Commun|tyacqu|red pneumon|a

lrom Wlklpedla Lhe free encyclopedla

Commun|tyacqu|red pneumon|a (CA) ls a Lerm used Lo descrlbe one of several dlseases ln whlch lndlvlduals
who have noL recenLly been hosplLallzed develop an lnfecLlon of Lhe lungs (pneumonla) CA ls a common
lllness and can affecL people of all ages CA ofLen causes problems llke dlfflculLy ln breaLhlng fever chesL
palns and a cough CA occurs because Lhe areas of Lhe lung whlch absorb oxygen (alveoll) from Lhe
aLmosphere become fllled wlLh fluld and cannoL work effecLlvely
CA occurs LhroughouL Lhe world and ls a leadlng cause of lllness and deaLh Causes of CA lnclude bacLerla
vlruses fungl and paraslLes CA can be dlagnosed by sympLoms and physlcal examlnaLlon alone Lhough x
rays examlnaLlon of Lhe spuLum and oLher LesLs are ofLen used lndlvlduals wlLh CA someLlmes requlre
LreaLmenL ln a hosplLal CA ls prlmarlly LreaLed wlLh anLlbloLlc medlcaLlon Some forms of CA can be
prevenLed by vacclnaLlon
S|gns and symptoms
SympLoms of CA commonly lnclude
O dyspnea
O coughlng LhaL produces greenlsh or yellow spuLum
O a hlgh fever LhaL may be accompanled wlLh sweaLlng chllls and unconLrollable shaklng
O sharp or sLabblng chesL paln
O rapld shallow breaLhlng LhaL ls ofLen palnful
Less common sympLoms lnclude
O Lhe coughlng up of blood (hemopLysls)
O headaches (lncludlng mlgralne headaches)
O loss of appeLlLe
O excesslve faLlgue
O blueness of Lhe skln (cyanosls)
O nausea
O vomlLlng
O dlarrhea
O olnL paln (arLhralgla)
O muscle aches (myalgla)
1he manlfesLaLlons of pneumonla llke Lhose for many condlLlons mlghL noL be Lyplcal ln older people 1hey
mlghL lnsLead experlence
O new or worsenlng confuslon
O hypoLhermla
O falls*
AddlLlonal sympLoms for lnfanLs could lnclude
O belng overly sleepy
O yellowlng of Lhe skln (aundlce)
O dlfflculLles feedlng
2

Cause
1here are over a hundred mlcroorganlsms whlch can cause CA 1he mosL common Lypes of mlcroorganlsms
are dlfferenL among dlfferenL groups of people newborn lnfanLs chlldren and adulLs are aL rlsk for dlfferenL
specLrums of dlsease causlng mlcroorganlsms ln addlLlon adulLs wlLh chronlc lllnesses who llve ln cerLaln
parLs of Lhe world who reslde ln nurslng homes who have recenLly been LreaLed wlLh anLlbloLlcs or who are
alcohollcs are aL rlsk for unlque lnfecLlons Lven when aggresslve measures are Laken a deflnlLe cause for
pneumonla ls only ldenLlfled ln half Lhe cases
Infants
newborn lnfanLs can acqulre lung lnfecLlons prlor Lo belng born elLher by breaLhlng lnfecLed amnloLlc fluld or
by bloodborne lnfecLlon across Lhe placenLa lnfanLs can also lnhale (asplraLe) fluld from Lhe blrLh canal as
Lhey are belng born 1he mosL lmporLanL lnfecLlon ln newborns ls caused by SLrepLococcus agalacLlae also
known as Croup 8 SLrepLococcus or C8S C8S causes aL leasL 30 of cases of CA ln Lhe flrsL week of llfe
3

