This document provides an overview of acute respiratory infections including etiology, classification, clinical presentation, diagnostic evaluation and treatment approaches. It discusses the major syndromes of community-acquired pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia. Evaluation involves history, examination, hematological and microbiological testing. Severity is assessed using CURB-65 or Pneumonia Severity Index to determine site of care. Treatment selection is based on syndrome, severity and likely pathogens.
This document provides guidelines for the diagnosis and management of community-acquired pneumonia (CAP). It defines CAP and discusses its epidemiology and common causes. Streptococcus pneumoniae is often the leading cause worldwide, though causes can vary regionally in India. Chest radiography is important for diagnosis but has limitations. Computed tomography is not routinely needed. The role of microbiological testing of blood and sputum in hospitalized patients is outlined.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
Guidelines for the management of adults with community acquired pneumoniaIbrahim Al Sharabi
This document provides guidelines for managing community-acquired pneumonia (CAP) in adults. It defines CAP and classifies patients into four groups based on treatment location and risk factors. It recommends treatments for each group. The guidelines stratify pathogens by group and recommend initial and alternative antibiotic therapies. It also provides guidance on evaluating non-responsive patients, managing complications, switching to oral therapy, and discharge criteria.
This document describes the case of a 70-year-old female patient admitted to the ICU with community acquired pneumonia. On examination, she displayed signs of confusion, fever, tachycardia, tachypnea, and hypoxemia. Diagnostic tests found consolidations in her left lung with a pleural effusion. She was given various antibiotic treatments but did not improve. A CT scan later found nonspecific interstitial pneumonia. The document also discusses definitions, causes, clinical features, severity indices, diagnostic testing, and treatment guidelines for community acquired pneumonia.
Community acquired pneumonia is a major cause of childhood morbidity and mortality worldwide, especially in developing countries. In India, acute respiratory infections account for 24% of the disease burden and 13% of deaths in children under 5 years of age. Pneumonia is commonly caused by pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Clinical features include fever, cough, difficulty breathing, and fast breathing. Chest x-rays are not always needed for diagnosis. Severity is assessed using WHO criteria to determine appropriate treatment setting and antibiotics. Supportive care includes oxygen and fluids. Antibiotics are typically given for 5-7 days but longer for severe or staphylococcal pneumonia
Management of community acquired pneumoniaNahid Sherbini
This document provides guidance on diagnosing and treating community-acquired pneumonia (CAP) in adults. It discusses the typical presentation of CAP and recommends empirically treating with antibiotics that cover both typical and atypical pathogens. It also describes the Pneumonia Severity Index for risk stratifying patients and determining whether hospitalization is needed. For low-risk patients meeting stability criteria within 3-4 days including normal vital signs and ability to take oral medications, outpatient treatment may be appropriate.
This document provides guidelines for the diagnosis and management of community-acquired pneumonia (CAP). It defines CAP and discusses its epidemiology and common causes. Streptococcus pneumoniae is often the leading cause worldwide, though causes can vary regionally in India. Chest radiography is important for diagnosis but has limitations. Computed tomography is not routinely needed. The role of microbiological testing of blood and sputum in hospitalized patients is outlined.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
Guidelines for the management of adults with community acquired pneumoniaIbrahim Al Sharabi
This document provides guidelines for managing community-acquired pneumonia (CAP) in adults. It defines CAP and classifies patients into four groups based on treatment location and risk factors. It recommends treatments for each group. The guidelines stratify pathogens by group and recommend initial and alternative antibiotic therapies. It also provides guidance on evaluating non-responsive patients, managing complications, switching to oral therapy, and discharge criteria.
This document describes the case of a 70-year-old female patient admitted to the ICU with community acquired pneumonia. On examination, she displayed signs of confusion, fever, tachycardia, tachypnea, and hypoxemia. Diagnostic tests found consolidations in her left lung with a pleural effusion. She was given various antibiotic treatments but did not improve. A CT scan later found nonspecific interstitial pneumonia. The document also discusses definitions, causes, clinical features, severity indices, diagnostic testing, and treatment guidelines for community acquired pneumonia.
