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Community Acquired Pneumonia Fmdrl


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Community Acquired Pneumonia Fmdrl

  1. 1. Community Acquired Pneumonia Peter Valenzuela, MD, MBA, FAAFP Assistant Dean for Clinical Affairs Assistant Professor/Dept. of Family Medicine
  2. 2. Objectives <ul><li>Identify the pathogens common to CAP </li></ul><ul><li>Describe the signs and symptoms of CAP </li></ul><ul><li>Describe the diagnostic criteria for CAP </li></ul><ul><li>Discuss treatment options for CAP </li></ul>
  3. 3. Background <ul><li>Total annual cost of health care for CAP in U.S. is $8.4 billion </li></ul><ul><li>5.6 million cases of CAP in U.S. each year </li></ul><ul><ul><li>J Respir Dis 2002; 23:10-7 </li></ul></ul><ul><li>Pneumonia and influenza combined are 7 th leading cause of death in U.S. </li></ul><ul><ul><li>21.8 deaths per 100,000 </li></ul></ul><ul><ul><li>Natl Vital Stat Rep 2003; 52:1-115 </li></ul></ul>
  4. 4. Definition <ul><li>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 </li></ul>
  5. 5. Types-Pathogens <ul><li>Typical CAP (60-70%) </li></ul><ul><ul><li>Streptococcus pneumoniae </li></ul></ul><ul><li>Atypical CAP (30-40%) </li></ul><ul><ul><li>Influenza virus </li></ul></ul><ul><ul><li>Mycoplasma </li></ul></ul><ul><ul><li>Chlamydia </li></ul></ul><ul><ul><li>Legionella </li></ul></ul>
  6. 6. Signs & Symptoms <ul><li>Clinical symptoms </li></ul><ul><ul><li>Cough (productive or non-productive) </li></ul></ul><ul><ul><li>Fever (>100.4) </li></ul></ul><ul><ul><li>Chills/Rigors </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Fatigue/Myalgia </li></ul></ul><ul><ul><li>Gastrointestinal (Legionella) </li></ul></ul>
  7. 7. Signs & Symptoms <ul><li>Physical exam </li></ul><ul><ul><li>Dullness to percussion of chest </li></ul></ul><ul><ul><li>Crackles or rales on auscultation </li></ul></ul><ul><ul><li>Bronchial breath sounds </li></ul></ul><ul><ul><li>Egophony (“E” to “A” changes) </li></ul></ul>
  8. 8. Diagnosis- Labs <ul><li>All patients with suspected CAP should have chest radiograph </li></ul><ul><li>Leukocyte count </li></ul><ul><li>Sputum Gram stain </li></ul><ul><li>Blood cultures x 2 </li></ul><ul><li>Serum/urine antigens </li></ul>
  9. 9. Radiograph findings <ul><li>Lobar consolidation is common in typical pneumonia </li></ul><ul><li>This image can be accessed at </li></ul>
  10. 10. Radiograph findings <ul><li>Diffuse or patchy infiltrates are more common in atypical pneumonia </li></ul><ul><li>This image can be accessed at </li></ul>
  11. 11. Management <ul><li>Inpatient cost for CAP is $7,500 </li></ul><ul><li>Outpatient cost for CAP is $150-$350 </li></ul><ul><li>Pneumonia Severity Index- assesses need for hospitalization </li></ul><ul><li>This index can be accessed at </li></ul>
  12. 12. Management Algorithm <ul><li>This algorithm can be accessed at </li></ul>
  13. 13. Treatment <ul><li>Preferred outpatient management is single therapy with one of the following </li></ul><ul><ul><li>Macrolide </li></ul></ul><ul><ul><li>Fluoroqunolone </li></ul></ul><ul><ul><li>Doxycycline </li></ul></ul><ul><li>Preferred inpatient management </li></ul><ul><ul><li>Beta-lactam + macrolide </li></ul></ul><ul><ul><li>Fluoroquinolone </li></ul></ul>
  14. 14. Summary <ul><li>Identify the pathogens common to CAP </li></ul><ul><li>Describe the signs and symptoms of CAP </li></ul><ul><li>Describe the diagnostic labs for CAP </li></ul><ul><li>Discuss treatment options for CAP </li></ul>
  15. 15. Questions?
  16. 16. References <ul><li>Lutfiyya N, et al, Diagnosis and treatment of community-acquired pneumonia Am Fam Physician 2006;73:442-50 </li></ul><ul><li>Niederman MS. Community-acquired pneumonia: management controversies, part 1; practical recommendations from the latest guidelines. J Respir Dis 2002;23:10-7. </li></ul><ul><li>Arias E, Anderson RN, Kung HC, Murphy SL, Kochanek KD. Deaths: final data for 2001. Natl Vital Stat Rep 2003;52:1-115. </li></ul><ul><li>Fish D. Pneumonia. PSAP, Pharmacotherapy Self-Assessment Program. Kansas City, Mo.: American College of Clinical Pharmacy, 2002:202 . </li></ul><ul><li>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. </li></ul>