CLher bacLerlal causes ln Lhe newborn perlod lnclude llstetlo mooocytoqeoes and Luberculosls vlruses can
also be Lransferred from moLher Lo chlld herpes slmplex vlrus ls Lhe mosL common and llfeLhreaLenlng buL
adenovlrus mumps and enLerovlrus can also cause dlsease
CA ln older lnfanLs reflecLs lncreased exposure Lo mlcroorganlsms Common bacLerlal causes lnclude
5tteptococcos poeomooloe scbetlcblo coll klebslello poeomooloe Motoxello cotottbolls and 5topbylococcos
ooteos A unlque cause of CA ln Lhls group ls cblomyJlo ttocbomotls whlch ls acqulred durlng blrLh buL whlch
does noL cause pneumonla unLll 24 weeks laLer MaLernallyderlved syphllls can be a cause of CA ln Lhls age
group Common vlruses lnclude resplraLory syncyLlal vlrus (8Sv) meLapneumovlrus adenovlrus
paralnfluenza lnfluenza and rhlnovlrus 8Sv ln parLlcular ls a common source of lllness and hosplLallzaLlon
4

lungl and paraslLes are noL Lyplcally encounLered ln oLherwlse healLhy lnfanLs
Ch||dren
lor Lhe mosL parL chlldren older Lhan one monLh of llfe are aL rlsk for Lhe same mlcroorganlsms as adulLs
Powever chlldren less Lhan flve years are much less llkely Lo have pneumonla caused by Mycoplosmo
poeomooloe cblomyJopbll poeomooloe or leqlooello poeomopbllo ln conLrasL older chlldren and Leenagers
are more llkely Lo acqulre Mycoplosmo poeomooloe and cblomyJopbllo poeomooloe Lhan adulLs
3

Adu|ts
1he full specLrum of mlcroorganlsms ls responslble for CA ln adulLs Several lmporLanL groups of organlsms
are more common among people wlLh cerLaln rlsk facLors ldenLlfylng people aL rlsk for Lhese organlsms ls
lmporLanL for approprlaLe LreaLmenL
O vlruses
vlruses cause 20 of CA cases 1he mosL common vlruses are lnfluenza paralnfluenza resplraLory syncyLlal
vlrus meLapneumovlrus and adenovlrus Less common vlruses causlng slgnlflcanL lllness lnclude chlcken pox
SA8S avlan flu and hanLavlrus
6

O ALyplcal organlsms
1he mosL common bacLerlal causes of pneumonla are Lhe socalled aLyplcal bacLerla Mycoplosmo poeomooloe
and cblomyJopbllo poeomooloe leqlooello poeomopbllo ls consldered aLyplcal buL ls less common ALyplcal
organlsms are more dlfflculL Lo grow respond Lo dlfferenL anLlbloLlcs and were dlscovered more recenLly Lhan
Lhe Lyplcal bacLerla dlscovered ln Lhe early LwenLleLh cenLury
O SLrepLococcus pneumonlae
5tteptococcos poeomooloe ls a common bacLerlal cause of CA (mosL common cause ln uk) rlor Lo Lhe
developmenL of anLlbloLlcs and vacclnaLlon lL was a leadlng cause of deaLh 1radlLlonally hlghly senslLlve Lo
penlclllln durlng Lhe 1970s reslsLance Lo mulLlple anLlbloLlcs began Lo develop CurrenL sLralns of drug reslsLanL
SLrepLococcus pneumonlae or u8S are common accounLlng for LwenLy percenL of all SLrepLococcus
pneumonlae lnfecLlons AdulLs wlLh rlsk facLors for u8S lncludlng belng older Lhan 63 havlng exposure Lo
chlldren ln day care havlng alcohollsm or oLher severe underlylng dlsease or recenL LreaLmenL wlLh anLlbloLlcs
should lnlLlally be LreaLed wlLh anLlbloLlcs effecLlve agalnsL u8S
7

O Pemophllus lnfluenzae
emopbllos lofloeozoe ls anoLher common bacLerlal cause of CA llrsL dlscovered ln 1892 lL was lnlLlally
belleved Lo be Lhe cause of lnfluenza because lL commonly causes CA ln people who have suffered recenL lung
damage from vlral pneumonla
O LnLerlc Cram negaLlve bacLerla
1he enLerlc Cram negaLlve bacLerla such as scbetlcblo coll and klebslello poeomooloe are a group of bacLerla
LhaL Lyplcally llve ln Lhe human lnLesLlnes AdulLs wlLh rlsk facLors for lnfecLlon lncludlng resldence ln a nurslng
home serlous hearL and lung dlsease and recenL anLlbloLlc use should lnlLlally be LreaLed wlLh anLlbloLlcs
effecLlve agalnsL LnLerlc Cram negaLlve bacLerla
O seudomonas aeruglnosa
9seoJomooos oetoqlooso ls an uncommon cause of CA buL ls a parLlcularly dlfflculL bacLerla Lo LreaL
lndlvlduals who are malnourlshed have a lung dlsease called bronchlecLasls are on corLlcosLerolds or have
recenLly had sLrong anLlbloLlcs for a week or more should lnlLlally be LreaLed wlLh anLlbloLlcs effecLlve agalnsL
9seoJomooos oetoqlooso
8