Community acquired pneumonia is a major cause of childhood morbidity and mortality worldwide, especially in developing countries. In India, acute respiratory infections account for 24% of the disease burden and 13% of deaths in children under 5 years of age. Pneumonia is commonly caused by pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Clinical features include fever, cough, difficulty breathing, and fast breathing. Chest x-rays are not always needed for diagnosis. Severity is assessed using WHO criteria to determine appropriate treatment setting and antibiotics. Supportive care includes oxygen and fluids. Antibiotics are typically given for 5-7 days but longer for severe or staphylococcal pneumonia
Management of community acquired pneumoniaNahid Sherbini
This document provides guidance on diagnosing and treating community-acquired pneumonia (CAP) in adults. It discusses the typical presentation of CAP and recommends empirically treating with antibiotics that cover both typical and atypical pathogens. It also describes the Pneumonia Severity Index for risk stratifying patients and determining whether hospitalization is needed. For low-risk patients meeting stability criteria within 3-4 days including normal vital signs and ability to take oral medications, outpatient treatment may be appropriate.
1. Community acquired pneumonia (CAP) is a major cause of illness and death globally, especially in developing countries, despite availability of vaccines and antibiotics.
2. Streptococcus pneumoniae is the most common cause of CAP, especially in infants and young children, and is responsible for over 1 million deaths annually. Viruses are also a common cause, particularly in infants.
3. Diagnosis of CAP is usually clinical based on symptoms like fever, cough and fast breathing. Laboratory tests can provide some guidance on likely pathogens but often do not identify an exact cause. Empiric antibiotic treatment should be started before establishing an etiology.
Management Of Community Acquired PneumoniaAshraf ElAdawy
This document provides information on community-acquired pneumonia (CAP), including its definition, classification, pathogens, pathophysiology, diagnosis, and methods for assessing severity. CAP is defined as an alveolar infection developing outside of a hospital within 48 hours of admission. The most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria. Severity must be assessed to determine the appropriate site of care, and several prognostic scoring systems are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to guide management decisions.
Pneumonia-medical information (symptoms , management , diagnosis)martinshaji
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.
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Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
The document discusses various types and causes of pneumonia, describing bacterial, viral, and other pathogens that can lead to pneumonia in children of different ages. It also outlines clinical presentations and symptoms of pneumonia in newborns, infants, children and adolescents. Evaluation and treatment recommendations are provided, including indications for hospital admission and management of potential complications.
The document summarizes a hospital's progress over the last 12 months in treating community acquired pneumonia across several key measures, including offering smoking cessation information, flu and pneumonia vaccination rates, administering antibiotics within 4 hours of admission and assessing oxygenation status within 24 hours of admission.
Community Acquired Pneumonia- Comprehensive Reviewjamal turki
1) Biomarkers such as procalcitonin, C-reactive protein, pro-adrenomedullin, and genomic bacterial load can help determine the severity of community-acquired pneumonia and risk of adverse outcomes.
2) Studies have found that using procalcitonin levels to guide antibiotic treatment of community-acquired pneumonia can reduce antibiotic use by up to 50% without increasing adverse outcomes.
3) Macrolide-based antibiotic regimens for treatment of community-acquired pneumonia may reduce mortality compared to non-macrolide regimens or fluoroquinolone monotherapy according to systematic reviews.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and differentiates it from healthcare-associated pneumonia. The clinical presentation of CAP is described, including common symptoms like cough and fever. Diagnostic testing for CAP including imaging, cultures, and antigen tests is outlined. The document reviews the typical and atypical bacterial causes of CAP and how comorbidities can influence pathogen selection. Guidelines for empiric antibiotic therapy for outpatient and hospitalized CAP patients are provided, including considerations for multidrug resistant pathogens. Treatment of influenza pneumonia is also summarized.
Community Acquired Pneumonia can be caused by various pathogens including bacteria, viruses, and fungi. The document discusses classifications of pneumonia based on location and acquisition. It focuses on community acquired pneumonia, describing the most common pathogens such as Streptococcus pneumoniae. Severity assessment is important for determining appropriate treatment setting and prognosis. Several prognostic severity scales are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to help decide between outpatient or inpatient care.
