Community-acquired pneumonia overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Community-acquired pneumonia is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs. CAP is a common illness and can affect people of all ages. It often causes problems like breathing difficulties, fever, chest pains, and a cough. CAP occurs when the alveoli become filled with fluid and cannot work effectively. It occurs throughout the world and is a leading cause of illness and death. Causes of CAP include bacteria, viruses, fungi, and parasites. CAP can be diagnosed by its symptoms and a physical examination alone, though x-rays, examinations of the sputum, and other tests are often used. CAP is primarily treated with antibiotic medication. Some forms of CAP can be prevented by vaccination.
Historical Perspective
Sir William Osler, known as "the father of modern medicine," appreciated the morbidity and mortality of pneumonia, describing it as the "captain of the men of death" in 1918. However, several key developments in the 1900s improved the outcome for those with pneumonia. With the advent of penicillin and other antibiotics, modern surgical techniques, and intensive care in the twentieth century, mortality from pneumonia dropped precipitously in the developed world. Vaccination of infants against Haemophilus influenzae type b began in 1988 and led to a dramatic decline in cases shortly thereafter.[1] Vaccination against Streptococcus pneumoniae in adults began in 1977 and in children it began in 2000, resulting in a similar decline.[2]
Pathophysiology
Since the lower respiratory tract is maintained sterile by different pulmonary defence mechanisms,[3] acquiring community-acquired pneumonia connotes a breach of host defence mechanisms and/or overwhelming inoculation of virulent infectious agents. Modes of transmission include macro- or micro-aspiration, from circulation, local spead, traumatic inoculation, or can be iatrogenic. Impaired immunity and inability to filter out pathogen increase the risk for developing pneumonia. Causative etiologies vary with age, immune status, geographical area, and comorbid conditions.
Causes
Community-acquired pneumonia can be caused by viral, bacterial, and fungal organisms. Causative etiology varies with age, immune status, epidemiologic background, and comorbidity.
Differentiating Community-acquired pneumonia from other Diseases
Pneumonia should be differentiated from other conditions that cause cough, fever, shortness of breath and tachypnea, such as asthma, COPD, CHF, cancer, GERD, and pulmonary emboli.
Epidemiology and Demographics
Pneumonia is the leading cause of death in children younger than 5 years of age worldwide. Both children and the elderly are at a higher risk for pneumonia complications. Countries in the Middle East and Africa have a higher mortality rate among children with pneumonia.
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
CURB-65
Pneumonia Severity Index
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
Ultrasound
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ Adams WG, Deaver KA, Cochi SL, et al. Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era.JAMA1993;269:221-6. PMID 8417239
- ↑ Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of pneumococcal protein-polysaccharide conjugate vaccine. New Engl J Med. 2003;348:1737–1746. PMID 12724479
- ↑ Mason, CM.; Nelson, S. (2005). "Pulmonary host defenses and factors predisposing to lung infection". Clin Chest Med. 26 (1): 11–7. doi:10.1016/j.ccm.2004.10.018. PMID 15802161. Unknown parameter
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