Pneumonia, Adult

Basics

Description

  • Epidemiology:
    • Seventh leading cause of death and leading cause from infectious disease in the U.S.
  • Highest mortality in elderly and patients with the following coexisting conditions:
    • Chronic heart, lung, liver, and kidney disease
    • Diabetes mellitus
    • Alcoholism
    • Malignancy
    • Asplenia
    • Immunosuppression
    • Use of antimicrobials within last 3 mo
  • Classifications:
    • Source based:
      • Community acquired (CAP)
      • Hospital acquired (HAP)
      • Ventilator associated (VAP)
    • Symptom based:
      • Typical
      • Atypical
  • Complications:
    • Bacteremia
    • Sepsis
    • Abscess
    • Empyema
    • Respiratory failure

Etiology

  • CAP (typicals):
    • Streptococcus pneumoniae
    • Haemophilus influenzae
    • Klebsiella pneumoniae
    • Moraxella catarrhalis
    • Streptococcus pyogenes
    • Staphylococcus aureus
  • CAP (atypicals):
    • Mycoplasma pneumoniae
    • Chlamydophila pneumoniae
    • Legionella pneumophila
    • Viral
  • HCAP/HAP/VAP:
    • Gram negatives (Pseudomonas, Stenotrophomonas)
    • Methicillin-resistant S. aureus (MRSA)
  • Immunosuppressed:
    • Mycobacterium tuberculosis
    • Pneumocystis jirovecii
  • Aspiration:
    • Chemical pneumonitis ± oral and gastric anaerobes

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