Community acquired pneumonia (CAP) is caused by pathogens acquired outside of a hospital setting. It is classified based on location and timing of acquisition. Empirical antibiotic treatment is recommended and should not be delayed. Severity is assessed using scoring systems like PORT and CURB-65 to determine treatment setting. Common pathogens include Streptococcus pneumoniae and atypical bacteria. Radiography can help establish diagnosis and prognosis. Outpatient treatment involves oral antibiotics while inpatient may require IV antibiotics. Duration of treatment and prevention strategies like vaccination are also discussed.
Community acquired pneumonia (cap) in childrenRoberto Razon
This document discusses community-acquired pneumonia (CAP) in children. It defines CAP and provides epidemiological data, noting that CAP affects over 450 million people annually worldwide, with over 150 million new cases in children under 5, most in developing countries. Mortality is also discussed, with over 2 million child deaths from pneumonia each year, mostly in developing nations. The document then covers etiology, risk factors like HIV, and interventions to control childhood pneumonia. It concludes by outlining Cuba's national CAP management consensus, including antimicrobial treatment guidelines based on a child's age and the severity and suspected cause of their pneumonia.
This document discusses community acquired pneumonia (CAP). It begins by defining CAP and discussing its epidemiology and classification. It then covers the incidence, clinical presentation, radiological manifestations, and typical microbiological findings of CAP. It discusses specific investigations and pathogens involved in severe CAP. Scoring systems for assessing CAP severity, including PSI, CURB-65 and CRB-65, are outlined. Guidelines are provided on treatment based on severity, including empiric antibiotic choice. Risk factors for drug-resistant pathogens and tuberculosis are noted. The document concludes with recommendations for empiric treatment of severe CAP patients admitted to the ICU.
Aspiration pneumonia occurs when gastric contents are aspirated into the lungs, causing infection. It can range from mild to life-threatening. Historically, anaerobic bacteria were most common causes, but recently aerobic bacteria like streptococcus pneumoniae and hospital-acquired gram-negative rods have emerged as primary pathogens. Risk factors include impaired swallowing or consciousness. Diagnosis is based on clinical presentation and chest imaging. Treatment involves antibiotics selected according to likely causative organisms and infection severity and source. Preventive measures focus on managing risk factors in high-risk patients.
- Community acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside the hospital setting. Diagnosis involves presence of respiratory and systemic symptoms along with new radiological shadows on chest x-ray.
- Severity is classified using CURB-65 criteria to determine if hospital admission is required. Treatment involves antibiotics, with specific regimens depending on risk factors for multidrug-resistant organisms.
- Duration of treatment is typically 5-7 days but may be prolonged for specific cases. Prevention involves smoking cessation, hand washing, vaccination, and controlling underlying conditions like diabetes.
Although there are no large epidemiological studies from India, mortality data on total number of deaths from lower respiratory tract infection are available. Whereas the world wide mortality of CAP in hospitalised patients varies from 14%–50%, the reported mortality in India varies from 3.3% to 40% with higher rates in elderly & in those requiring intensive care unit (ICU) care. Use of clinical scores like CURB-65, & CRB 65 help to stratify risk of severe disease & need for hospitalisation & ICU care. Early initiation of appropriate antibiotic based upon the knowledge of local resistant patterns of existing pathogens is the key for successful treatment.
This document discusses community-acquired pneumonia (CAP) in both children and adults. It provides information on the definition, most common causes, symptoms, physical exam findings, diagnostic testing, treatment recommendations, and management of CAP. Specifically, it notes that CAP is a significant cause of morbidity and mortality in children and the elderly. It recommends physical exams, labs, chest x-rays, and severity scores to evaluate patients and determine treatment approach. First-line antibiotic treatment depends on patient factors but usually includes macrolides or doxycycline. Hospitalization is advised if severity criteria are met.
This document discusses hospital-acquired pneumonia (HCAP) and the nurse's role in prevention. It describes a case study of a 68-year-old man presenting with symptoms of pneumonia including cough, shortness of breath, and fever. Key risk factors for this patient include age, recent hip fracture, and chronic illnesses like diabetes and hypertension. The document outlines signs and symptoms of HCAP, treatment options including antibiotics and oxygen therapy, and the importance of infection control practices like hand hygiene in prevention.