Many less common organlsms cause CA 1hey are Lyplcally ldenLlfled because an lndlvldual has speclal rlsk
facLors or afLer LreaLmenL for Lhe common causes has falled 1hese rarer causes are covered ln more deLall ln
Lhelr speclflc pages bacLerlal pneumonla vlral pneumonla fungal pneumonla and paraslLlc pneumonla
|sk factors
Some people have an underlylng problem whlch lncreases Lhelr rlsk of geLLlng an lnfecLlon Some lmporLanL
slLuaLlons are covered below
CbsLrucLlon
When parL of Lhe alrway (bronchl) leadlng Lo Lhe alveoll ls obsLrucLed Lhe lung ls noL able Lo clear fluld when lL
accumulaLes 1hls can lead Lo lnfecLlon of Lhe fluld resulLlng ln CA Cne cause of obsLrucLlon especlally ln
young chlldren ls lnhalaLlon of a forelgn obecL such as a marble or Loy 1he obecL ls lodged ln Lhe small
alrways and pneumonla can form ln Lhe Lrapped areas of lung AnoLher cause of obsLrucLlon ls lung cancer
whlch can grow lnLo Lhe alrways block Lhe flow of alr
Lung dlsease
eople wlLh underlylng lung dlsease are more llkely Lo develop CA ulseases such as emphysema or hablLs
such as smoklng resulL ln more frequenL and more severe bouLs of CA ln chlldren recurrenL eplsodes of CA
may be Lhe flrsL clue Lo dlseases such as cysLlc flbrosls or pulmonary sequesLraLlon
lmmune problems
eople who have lmmune sysLem problems are more llkely Lo geL CA eople who have AluS are much more
llkely Lo develop CA CLher lmmune problems range from severe lmmune deflclencles of chlldhood such as
WlskoLLAldrlch syndrome Lo less severe deflclencles such as common varlable lmmunodeflclency
9

