\n catarrhalis, S pneumoniae <\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

Post -viral <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Staphylococcus <\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

Neonates <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Group B\n streptococci <\/o:p><\/span><\/p>\n

Escherichia\n coli for India  <\/o:p><\/span><\/p>\n

Listeria monocytogenes\n <\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

Recurrent <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Obstruction, bronchogenic carcinoma,\n lymphoma, Wegener granu<\/span>lomatosis,\n immunodeficiency <\/o:p><\/span><\/p>\n

 <\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n<\/tbody><\/table>

Age wise\ncauses of Pneumonia<\/b><\/p>\n \n \n
\n

NEONATES <\/span><\/b><\/o:p><\/b><\/p>\n <\/td>\n

\n

CHILDREN <\/span><\/b><\/o:p><\/b><\/p>\n

 <\/b><\/p>\n <\/td>\n

\n

YOUNG ADULTS <\/span><\/b><\/o:p><\/b><\/p>\n

 <\/b><\/p>\n <\/td>\n

\n

ELDERLY <\/span><\/b><\/o:p><\/b><\/p>\n

 <\/b><\/p>\n <\/td>\n <\/tr>\n

\n

GBS <\/span><\/o:p><\/span><\/p>\n

E coli <\/o:p><\/span><\/p>\n

Listeria <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Viruses <\/o:p><\/span><\/p>\n

S pneumoniae<\/span><\/o:p><\/span><\/p>\n

Mycoplasma <\/span><\/o:p><\/span><\/p>\n

C pneumoniae <\/span><\/o:p><\/span><\/p>\n

Staphylococcus\n aureus <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Mycoplasma <\/span><\/o:p><\/span><\/p>\n

S\n pneumoniae <\/span><\/o:p><\/span><\/p>\n

Viruses <\/o:p><\/span><\/p>\n

C\n pneumoniae <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

S pneumoniae <\/o:p><\/span><\/p>\n

H influenzae <\/o:p><\/span><\/p>\n

S aureus <\/span><\/o:p><\/span><\/p>\n

Gram (-) rods <\/span><\/o:p><\/span><\/p>\n

Anaerobes in debilitated patients like in\n case of PD, AD or neurodegenerative disorders <\/span><\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n<\/tbody><\/table>

Symptoms<\/b><\/p>

\u00b7       \n<\/span><\/span>Cough, shortness of breath, fast\nbreathing and altered mentation due to hypoxia<\/o:p><\/span><\/p>

\u00b7       \n<\/span><\/span>Atypical symptoms: Dry cough,\nheadache, myalgia, sore throat, GI symptoms and seizures <\/o:p><\/span><\/p>

Seizures\nare seen in legionella pneumophila that can cause SIADH.  <\/span><\/o:p><\/span><\/p>

\u00b7       \n<\/span><\/span>Lung exam shows bronchial breath\nsounds, rales, wheezing, dullness to percussion, egophony, and tactile\nfremitus. <\/span><\/p>

Diagnosis <\/b><\/o:p><\/b><\/p>

\u00b7       \n<\/span><\/span>Requires two or more symptoms of acute\nrespiratory infection plus infiltrates\/ consolidation on chest x-ray or CT\nchest <\/o:p><\/span><\/p>

\u00b7       \n<\/span><\/span>Work up <\/o:p><\/span><\/p>

1.      <\/span><\/span>Sputum\nGram stain and nasopharyngeal aspirate<\/o:p><\/span><\/p>

–<\/span> An\nadequate sputum Gram stain sample has many PMNs (>25 cells\/High power field)\nand <\/span>few epithelial cells (< 10 cells\/HPF)\n<\/o:p><\/span><\/p>

2.      <\/span><\/span>Blood\nculture<\/o:p><\/span><\/p>

3.      <\/span><\/span>ABG\nonly in hospitalized patients or outpatients with persistent symptoms<\/o:p><\/span><\/p>

4.      <\/span><\/span>If\nLegionella is suspected: Urine Legionella antigen test, sputum staining with\ndirect fluorescent antibody (DFA) <\/o:p><\/span><\/p>

