WE ORGANISM RESPONSIBLE EPIDEMIOLOGY _CLNICALFEATURES TREATMENT COMETS caaaipagere paveas| Seen eee Peete ere ee Compicaions eee ae tere ee gene ieee, eee eae ate eae eran eliee ete eee Sey eae SS eee Popov | aicemceg: dcea ites dina oes eee aera et eee eee ae ae prctinona gallon, ee ee ey ieatigue es eee oe cause of illness. to 25% of all asc uescian ea eee amie ee beeen’ ees perce Deak card Tato ot hom teal invasive discasc. Heeppiiie | Feanepta Incidence genet in Frequent insidious Ampicilin,d- Complications in- cflabiase: ifr alcoholics, the cl- onset associated generation ‘dude lung abscess, ee a re Ee eee eee eat esac Ea are ties and nursing tion 2to 6 weeks (azithromycin, tis, pericarditis, Sel rela ett aes tL azatecienycta cepa Guibas, maracas tacpie, COPD, and chil- productive cough. dren <5 yearsold. Usually involves Accounts for 5% tone or more lobes. 20% ofcommu- Bacteremia is nity-acquized common. Infil- pneumonias. trate, occasional Morality rate: bronchopneumo- 30%. nia pattern on chest x13. Legionnaires’ Legionella ghestoccurrence Flulike symptoms, Erythromycin Complications disease ‘prewmophila insummerand fll. High fevers, men -H/—rfampin (in include hypo- May cause disease tal confusion, severely compro- tension, shock, sporadically or Incadache, pleu- mised patient) or ane acute renal as parcofan risicpain, myal- clarithromycin, or failure ‘epidemic. sias, dyspnea, a macrolide Incidence greatest in productive cough, (azithromycin), or middle-aged and —_hemoprysi 8 Ruoroquinolone ‘older men, smok- leukocytosis. (ofloxacin, ev- etsand patients Bronchopneumo- ofloxacin, with chronic ‘ia, unilateral spartloxacin). diseases, those e- or bilateral dis- ceiving immuno- ease, lobar suppressive consolidation, therapy, oF those in close proximity Accounts for 15% ‘of communi acquired pneumonias. Morality rate: 15% 0 50%. (continued)TPE ORGANISM RESPONSIBLE EPIDEMIOLOGY CCINICAL FEATURES TREATMENT COMMENTS Howpital Acquired Pneumonia Preudomonas Prendomonas Incidence greatest in Diffie consolida-Aminoglycoside Complications in- pneumonia aeruginosa those with pre- tion on chest and anti- ‘ude lung cav existing lun weny. Toric seudomonal tion. Has capacity dlieacancee ——pearnce fever, Agents Gcaclin, to vade Blood {particularly chills productive piperacillin, vessels, causing Jeukemia); those cough, relative imezlocillin, hhemorthage and with homografe ——bradyeardia, cefiaridine), lung infaretion transplants, burns; leukocytosis. Usually requires debilitated per- hospitalization. sons; and patients receiving anti- microbial therapy and treatments such as tachoos- tomy, suctioning, and in postopera. tive settings. Al ost aways of nosocomial origin. Accounts for 15% ‘of hospieale acquired preumonizs. Morality ate: 40% 10 60% Staphylococcal __Staphocnoeus Incidence greatest in in Complications in- pneumonia ‘urns immunocompro- “H/rifampin or clue pleura effu- mised paints, ing infection gentamicin: sion/pneumotho- TV drug user, and Bacteremia is mathcilin- rax lung abscess, asacomplicaton common, resistant: van- empyema, menin- of epidemic comycin siti endocard influenza, + tifampin or Frequently re. Commonly nosooo- yentamicia quires hosptalia- milin figs lon, Treatment ‘Accounts for 10% pate 10 30% of and prolonged be- hospital-acquized cause disease rends peumonias to destroy lng, Morality ate: 25% tise 10 60%. Klebsiella Kiebiella pneumoniae Incidence greatest in Tissue necrosis oe-_‘Third-generation pneumonia (riedlanders thee; alco-eursapidly. Toxic cephalosporins Complications in- brcillarencapsulatcd holies patients appearance: fever, (cefotaxime, cef> clude multiple gram-nogatie arabic withchronicdis- cough, sputum rion) plus lung abscesses bacillus) case such as dia- production, bron- aminoglycoside, with cyst forma- betes hear anspscudomonal tion, empyema, failure, COPD; —__lungabsces. penicilin, pericarditis, patients in chronic _Lobarconsoida-‘monobactam. pleural ffison. tion, bronchop-_(azrconamm).or Maybe fulminat- fusing homes. neumonia paren quinolone. ing, progressing to Accounts for 296 ton chest x-ray. fatal outcome, 5% of commun acquired and 10% 10 30% of hospi- tabacquived pewmonizs Morality rate: 40% 10 50% (continued)TPE ORGAWSM RESPONSIBLE EPIDEMIOLOGY (CLINICAL FEATURES TREATMENT ‘COMMENTS Pneumonia in Immunocompromised Host Preumocpsis carinii Pnewmocystis Incidence greatest in Pulmonary infil- _TrimethoprimAulfa- Complications in- pneumonia carinii patients with trates on chest methoxazole clude respiratory (cr) AIDS and patients x-ray. Nonpro- failure. receiving immuno- ductive cough, suppressive ther- fever, dyspnea. apy for cancer, organ transplants, pprimequine plus and other disor- «indamycin. ders Frequently seen with cyto- smegalovirus infection Mortality rate 15% 10 20% in hospi- talied and fatal if not eated. Fungal pneumonia Apergilu firmigarus Incidence greatest. in Cough, hemoptysis, Flucytosine with Complications i immunocompro- infiltrates, fungus amphotericin Bin clude dissemina- mised and neutro- ball on chest rnon-neutropenie tion to brain, penic patients xray. myocardium, Mortality rate: 15% and/or thyroid 10 20%, sland. ‘Tuberculosis Mycobacterion Incidence increased Weightloss, fever, Rifampin, strepto-__ Complications in- ‘tuberculosis inindigent immi- night sweats, ‘mycin, etham- clude reinfection ‘gant, and prison cough, spurum burl, INE and acute respira- Populations, peo- production, he- (isoniazid), tory infection. ple with AIDS, sopeysis, no pyrazinamide andthehomeles. spefc infiltrate Mortality rate <1% (lower lobo, hilar (depending on node enlargement, comorbidity) pleural effusion on chest ay.