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Community Acquired Pneumonia Fmdrl
 

Community Acquired Pneumonia Fmdrl

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Community Acquired Pneumonia Fmdrl Community Acquired Pneumonia Fmdrl Presentation Transcript

  • Community Acquired Pneumonia Peter Valenzuela, MD, MBA, FAAFP Assistant Dean for Clinical Affairs Assistant Professor/Dept. of Family Medicine
  • Objectives
    • Identify the pathogens common to CAP
    • Describe the signs and symptoms of CAP
    • Describe the diagnostic criteria for CAP
    • Discuss treatment options for CAP
  • Background
    • Total annual cost of health care for CAP in U.S. is $8.4 billion
    • 5.6 million cases of CAP in U.S. each year
      • J Respir Dis 2002; 23:10-7
    • Pneumonia and influenza combined are 7 th leading cause of death in U.S.
      • 21.8 deaths per 100,000
      • Natl Vital Stat Rep 2003; 52:1-115
  • Definition
    • Community-Acquired Pneumonia (CAP) -lower respiratory tract infection in a non-hospitalized person associated with symptoms of acute infection with or without new infiltrate on chest radiograph
  • Types-Pathogens
    • Typical CAP (60-70%)
      • Streptococcus pneumoniae
    • Atypical CAP (30-40%)
      • Influenza virus
      • Mycoplasma
      • Chlamydia
      • Legionella
  • Signs & Symptoms
    • Clinical symptoms
      • Cough (productive or non-productive)
      • Fever (>100.4)
      • Chills/Rigors
      • Dyspnea
      • Fatigue/Myalgia
      • Gastrointestinal (Legionella)
  • Signs & Symptoms
    • Physical exam
      • Dullness to percussion of chest
      • Crackles or rales on auscultation
      • Bronchial breath sounds
      • Egophony (“E” to “A” changes)
  • Diagnosis- Labs
    • All patients with suspected CAP should have chest radiograph
    • Leukocyte count
    • Sputum Gram stain
    • Blood cultures x 2
    • Serum/urine antigens
  • Radiograph findings
    • Lobar consolidation is common in typical pneumonia
    • This image can be accessed at http://www.emedicine.com/med/images/187614_2228CONSOLID.JPG
  • Radiograph findings
    • Diffuse or patchy infiltrates are more common in atypical pneumonia
    • This image can be accessed at http://www.mevis.de/~hhj/Lunge/ima/InfOrniThA54.JPG
  • Management
    • Inpatient cost for CAP is $7,500
    • Outpatient cost for CAP is $150-$350
    • Pneumonia Severity Index- assesses need for hospitalization
    • This index can be accessed at http://www.medscape.com/content/2004/00/49/50/495094/art-jags495094.app.gif
  • Management Algorithm
    • This algorithm can be accessed at http://www.aafp.org/afp/20060201/442_f1.gif
  • Treatment
    • Preferred outpatient management is single therapy with one of the following
      • Macrolide
      • Fluoroqunolone
      • Doxycycline
    • Preferred inpatient management
      • Beta-lactam + macrolide
      • Fluoroquinolone
  • Summary
    • Identify the pathogens common to CAP
    • Describe the signs and symptoms of CAP
    • Describe the diagnostic labs for CAP
    • Discuss treatment options for CAP
  • Questions?
  • References
    • Lutfiyya N, et al, Diagnosis and treatment of community-acquired pneumonia Am Fam Physician 2006;73:442-50
    • Niederman MS. Community-acquired pneumonia: management controversies, part 1; practical recommendations from the latest guidelines. J Respir Dis 2002;23:10-7.
    • Arias E, Anderson RN, Kung HC, Murphy SL, Kochanek KD. Deaths: final data for 2001. Natl Vital Stat Rep 2003;52:1-115.
    • Fish D. Pneumonia. PSAP, Pharmacotherapy Self-Assessment Program. Kansas City, Mo.: American College of Clinical Pharmacy, 2002:202 .
    • Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.