5.      <\/span><\/span>Chlamydia\npneumoniae<\/b>: Serologic\ntesting, poly<\/span>merase chain\nreaction (PCR). <\/span><\/o:p><\/span><\/p>

6.      <\/span><\/span>Mycoplasma<\/b>: Serum\ncold agglutinins and serum Mycoplasma antigen may also be used. <\/o:p><\/span><\/p>

7.      <\/span><\/span>S pneumoniae<\/b>:\nUrine pneumococcal antigen test, culture. <\/o:p><\/span><\/p>

8.      <\/span><\/span>Viral<\/b>: Nasopharyngeal aspirate, PCR for COVID-19, <\/span>influenza,\nrespiratory syncytial virus<\/span><\/p>

Treatment<\/b><\/p>

CURB -65\nor CRB 65 is used to decide for need for hospitalization <\/o:p><\/b><\/p>

C<\/b>onfusion <\/span><\/o:p><\/span><\/p>

U<\/b>remia (BUN > 19) <\/span><\/o:p><\/span><\/p>

R<\/b>espiratory rate (> 30 breaths\/min) <\/span><\/o:p><\/span><\/p>

B<\/b>lood pressure (SBP < 90 mm Hg\nor <\/span>DBP < 60 mm Hg) <\/span><\/o:p><\/span><\/p>

Age > 65\nyears<\/b> <\/span><\/p>\n \n \n \n \n
\n

Score\n <\/o:p><\/b><\/p>\n <\/td>\n

\n

Suggested\n care <\/o:p><\/b><\/p>\n <\/td>\n <\/tr>\n

\n

0-1 (Age alone if present) <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Outpatient treatment <\/span><\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

2 <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Inpatient care<\/span><\/o:p><\/span><\/p>\n

 <\/span><\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n

\n

3 <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

ICU care<\/span><\/o:p><\/span><\/p>\n

 <\/span><\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n<\/tbody><\/table>

\u00b7       \n<\/span><\/span>Outpatient treatment with oral\nantibiotics is recommended in uncomplicated cases. <\/o:p><\/span><\/p>

\u00b7       \n<\/span><\/span>For patients with\nobstructive diseases (eg, cystic fibrosis [CF] or bronchiecta<\/span>sis),\nconsider adding pseudomonas, staphylococcal, or anaerobic coverage. <\/span><\/p>\n \n \n \n \n \n
\n

Patient Features<\/span><\/b><\/o:p><\/b><\/p>\n <\/td>\n

\n

Empirical coverage  <\/span><\/b><\/o:p><\/b><\/p>\n

 <\/b><\/p>\n <\/td>\n <\/tr>\n

\n

CURB score 0-1 <\/span><\/b><\/o:p><\/b><\/p>\n

Outpatient community-acquired pneumonia, \u2264 65 years\n of age, otherwise healthy, no antimicrobials within 3 months <\/span><\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n

\n

Amoxicillin with azithromycin <\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n

\n

CURB score 0-1 <\/span><\/b><\/o:p><\/b><\/p>\n

> 65 years of age or comorbidity (COPD, <\/span>heart\n failure, renal failure, diabetes, liver <\/span>disease, alcoholic or\n antimicrobial use <\/span>within 3 months <\/span><\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n

\n

Amoxicillin with clavulanic acid + Azithromycin\n <\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n

\n

CURB score of 2 <\/span><\/b><\/o:p><\/b><\/p>\n

 <\/span><\/p>\n

Community-acquired pneumonia\n requiring hospitalization <\/span><\/o:p><\/span><\/p>\n

