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Munity Acquired Pneumonia
Munity Acquired Pneumonia
Munity Acquired Pneumonia
Microbiology
Ø Typical bacteria
o Common causes — S.pneumoniae (pneumococcus)
o Haemophilus influenzae
o Moraxella catarrhalis
o Staphylococcus aureus
o Group A streptococci
o Aerobic gram -ve (eg, Enterobacteriaceae such as Klebsiella or E.coli)
o Microaerophilic bacteria and anaerobes (associated with aspiration)
Ø Atypical bacteria
refers to the intrinsic resistance of these organisms to beta-lactams and their
inability to be visualized on Gram stain or cultured using traditional techniques
o Legionella spp water contamination
o Mycoplasma pneumoniae
o Chlamydia pneumoniae
o Chlamydia psittaci
o Coxiella burnetiid
Ø Respiratory viruses
o Influenza A and B viruses most common viral pneumonia
o Rhinoviruses: usually come with sneezing &rhinorrhea
o Parainfluenza viruses
o Adenoviruses
o Respiratory syncytial virus common in pediatrics
o Human metapneumovirus: it is rare
o Coronaviruses (eg, Middle East respiratory syndrome coronavirus)
o Human bocaviruses
Pathogenesis
Ø respiratory viral infection progress going to the LRT, present
with cough→ reach to the alveoli encounter with bacteria→ pus
Clinical Presentation:
Ø Variable severity / Cough (with or without sputum production)
Ø Dyspnea / Fever
Ø Pleuritic chest pain sharp pain when taking a deep breath
Ø Sepsis / Septic shock in severe cases may lead to hypotension
Ø Multilobar infiltrates
Complications of CAP
Ø Septic shock / inotropic support
Ø Respiratory failure / intubation
Ø Lung abscess common in aspiration pneumonia
Ø Complicated pleural effusion and empyema must be drained
Ø Antibiotic alone doesn’t work Aspiration and chest tube insertion
Ø Pleura might fibroses trapping of lung in the future
Management
Ø Target S. pneumoniae the commonest and atypical pathogens.
Ø Outpatients
o Oral amoxicillin (or Amoxacillin, 3rd generation cephalosporins) +
macrolide (eg, azithromycin or clarithromycin) or doxycycline.
o a respiratory fluoroquinolone (Levofloxacin)
Ø Inpatient:
Ø B-Lactam (penicillin's or 3rd gen. cephalosporins (ceftriaxone) +
Macrolid/doxycycline
Ø MRSA/Pseudomonas use appropriate AB
Ø ICU use broad spectrum AB