athophys|o|ogy
1he sympLoms of CA are Lhe resulL of boLh Lhe lnvaslon of Lhe lungs by mlcroorganlsms and Lhe lmmune
sysLems response Lo Lhe lnfecLlon 1he mechanlsms of lnfecLlon are qulLe dlfferenL for vlruses and Lhe oLher
mlcroorganlsms
O Iltoses
vlruses musL lnvade cells ln order Lo reproduce 1yplcally a vlrus wlll reach Lhe lungs by Lravellng ln dropleLs
Lhrough Lhe mouLh and nose wlLh lnhalaLlon 1here Lhe vlrus lnvades Lhe cells llnlng Lhe alrways and Lhe alveoll
1hls lnvaslon ofLen leads Lo cell deaLh elLher Lhrough dlrecL kllllng by Lhe vlrus or by selfdesLrucLlon Lhrough
apopLosls lurLher damage Lo Lhe lungs occurs when Lhe lmmune sysLem responds Lo Lhe lnfecLlon WhlLe blood
cells ln parLlcular lymphocyLes are responslble for acLlvaLlng a varleLy of chemlcals (cyLoklnes) whlch cause
leaklng of fluld lnLo Lhe alveoll 1he comblnaLlon of cellular desLrucLlon and fluldfllled alveoll lnLerrupLs Lhe
LransporLaLlon of oxygen lnLo Lhe bloodsLream ln addlLlon Lo Lhe effecLs on Lhe lungs many vlruses affecL oLher
organs and can lead Lo lllness affecLlng many dlfferenL bodlly funcLlons vlruses also make Lhe body more
suscepLlble Lo bacLerlal lnfecLlon for Lhls reason bacLerlal pneumonla ofLen compllcaLes vlral CA
O octetlo ooJ fooql
8acLerla and fungl also Lyplcally enLer Lhe lung wlLh lnhalaLlon Lhough Lhey can reach Lhe lung Lhrough Lhe
bloodsLream lf oLher parLs of Lhe body are lnfecLed CfLen bacLerla llve ln parLs of Lhe upper resplraLory LracL
and are consLanLly belng lnhaled lnLo Lhe alveoll Cnce lnslde Lhe alveoll bacLerla and fungl Lravel lnLo Lhe
spaces beLween Lhe cells and also beLween adacenL alveoll Lhrough connecLlng pores 1hls lnvaslon Lrlggers Lhe
lmmune sysLem Lo respond by sendlng whlLe blood cells responslble for aLLacklng mlcroorganlsms (neuLrophlls)
Lo Lhe lungs 1he neuLrophlls engulf and klll Lhe offendlng organlsms buL also release cyLoklnes whlch resulL ln a
general acLlvaLlon of Lhe lmmune sysLem 1hls resulLs ln Lhe fever chllls and faLlgue common ln CA 1he
neuLrophlls bacLerla and fluld leaked from surroundlng blood vessels flll Lhe alveoll and resulL ln lmpalred
oxygen LransporLaLlon 8acLerla ofLen Lravel from Lhe lung lnLo Lhe blood sLream and can resulL ln serlous lllness
such as sepLlc shock ln whlch Lhere ls low blood pressure leadlng Lo damage ln mulLlple parLs of Lhe body
lncludlng Lhe braln kldney and hearL
O 9otosltes
1here are a varleLy of paraslLes whlch can affecL Lhe lungs ln general Lhese paraslLes enLer Lhe body Lhrough
Lhe skln or by belng swallowed Cnce lnslde Lhe body Lhese paraslLes Lravel Lo Lhe lungs mosL ofLen Lhrough Lhe
blood 1here a slmllar comblnaLlon of cellular desLrucLlon and lmmune response causes dlsrupLlon of oxygen
LransporLaLlon
|agnos|s
lndlvlduals wlLh sympLoms of CA requlre furLher evaluaLlon hyslcal examlnaLlon by a healLh provlder may
reveal fever an lncreased resplraLory raLe (Lachypnea) low blood pressure (hypoLenslon) a fasL hearL raLe
(Lachycardla) and/or changes ln Lhe amounL of oxygen ln Lhe blood leellng Lhe way Lhe chesL expands
(palpaLlon) and Lapplng Lhe chesL wall (percusslon) Lo ldenLlfy dull areas whlch do noL resonaLe can ldenLlfy
areas of Lhe lung whlch are sLlff and full of fluld (consolldaLed) LxamlnaLlon of Lhe lungs wlLh Lhe ald of a
sLeLhoscope can reveal several Lhlngs A lack of normal breaLh sounds or Lhe presence of crackllng sounds
(rales) when Lhe lungs are llsLened Lo (ausculLaLed) can also lndlcaLe consolldaLlon lncreased vlbraLlon of Lhe
chesL when speaklng (LacLlle fremlLus) and lncreased volume of whlspered speech durlng ausculLaLlon of Lhe
chesL can also reveal consolldaLlon
10

xrays of Lhe chesL examlnaLlon of Lhe blood and spuLum for lnfecLlous mlcroorganlsms and blood LesLs are
commonly used Lo dlagnose lndlvlduals wlLh suspecLed CA based upon sympLoms and physlcal examlnaLlon
1he use of each LesL depends on Lhe severlLy of lllness local pracLlces and Lhe concern for any compllcaLlons
resulLlng from Lhe lnfecLlon All paLlenLs wlLh CA should have Lhe amounL of oxygen ln Lhelr blood monlLored
wlLh a machlne called a pulse oxlmeLer 1hls helps deLermlne how well Lhe lungs are able Lo work desplLe
lnfecLlon ln some cases analysls of arLerlal blood gas may be requlred Lo accuraLely deLermlne Lhe amounL of
oxygen ln Lhe blood CompleLe blood counL (C8C) a blood LesL may reveal exLra whlLe blood cells lndlcaLlng
an lnfecLlon ChesL xrays and chesL compuLed Lomography (C1) can reveal areas of opaclLy (seen as whlLe)
whlch represenL consolldaLlon A normal chesL xray makes CA less llkely however CA ls someLlmes noL
seen on xrays because Lhe dlsease ls elLher ln lLs lnlLlal sLages or lnvolves a parL of Lhe lung noL easlly seen by
xray ln some cases chesL C1 can reveal a CA whlch ls noL presenL on chesL xray xrays can ofLen be
mlsleadlng as many oLher dlseases can mlmlc CA such as hearL problems or oLher Lypes of lung damage
11