 <\/span><\/p>\n

Non\n severe <\/span><\/o:p><\/span><\/p>\n <\/td>\n

\n

Ampicillin-sulbactam\n + Azithromycin <\/o:p><\/span><\/p>\n

 <\/span><\/p>\n

Or<\/o:p><\/span><\/p>\n

 <\/o:p><\/span><\/p>\n

Respiratory Fluoroquinolone\n <\/o:p><\/span><\/p>\n

–       \n <\/span><\/span>Levofloxacin\n <\/span><\/o:p><\/span><\/p>\n

–       \n <\/span><\/span>Moxifloxacin\n <\/span><\/o:p><\/span><\/p>\n

–       \n <\/span><\/span>Gemifloxacin<\/span><\/o:p><\/span><\/p>\n

 <\/span><\/p>\n

If recent hospitalization or antibiotic\n treatment <\/o:p><\/span><\/p>\n

–       \n <\/span><\/span>Add Linezolid <\/o:p><\/span><\/p>\n

–       \n <\/span><\/span>Add Meropenem <\/o:p><\/span><\/p>\n

 <\/span><\/p>\n <\/td>\n <\/tr>\n

\n

Hospital-acquired pneumonia- <\/span><\/b>hospitalized\n > 48 hours or in a long-term <\/span><\/b>care\n facility > 14 days; ventilator-associated pneumonia <\/span><\/b><\/o:p><\/b><\/p>\n <\/td>\n

\n

Extended-spectrum cephalosporin or\n carbapenem <\/span>with\n antipseudomonal activity <\/span><\/o:p><\/span><\/p>\n

Add an aminoglycoside or a fluoroquinolone\n for <\/span>coverage of resistant organisms like\n pseudomonas <\/span>until lab sensitivities identify the best\n single agent <\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n<\/tbody><\/table>

Extra mile\n<\/o:p><\/b><\/p>\n \n
\n

Evaluate\n for c<\/span>omplications\n of pneumonia <\/span><\/o:p><\/span><\/p>\n

1.     \n <\/span><\/span>Pleural\n effusion<\/span><\/o:p><\/span><\/p>\n

2.     \n <\/span><\/span>Empyema<\/span><\/o:p><\/span><\/p>\n

3.     \n <\/span><\/span>Lung\n abscess<\/span><\/o:p><\/span><\/p>\n

4.     \n <\/span><\/span>Necrotizing\n pneumonia and Empyema treatment requires surgical drainage and chest tube\n placement<\/span>. <\/span><\/o:p><\/span><\/p>\n <\/td>\n <\/tr>\n<\/tbody><\/table>\n \n
\n

Pneumococcal vaccine should be given to <\/span><\/o:p><\/span><\/p>\n

1.     \n <\/span><\/span>All children<\/span><\/o:p><\/span><\/p>\n

2.     \n <\/span><\/span>Patients > 65 <\/span>years of age<\/span><\/o:p><\/span><\/p>\n

3.     \n <\/span><\/span>Patients\n with splenic dysfunction (eg, sickle cell) or asplenia<\/span><\/o:p><\/span><\/p>\n

4.     \n <\/span><\/span>Immunocompromised\n patients<\/span><\/o:p><\/span><\/p>\n

5.     \n <\/span><\/span> D<\/span>iabetes Mellitus  <\/span><\/o:p><\/span><\/p>\n

 <\/b><\/p>\n <\/td>\n <\/tr>\n<\/tbody><\/table>

 <\/b><\/p>

 <\/span><\/p>

 <\/span><\/i><\/p>

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<\/p>

 <\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Diagnosis of pneumonia requires two or more symptoms of acute respiratory infection plus infiltrates\/ consolidation on chest x-ray or CT chest. It usually starts as sudden onset fever with productive cough (purulent yellow- green sputum or hemoptysis), breathing difficulty, night sweats, pleuritic chest pain.  The most reliable auscultation finding is Bronchial breathing with I:E ratio […]<\/p>\n","protected":false},"author":1,"featured_media":903,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[140,145],"tags":[],"class_list":["post-874","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-fmg-exam","category-pneumonia"],"_links":{"self":[{"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/posts\/874","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/comments?post=874"}],"version-history":[{"count":4,"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/posts\/874\/revisions"}],"predecessor-version":[{"id":878,"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/posts\/874\/revisions\/878"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/media\/903"}],"wp:attachment":[{"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/media?parent=874"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/categories?post=874"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.fmgesolutions.com\/New-Blog\/wp-json\/wp\/v2\/tags?post=874"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}