Pneumonia classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
Pneumonia can be classified in community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), ventilator-associated pneumonia (VAP), and hospital-acquired pneumonia (HAP) according to the setting in which the infection took place. Other classifications include typical and atypical pneumonia, based on the presentation; and bacterial, viral, and fungal, based on the causative pathogen.
Classification
Classification by Setting
Despite having several classification schemes, the most clinically relevant classification relates to the setting in which pneumonia was acquired. The following are the 4 categories are defined by the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS):[1][2]
- Community-acquired pneumonia (CAP): Pneumonia not acquired in a hospital setting or in a long-term care facility.[3]
- Hospital-acquired pneumonia (HAP): Pneumonia that occurs after 48 hours (or more) of hospitalization that was absent on admission.
- Healthcare-associated pneumonia (HCAP): Pneumonia in patients hospitalized within 90 days of infection, residents of long-term care facility, patients receiving parenteral antibiotics and chemotherapy within 30 days of infection.
- Ventilator-associated pneumonia (VAP): Pneumonia that occurs after 48 hours (or more) of endotracheal intubation.[4]
- Aspiration pneumonia: Pneumonia occuring after inhalation of colonized oropharyngeal material.
Classification by Microbiological Agent
Another important clinical and laboratory classification of pneumonia is based on the identification of the causative agent. Although it is of major importance for tailoring therapy, approximately one half of pneumonias do not have an identifiable causative organism. This is the main rationale behind using empirical therapy. The main groups of by causative agent are:
- Bacterial pneumonia
- Viral pneumonia
- Fungal pneumonia
- Protozoal pneumonia
- Idiopathic interstitial pneumonia (non-infectious)
Classification by Symptoms
Pneumonia can also be classified as typical or atypical pneumonia, depending on the clinical manifestations, chest X-ray findings, and the pathogen that causes the infection.
| Typical Pneumonia | Atypical Pneumonia | |
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| Common Pathogens | ||
| Common Findings |
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Classification by Anatomic Involvement
Despite being the initial classification scheme developed based on findings on autopsy, the anatomic classification is no longer of major clinical importance. Three major classes are observed:
- Lobar pneumonia (involving only one lobe of the lung; mostly observed with Streptoccocus pneumoniae or Klebsiella pneumoniae)
- Multilobar pneumonia
- Interstitial pneumonia (involves the interstitium rather than airways and alveoli; mostly seen with viral and atypical pneumonias)
Classification of Idiopathic Interstitial Pneumonias[5]
Major idiopathic interstitial pneumonias
- Idiopathic pulmonary fibrosis
- Idiopathic nonspecific interstitial pneumonia
- Respiratory bronchiolitis–interstitial lung disease
- Desquamative interstitial pneumonia
- Cryptogenic organizing pneumonia
- Acute interstitial pneumonia
Rare idiopathic interstitial pneumonias
- Idiopathic lymphoid interstitial pneumonia
- Idiopathic pleuroparenchymal fibroelastosis
Unclassifiable idiopathic interstitial pneumonia
References
- ↑ Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). "Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults". Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. Unknown parameter
|iss#=ignored (help) - ↑ "Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. ISSN 1073-449X.
- ↑ Andrews J, Nadjm B, Gant V, Shetty N (2003). "Community-acquired pneumonia". Curr Opin Pulm Med. 9 (3): 175–80. PMID 12682561.
- ↑ American Thoracic Society. Infectious Diseases Society of America (2005). "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia". Am J Respir Crit Care Med. 171 (4): 388–416. doi:10.1164/rccm.200405-644ST. PMID 15699079.
- ↑ Travis, William D.; Costabel, Ulrich; Hansell, David M.; King, Talmadge E.; Lynch, David A.; Nicholson, Andrew G.; Ryerson, Christopher J.; Ryu, Jay H.; Selman, Moisés; Wells, Athol U.; Behr, Jurgen; Bouros, Demosthenes; Brown, Kevin K.; Colby, Thomas V.; Collard, Harold R.; Cordeiro, Carlos Robalo; Cottin, Vincent; Crestani, Bruno; Drent, Marjolein; Dudden, Rosalind F.; Egan, Jim; Flaherty, Kevin; Hogaboam, Cory; Inoue, Yoshikazu; Johkoh, Takeshi; Kim, Dong Soon; Kitaichi, Masanori; Loyd, James; Martinez, Fernando J.; Myers, Jeffrey; Protzko, Shandra; Raghu, Ganesh; Richeldi, Luca; Sverzellati, Nicola; Swigris, Jeffrey; Valeyre, Dominique (2013). "An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias". American Journal of Respiratory and Critical Care Medicine. 188 (6): 733–748. doi:10.1164/rccm.201308-1483ST. ISSN 1073-449X.