Several LesLs can be performed Lo ldenLlfy Lhe cause of an lndlvlduals CA 8lood culLures can be drawn Lo
lsolaLe any bacLerla or fungl ln Lhe blood sLream SpuLum Crams sLaln and culLure can also reveal Lhe
causaLlve mlcroorganlsm ln more severe cases a procedure whereln a flexlble scope ls passed Lhrough Lhe
mouLh lnLo Lhe lungs (bronchoscopy) can be used Lo collecL fluld for culLure Speclal LesLs can be performed lf
an uncommon mlcroorganlsm ls suspecLed (such as LesLlng Lhe urlne for Leglonella anLlgen when Leglonnalres
dlsease ls a concern)
1reatment
CA ls LreaLed by admlnlsLerlng an anLlbloLlc whlch ls effecLlve ln kllllng Lhe offendlng mlcroorganlsm as well as
managlng any compllcaLlons of Lhe lnfecLlon lf Lhe causaLlve mlcroorganlsm ls unldenLlfled dlfferenL
anLlbloLlcs are LesLed ln Lhe laboraLory ln order Lo ldenLlfy whlch medlcaLlon wlll be mosL effecLlve CfLen
however no mlcroorganlsm ls ever ldenLlfled Also slnce laboraLory LesLlng can Lake several days Lhere ls
some delay unLll an organlsm ls ldenLlfled ln boLh cases a persons rlsk facLors for dlfferenL organlsms musL
be remembered when chooslng Lhe lnlLlal anLlbloLlcs (called emplrlc Lherapy) AddlLlonal conslderaLlon musL
be glven Lo Lhe seLLlng ln whlch Lhe lndlvldual wlll be LreaLed MosL people wlll be fully LreaLed afLer Laklng
oral pllls whlle oLher people need Lo be hosplLallzed for lnLravenous anLlbloLlcs and posslbly lnLenslve care ln
general all Lheraples ln older chlldren and adulLs wlll lnclude LreaLmenL for aLyplcal bacLerla 1yplcally Lhls ls a
macrollde anLlbloLlc such as azlLhromycln or clarlLhromycln alLhough a fluoroqulnolone such as levofloxacln
can subsLlLuLe uoxycycllne ls now Lhe anLlbloLlc of cholce ln Lhe uk for compleLe coverage of Lhe aLyplcal
bacLerla 1hls ls due Lo lncreased levels of closLrldlum dlfflclle seen ln hosplLal paLlenLs belng llnked Lo Lhe
lncreased use of clarlLhromycln
-ewborns
MosL newborn lnfanLs wlLh CA are hosplLallzed and glven lnLravenous amplclllln and genLamlcln for aL leasL
Len days 1hls LreaLs Lhe common bacLerla 5tteptococcos oqoloctloe llstetlo mooocytoqeoes and scbetlcblo
coll lf herpes slmplex vlrus ls Lhe cause lnLravenous acyclovlr ls admlnlsLered for 21 days
Ch||dren
1reaLmenL of CA ln chlldren depends on boLh Lhe age of Lhe chlld and Lhe severlLy of hls/her lllness Chlldren
less Lhan flve do noL Lyplcally recelve LreaLmenL Lo cover aLyplcal bacLerla lf a chlld does noL need Lo be
hosplLallzed amoxlclllln for seven days ls a common LreaLmenL Powever wlLh lncreaslng prevalence of u8S
oLher agenLs such as cefpodoxlme wlll mosL llkely become more popular ln Lhe fuLure
12
PosplLallzed chlldren
should recelve lnLravenous amplclllln cefLrlaxone or cefoLaxlme Accordlng Lo a recenL meLaanalysls a 3 days
course of anLlbloLlcs seems Lo be sufflclenL for mosL cases of mlld Lo moderaLe CA ln chlldren
1