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
Journal: Approach to Common Bacterial Infections: Community acquired pneumoniaRobin Thomas
1. Community acquired pneumonia (CAP) presents differently in children and adults, with two main challenges being defining CAP in young children who often have viral and bacterial co-infections, and identifying the pathogen to avoid unnecessary antibiotic use.
2. The most prominent bacterial pathogens causing CAP across all age groups are Streptococcus pneumoniae and atypical organisms like Mycoplasma pneumoniae, while viruses account for the majority of CAP in children under 2 years old.
3. Clinical diagnosis and treatment of CAP in children is typically based on age, with guidelines recommending antibiotics for presumed bacterial CAP and observation without antibiotics for presumed viral CAP in preschool aged children.
This document discusses community-acquired pneumonia (CAP). It notes that CAP affects 5-6 million people per year in the US, with 20% hospitalized and 10% requiring ICU admission. Mortality rates are 1-5% for outpatients and 12% for inpatients, rising to 50% for those in the ICU. The document reviews common causative respiratory pathogens and risk factors for multi-drug resistant organisms. It also discusses signs and symptoms, diagnostic testing, imaging findings, severity assessment tools, and treatment guidelines for CAP.
This document discusses community acquired pneumonia (CAP) and severe CAP. It defines severe CAP and notes the most common causative pathogens. It recommends empiric antibiotic therapy covering Streptococcus pneumoniae, Legionella sp, Haemophilus influenzae, and gram-negative rods. It discusses evaluating patients for CAP severity using criteria like CURB-65 score. It also addresses considerations for broader antibiotic coverage of pathogens like Pseudomonas, CA-MRSA, and aspiration pneumonia. Biomarkers and quantitative bacterial load are presented as promising new approaches. The document concludes by noting long-term mortality risks following CAP, potentially due to cardiovascular impacts.
This document discusses community-acquired pneumonia (CAP), including its causes, diagnosis, clinical features, imaging findings, and treatment. It begins by defining CAP and describing its historical significance as a major cause of death. It then covers common, less common, and uncommon infectious and non-infectious causes of CAP. The document outlines approaches to diagnosis including microbiological testing and the roles of imaging like chest X-rays, CT scans, and lung ultrasounds. It details typical patterns seen on imaging for different pathogens. It also discusses clinical features associated with certain causes and poor prognostic factors. The document concludes by addressing empirical outpatient and inpatient treatment of CAP.
1. Community acquired pneumonia (CAP) is a major cause of illness and death globally, especially in developing countries, despite availability of vaccines and antibiotics.
2. Streptococcus pneumoniae is the most common cause of CAP, especially in infants and young children, and is responsible for over 1 million deaths annually. Viruses are also a common cause, particularly in infants.
3. Diagnosis of CAP is usually clinical based on symptoms like fever, cough and fast breathing. Laboratory tests can provide some guidance on likely pathogens but often do not identify an exact cause. Empiric antibiotic treatment should be started before establishing an etiology.
Management Of Community Acquired PneumoniaAshraf ElAdawy
This document provides information on community-acquired pneumonia (CAP), including its definition, classification, pathogens, pathophysiology, diagnosis, and methods for assessing severity. CAP is defined as an alveolar infection developing outside of a hospital within 48 hours of admission. The most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria. Severity must be assessed to determine the appropriate site of care, and several prognostic scoring systems are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to guide management decisions.
Pneumonia-medical information (symptoms , management , diagnosis)martinshaji
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.
please comment
thank u
Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
The document discusses various types and causes of pneumonia, describing bacterial, viral, and other pathogens that can lead to pneumonia in children of different ages. It also outlines clinical presentations and symptoms of pneumonia in newborns, infants, children and adolescents. Evaluation and treatment recommendations are provided, including indications for hospital admission and management of potential complications.
The document summarizes a hospital's progress over the last 12 months in treating community acquired pneumonia across several key measures, including offering smoking cessation information, flu and pneumonia vaccination rates, administering antibiotics within 4 hours of admission and assessing oxygenation status within 24 hours of admission.
Community Acquired Pneumonia- Comprehensive Reviewjamal turki
1) Biomarkers such as procalcitonin, C-reactive protein, pro-adrenomedullin, and genomic bacterial load can help determine the severity of community-acquired pneumonia and risk of adverse outcomes.
