Community Acquired Pneumonia

Sophie Tatishvili
Harrissons Principles of Internal medicine. 19-th edition.
By Tanya Feke, MD | Reviewed by a board-certified physician
Updated August 17, 2018
Pneumonia Severity Index

February 2008 Blood Purification 26(1):30-5 DOI: 10.1159/000110560

http://www.tamingthesru.com/blog/annals-of-b-pod/spring- 2017/pneumonia
CAP Treatment

US Pharm. 2015;40(4):HS9-HS13.
 Mycoplasma pneumoniae pneumonia
Mycoplasmas are prokaryotes of the class Mycoplasma pneumonia may begin
Mollicutes. Their size (150–350 nm) is closer with a sore throat, the most common
to that of viruses than to that of bacteria. presenting symptom is cough. The
Unlike viruses, however, mycoplasmas grow in cough is typically nonproductive, but
cell-free culture media; in fact, they are the some patients produce sputum.
smallest organisms capable of independent Headache, malaise, chills, and fever
replication. are noted in the majority of patients.
M. pneumoniae attaches to ciliated On physical examination, wheezes or
respiratory epithelial cells by means of a rales are detected in ~80% of patients
complex terminal organelle at the tip of with M. pneumoniae pneumonia.
one end of the organism. Cytoadherence
is mediated by interactive adhesins and
accessory proteins clustered on this
organelle. After extracellular attachment ,
M. pneumoniae causes injury to host
respiratory tissue. The mechanism of
injury is thought to be mediated by the
production of hydrogen peroxide and of a
recently identified
 Mycoplasma pneumoniae pneumonia tests

Antimicrobial Agents of Choice for Mycoplasma Infections

Organism Drug(s)
M. pneumoniae Azithromycin, clarithromycin, erythromycin, doxycycline,
levofloxacin, moxifloxacin, gemifloxacin (not ciprofloxacin)

Harrissons. Internal Medicine. 18th. Edition.

Mycoplasma pneumoniae pneumonia

Four categories of chest x-rays of

Mycoplasma pneumoniae
pneumonia. Homogeneous dense
lobar consolidation (a), patchy
consolidation (b), nodular opacity
(c), and bilateral parahilar
infiltration (d)

Yoon et al. BMC Infectious Diseases (2017) 17:402 DOI 10.1186/s12879-017-2500-z

 Clinical Clues Suggestive of Legionnaires’ Disease

Diarrhea
High fever (>40°C; >104°F) Numerous neutrophils but no
organisms revealed by Gram’s staining of respiratory
secretions
Hyponatremia (serum sodium level < 131 mg/dl
Failure to respond to β-lactam drugs (penicillins or
cephalosporins) and aminoglycoside antibiotics.
Occurrence of illness in an environment in which the potable
water supply is known to be contaminated with Legionella
Onset of symptoms within 10 days after discharge from the
hospita
Harrissons. Internal Medicine. 18th. Edition.
 Chest radiographic findings in a 52-year-old man

A 52-year-old man who presented with pneumonia subsequently diagnosed as Legionnaires’ disease.
The patient was a cigarette smoker with chronic obstructive pulmonary disease and alcoholic cardiomyopathy;
he had received glucocorticoids.
L. pneumophila was identified by direct fluorescent antibody staining and culture of sputum.
Left: Baseline chest radiograph showing long-standing cardiomegaly.
Center: Admission chest radiograph showing new rounded opacities.
Right: Chest radiograph taken 3 days after admission, during treatment with erythromycin.
 Utility of Special Laboratory Tests for the
Diagnosis of Legionnaires’ Disease

Test Sensitivity, % Specificity, %

Culture
•Sputum 80 100
•Transtracheal aspirate 90 100
Direct fluorescent 50–70 96–99
antibody staining of
sputum
Urinary antigen testing 70 100
Antibody serology 40–60 96–99

Harrissons. Internal Medicine. 18th. Edition .

US Pharm. 2016;41(4):39-42 .
Q fever is a zoonosis and direct or indirect contact with animals is
important in its epidemiology.
Almost all patients with Q fever pneumonia complain of fever. A variety
of other symptoms are frequently present, however headache is more
common than it is in patients with pneumonia due to other aetiologies.
In most instances the laboratory diagnosis of C. burnetii infection is
serological.
The treatment of choice for Q fever pneumonia is doxycycline for 10
days. Alternative therapies are a fluoroquinolone or a macrolide plus
rifampin. The latter recommendations are based on in vitrosusceptibility
results and anecdotal experience.

European Respiratory Journal 2003 21: 713 719; DOI: 10.1183/09031936.03.00099703

 Pneumocystis jiroveci Pneumonia
Most common opportunistic infection in persons with HIV infection.
Trimethoprim-sulfamethoxazole (TMP-SMX) has been shown to be as effective as intravenous pentamidine
and more effective than other alternative treatment regimens.
Physiologic changes include the following:
Hypoxemia with an increased alveolar-arterial oxygen gradient
Respiratory alkalosis
Impaired diffusing capacity
Changes in total lung capacity and vital capacity
symptoms of PJP include the following:
Progressive exertional dyspnea (95%)
Fever (>80%)
Nonproductive cough (95%)
Chest discomfort
Weight loss
Chills
Hemoptysis (rare)
Physical examination
The physical examination findings of PJP are nonspecific and include the following:
Tachypnea
Fever
Tachycardia
Pulmonary symptoms: Pulmonary examination may reveal mild crackles and rhonchi but may yield normal
findings in up to half of patients . https://emedicine.medscape.com/article/225976-overview#a19
Pneumocystis jiroveci Pneumonia

https://emedicine.medscape.com/article/225976-overview#a19