Adu|ts
ln 2001 Lhe Amerlcan 1horaclc SocleLy drawlng on work by Lhe 8rlLlsh and Canadlan 1horaclc SocleLles
esLabllshed guldellnes for Lhe managemenL of adulLs wlLh CA whlch dlvlded lndlvlduals wlLh CA lnLo four
caLegorles based upon common organlsms encounLered
13

O PealLhy ouLpaLlenLs wlLhouL rlsk facLors
1hls group Lhe largesL ls composed of oLherwlse healLhy paLlenLs wlLhouL rlsk facLors for u8S enLerlc Cram
negaLlve bacLerla 9seoJomooos or oLher less common causes of CA 1he prlmary mlcrooganlsms ln Lhls group
are vlruses aLyplcal bacLerla penlclllln senslLlve 5tteptococcos poeomooloe and emopbllos lofloeozoe
8ecommended managemenL ls wlLh a macrollde anLlbloLlc such as azlLhromycln or clarlLhromycln for seven
2
Lo
Len days
O CuLpaLlenLs wlLh underlylng lllness and/or rlsk facLors
1hls group does noL requlre hosplLallzaLlon lLs members elLher have underlylng healLh problems (such as
emphysema or congesLlve hearL fallure) or ls aL rlsk for u8S and/or enLerlc Cram negaLlve bacLerla 1reaLmenL
ls wlLh a fluoroqulnolone acLlve agalnsL 5tteptococcos poeomooloe such as levofloxacln or a beLalacLam
anLlbloLlc such as cefpodoxlme cefuroxlme amoxlclllln or amoxlclllln/clavulanaLe plus a macrollde anLlbloLlc
such as azlLhromycln or clarlLhromycln for seven Lo Len days
3

O PosplLallzed lndlvlduals noL aL rlsk for seudomonas
1hls group requlres hosplLallzaLlon and admlnlsLraLlon of lnLravenous anLlbloLlcs 1reaLmenL ls wlLh elLher an
lnLravenous fluoroqulnolone acLlve agalnsL 5tteptococcos poeomooloe such as levofloxacln or beLalacLam
anLlbloLlc such as cefoLaxlme cefLrlaxone amplclllln/sulbacLam or hlghdose amplclllln plus an lnLravenous
macrollde anLlbloLlc such as azlLhromycln or clarlLhromycln for seven Lo Len days
O lndlvlduals requlrlng lnLenslve care aL rlsk for seudomonas
lndlvlduals belng LreaLed ln an lnLenslve care unlL wlLh rlsk facLors for lnfecLlon wlLh 9seoJomooos oetoqlooso
requlre speclflc anLlbloLlcs LargeLlng Lhls dlfflculL Lo eradlcaLe bacLerla Cne posslble reglmen ls an lnLravenous
anLlpseudomonal beLalacLam such as cefeplme lmlpenem meropenem or plperaclllln/LazobacLam plus an
lnLravenous anLlpseudomonal fluoroqulnolone such as levofloxacln AnoLher recommended reglmen ls an
lnLravenous anLlpseudomonal beLalacLam such as cefeplme lmlpenem meropenem or plperaclllln/
LazobacLam plus an lnLravenous amlnoglycoslde such as genLamlcln or Lobramycln plus elLher an lnLravenous
macrollde such azlLhromycln or an lnLravenous nonpseudomonal fluoroqulnolone such as clprofloxacln
lor mlld Lo moderaLe communlLyacqulred pneumonla shorLer courses of anLlbloLlcs (37 days) seem Lo be
sufflclenL accordlng Lo a recenL meLaanalysls
1

