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accompanied by the presence of an acute infiltrate on a chest radiograph. 2 . • develops in a nursing home resident is included • diagnosis is Confirmed by chest X-ray. or auscultatory findings consistent with pneumonia NICE: • Pneumonia that is acquired outside hospital.Community Acquired Pneumonia (CAP)  Definition OF PNEUMONIA … an acute infection of the pulmonary parenchyma that is associated with symptoms of acute infection.

Presentations Classical • Sudden onset • High fever. shaking chills • Pleuritic chest pain. Viruses .How to diagnose 1. Ricketessiae. blood tinge • Poor general condition • Usually cause by : S. Legionella. SOB • Productive cough • Rusty sputum. Chlamydiae.pneumoniae 3 Atypical • Gradual & insidious onset • Low grade fever • Dry cough. No blood tinge • Good GC • Mycoplasma.

Laboratory Tests • CXR – PA & lateral • CBC with Differential • BUN and Creatinine • FBG. blood cultures • Oxygen saturation 4 . PPBG • Liver enzymes • Serum electrolytes • Gram stain of sputum • Culture of sputum • Pre Rx.

37:215-25 5 .CAP – Value of Chest Radiograph • Usually needed to establish diagnosis • It is a prognostic indicator • To rule out other disorders • May help in etiological diagnosis J Chr Dis 1984.

Infiltrate Patterns and Pathogens 6 .

CAP – The Pathogens Involved 7 .

Streptococcus pneumonia (Pneumococcus) Most common cause of CAP About 2/3 of CAP are due to S.pneumoniae These are gram positive diplococci Lobar infiltrate on CXR 8 .

Legionella H.aeruginosa – not in typical host S.influenzae CAP has associated of pleural effusion S.Pneumoniae – commonest – penicillin resistance problem S.pneumoniae primarily in patients of chronic alcoholism P.pneumoniae.pneumoniae.catarrhalis – Lungs Blood tinged sputum . Nosocom Aspiration CAP only is caused by multiple pathogens Extra pulmonary manifestations only in Atypical CAP 9 .influenza. Serious CAP K.Pneumococcal. K. Klebsiella. M.Aeruginosa causes CAP in pts with CSLD or CF.aureus. P.CAP – Special Features – Pathogen wise Typical – S. H.aureus causes CAP in post-viral influenza.

CAP – Evaluation of a Patient 10 .

CAP – Management Guidelines Rational use of microbiology laboratory Pathogen directed antimicrobial therapy whenever possible Prompt initiation of Antibiotic therapy Decision to hospitalize based on prognostic criteria .PORT or CURB 65 11 .

or systolic less than 90 mmHg) 4. low blood pressure (diastolic 60 mmHg or less. 12 . • Patients are stratified for risk of death as follows: • 0: low risk (less than 1% mortality risk) • 1 or 2: intermediate risk (1-10% mortality risk) • 3 or 4: high risk (more than 10% mortality risk). confusion (abbreviated Mental Test score 8 or less. intermediate or high risk of death using the CRB65 score CRB65 score for mortality risk assessment in primary care[a] • calculated by giving 1 point for each of the following prognostic features: 1. determine whether patients are at low. or new disorientation in person. place or time)[b] 2. age 65 years or more.Severity assessment in primary care • When a clinical diagnosis of community-acquired pneumonia is made in primary care. raised respiratory rate (30 breaths per minute or more) 3.

13 .consider home-based care for patients with a CRB65 score of 0 . particularly those with a CRB65 score of 2 or more.• Use clinical judgement in conjunction with the CRB65 score to inform decisions about whether patients need hospital assessment as follows: .consider hospital assessment for all other patients.

CURB 65 Rule – mortality risk assessment in hospital 14 .

15 .• Patients are stratified for risk of death as follows: • 0 or 1: low risk (less than 3% mortality risk) • 2: intermediate risk (3-15% mortality risk) • 3 to 5: high risk (more than 15% mortality risk).

Antibiotics of choice for CAP 16 .

Consider extending the course of the antibiotic for longer than 5 days as a possible management strategy for patients with low-severity CAP whose symptoms do not improve as expected 17 .Antibiotic therapy 1. Low-severity CAP • • • Offer a 5-day course of a single antibiotic to patients with low-severity CAP Consider amoxicillin in preference to a macrolide or a tetracycline for patients with low-severity community-acquired pneumonia. Consider a macrolide or a tetracycline for patients who are allergic to penicillin.

2. ** dual antibiotic therapy with a beta-lactamase stable beta-lactam and a macrolide for patients with highseverity CAP 18 . 7. 10-day course of antibiotic therapy for patients with moderate or high-severity CAP **dual antibiotic therapy with amoxicillin and a macrolide for patients with moderate-severity CAP.and high-severity CAP **.

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