osp|ta||ze
Some people wlLh CA requlre hosplLallzaLlon and more lnLenslve care Lhan Lhe maorlLy ln general a
dlscusslon beLween Lhe lndlvldual and hls or her healLh care provlder deLermlnes Lhe need for hosplLallzaLlon
Cllnlcal predlcLlon rules such as Lhe pneumonla severlLy lndex and Cu8863 have been developed Lo help
gulde Lhe declslon
14
lacLors whlch lncrease Lhe need for hosplLallzaLlon lnclude age greaLer Lhan 63
underlylng chronlc lllnesses a resplraLory raLe greaLer Lhan LhlrLy breaLhs per mlnuLe a sysLollc blood
pressure less Lhan 90 mmPg a hearL raLe greaLer Lhan 123 per mlnuLe LemperaLure less Lhan 33 or greaLer
Lhan 40C confuslon and evldence of lnfecLlon ouLslde Lhe lung LaboraLory resulLs whlch lncrease Lhe need
for hosplLallzaLlon lnclude arLerlal oxygen Lenslon less Lhan 60 mm Pg carbon dloxlde of greaLer Lhan 30
mmPg or pP less Lhan 733 whlle breaLhlng room alr hemaLocrlL less Lhan 30 creaLlnlne greaLer Lhan
12 mg/dl or blood urea nlLrogen greaLer Lhan 20 mg/ dl whlLe blood cell counL less Lhan 4 109/L or greaLer
Lhan 30 109/L and absoluLe neuLrophll counL less Lhan 1 x 109/L xray flndlngs whlch lncrease Lhe need
for hosplLallzaLlon lnclude lnvolvemenL of more Lhan one lobe of Lhe lung presence of a cavlLy and Lhe
presence of a pleural effuslon
rognos|s
lndlvlduals who are LreaLed for CA ouLslde of Lhe hosplLal have a morLallLy raLe less Lhan 1 lever Lyplcally
responds ln Lhe flrsL Lwo days of Lherapy and oLher sympLoms resolve ln Lhe flrsL week 1he xray however
may remaln abnormal for aL leasL a monLh even when CA has been successfully LreaLed Among lndlvlduals
who requlre hosplLallzaLlon Lhe morLallLy raLe averages 12 overall buL ls as much as 40 ln people who
have bloodsLream lnfecLlons or requlre lnLenslve care
13
lacLors whlch lncrease morLallLy are Lhe same as
Lhose whlch lncrease Lhe need for hosplLallzaLlon and are llsLed above
When CA does noL respond as expecLed Lhere are several posslble causes A compllcaLlon of CA may have
occurred or a prevlously unknown healLh problem may be playlng a role 8oLh slLuaLlons are covered ln more
deLall below AddlLlonal causes lnclude lnapproprlaLe anLlbloLlcs for Lhe causaLlve organlsm (le u8S) a
prevlously unsuspecLed mlcroorganlsm (such as Luberculosls) or a condlLlon whlch mlmlcs CA (such as
Wegeners granulomaLosls) AddlLlonal LesLlng may be performed and may lnclude addlLlonal radlologlc
lmaglng (such as a compuLed Lomography scan) or a procedure such as a bronchoscopy or lung blopsy
Comp||cat|ons
uesplLe approprlaLe anLlbloLlc Lherapy severe compllcaLlons can resulL from CA lncludlng
Seps|s
Sepsls can occur when mlcroorganlsms enLer Lhe blood sLream and Lhe lmmune sysLem responds Sepsls mosL
ofLen occurs wlLh bacLerlal pneumonla 5tteptococcos poeomooloe ls Lhe mosL common cause lndlvlduals
wlLh sepsls requlre hosplLallzaLlon ln an lnLenslve care unlL 1hey ofLen requlre medlcaLlons and lnLravenous
flulds Lo keep Lhelr blood pressure from golng Loo low Sepsls can cause llver kldney and hearL damage
among oLher Lhlngs
esp|ratory fa||ure
8ecause CA affecLs Lhe lungs ofLen lndlvlduals wlLh CA have dlfflculLy breaLhlng lf enough of Lhe lung ls
lnvolved lL may noL be posslble for a person Lo breaLhe enough Lo llve wlLhouL supporL nonlnvaslve
machlnes such as a bllevel poslLlve alrway pressure machlne may be used CLherwlse placemenL of a
breaLhlng Lube lnLo Lhe mouLh may be necessary and a venLllaLor may be used Lo help Lhe person breaLhe
|eura| effus|on and empyema
Cccaslonally mlcroorganlsms from Lhe lung wlll cause fluld Lo form ln Lhe space surroundlng Lhe lung called
Lhe pleural cavlLy lf Lhe mlcroorganlsms Lhemselves are presenL Lhe fluld collecLlon ls ofLen called an
empyema lf pleural fluld ls presenL ln a person wlLh CA Lhe fluld should be collecLed wlLh a needle
(LhoracenLesls) and examlned uependlng on Lhe resulL of Lhe examlnaLlon compleLe dralnage of Lhe fluld
may be necessary ofLen wlLh a chesL Lube lf Lhe fluld ls noL dralned bacLerla can conLlnue Lo cause lllness
because anLlbloLlcs do noL peneLraLe well lnLo Lhe pleural cavlLy
Abscess
8arely mlcroorganlsms ln Lhe lung wlll form a pockeL of fluld and bacLerla called an abscess Abscesses can be
seen on an xray as a cavlLy wlLhln Lhe lung Abscesses Lyplcally occur ln asplraLlon pneumonla and mosL ofLen
conLaln a mlxLure of anaeroblc bacLerla usually anLlbloLlcs are able Lo fully LreaL abscesses buL someLlmes
Lhey musL be dralned by a surgeon or radlologlsL
Lp|dem|o|ogy
CA ls a common lllness ln all parLs of Lhe world lL ls a maor cause of deaLh among all age groups ln chlldren
Lhe maorlLy of deaLhs occur ln Lhe newborn perlod wlLh over Lwo mllllon worldwlde deaLhs a year ln facL
Lhe WPC esLlmaLes LhaL one ln Lhree newborn lnfanL deaLhs are due Lo pneumonla
16
MorLallLy decreases
wlLh age unLll laLe adulLhood elderly lndlvlduals are parLlcularly aL rlsk for CA and assoclaLed morLallLy
More cases of CA occur durlng wlnLer monLhs Lhan durlng oLher Llmes of Lhe year CA occurs more
commonly ln males Lhan females and ln blacks Lhan Caucaslans lndlvlduals wlLh underlylng lllnesses such as
Alzhelmers dlsease cysLlc flbrosls emphysema Lobacco smoklng alcohollsm or lmmune sysLem problems
are aL lncreased rlsk for pneumonla
17

revent|on
ln addlLlon Lo LreaLlng any underlylng lllness whlch can lncrease a persons rlsk for CA Lhere are several
addlLlonal ways Lo prevenL CA Smoklng cessaLlon ls lmporLanL noL only for LreaLmenL of any underlylng lung
dlsease buL also because clgareLLe smoke lnLerferes wlLh many of Lhe bodys naLural defenses agalnsL CA
vacclnaLlon ls lmporLanL ln boLh chlldren and adulLs vacclnaLlons agalnsL oemopbllos lofloeozoe and
5tteptococcos poeomooloe ln Lhe flrsL year of llfe have greaLly reduced Lhelr role ln CA ln chlldren A vacclne
agalnsL 5tteptococcos poeomooloe ls also avallable for adulLs and ls currenLly recommended for all healLhy
lndlvlduals older Lhan 63 and any adulLs wlLh emphysema congesLlve hearL fallure dlabeLes melllLus clrrhosls
of Lhe llver alcohollsm cerebrosplnal fluld leaks or who do noL have a spleen A repeaL vacclnaLlon may also
be requlred afLer flve or Len years
18

lnfluenza vacclnes should be glven yearly Lo Lhe same lndlvlduals as recelve vacclnaLlon agalnsL 5tteptococcos
poeomooloe ln addlLlon healLh care workers nurslng home resldenLs and pregnanL women should recelve
Lhe vacclne
19
When an lnfluenza ouLbreak ls occurrlng medlcaLlons such as amanLadlne rlmanLadlne
zanamlvlr and oselLamlvlr have been shown Lo prevenL cases of lnfluenza

SCUCL
hLLp//enwlklpedlaorg/wlkl/CommunlLyacqulred_pneumonla


nC for AcuLe yelonephrlLls
SCUCL
hLLp//wwwdocsLoccom/docs/13189240/nurslngCrlbcomnurslngCarelanyelonephrlLls


urug SLudy for lurosemlde 20 mg
SCUCL
hLLp//wwwscrlbdcom/doc/33039619/u8uCS1uu?furosemldeLaslx

urug SLudy for vlLamln 8 Complex 1 Lab
SCUCL
hLLp//wwwscrlbdcom/doc/18469312/urugSLudyforparaceLamolomeprazoleandvlLamln8complex