2) Studies have found that using procalcitonin levels to guide antibiotic treatment of community-acquired pneumonia can reduce antibiotic use by up to 50% without increasing adverse outcomes.
3) Macrolide-based antibiotic regimens for treatment of community-acquired pneumonia may reduce mortality compared to non-macrolide regimens or fluoroquinolone monotherapy according to systematic reviews.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and differentiates it from healthcare-associated pneumonia. The clinical presentation of CAP is described, including common symptoms like cough and fever. Diagnostic testing for CAP including imaging, cultures, and antigen tests is outlined. The document reviews the typical and atypical bacterial causes of CAP and how comorbidities can influence pathogen selection. Guidelines for empiric antibiotic therapy for outpatient and hospitalized CAP patients are provided, including considerations for multidrug resistant pathogens. Treatment of influenza pneumonia is also summarized.
Community Acquired Pneumonia can be caused by various pathogens including bacteria, viruses, and fungi. The document discusses classifications of pneumonia based on location and acquisition. It focuses on community acquired pneumonia, describing the most common pathogens such as Streptococcus pneumoniae. Severity assessment is important for determining appropriate treatment setting and prognosis. Several prognostic severity scales are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to help decide between outpatient or inpatient care.
Community acquired pneumonia (CAP) is caused by pathogens acquired outside of a hospital setting. It is classified based on location and timing of acquisition. Empirical antibiotic treatment is recommended and should not be delayed. Severity is assessed using scoring systems like PORT and CURB-65 to determine treatment setting. Common pathogens include Streptococcus pneumoniae and atypical bacteria. Radiography can help establish diagnosis and prognosis. Outpatient treatment involves oral antibiotics while inpatient may require IV antibiotics. Duration of treatment and prevention strategies like vaccination are also discussed.
Community acquired pneumonia (cap) in childrenRoberto Razon
This document discusses community-acquired pneumonia (CAP) in children. It defines CAP and provides epidemiological data, noting that CAP affects over 450 million people annually worldwide, with over 150 million new cases in children under 5, most in developing countries. Mortality is also discussed, with over 2 million child deaths from pneumonia each year, mostly in developing nations. The document then covers etiology, risk factors like HIV, and interventions to control childhood pneumonia. It concludes by outlining Cuba's national CAP management consensus, including antimicrobial treatment guidelines based on a child's age and the severity and suspected cause of their pneumonia.
This document discusses community acquired pneumonia (CAP). It begins by defining CAP and discussing its epidemiology and classification. It then covers the incidence, clinical presentation, radiological manifestations, and typical microbiological findings of CAP. It discusses specific investigations and pathogens involved in severe CAP. Scoring systems for assessing CAP severity, including PSI, CURB-65 and CRB-65, are outlined. Guidelines are provided on treatment based on severity, including empiric antibiotic choice. Risk factors for drug-resistant pathogens and tuberculosis are noted. The document concludes with recommendations for empiric treatment of severe CAP patients admitted to the ICU.
Aspiration pneumonia occurs when gastric contents are aspirated into the lungs, causing infection. It can range from mild to life-threatening. Historically, anaerobic bacteria were most common causes, but recently aerobic bacteria like streptococcus pneumoniae and hospital-acquired gram-negative rods have emerged as primary pathogens. Risk factors include impaired swallowing or consciousness. Diagnosis is based on clinical presentation and chest imaging. Treatment involves antibiotics selected according to likely causative organisms and infection severity and source. Preventive measures focus on managing risk factors in high-risk patients.
- Community acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside the hospital setting. Diagnosis involves presence of respiratory and systemic symptoms along with new radiological shadows on chest x-ray.
- Severity is classified using CURB-65 criteria to determine if hospital admission is required. Treatment involves antibiotics, with specific regimens depending on risk factors for multidrug-resistant organisms.
- Duration of treatment is typically 5-7 days but may be prolonged for specific cases. Prevention involves smoking cessation, hand washing, vaccination, and controlling underlying conditions like diabetes.
Although there are no large epidemiological studies from India, mortality data on total number of deaths from lower respiratory tract infection are available. Whereas the world wide mortality of CAP in hospitalised patients varies from 14%–50%, the reported mortality in India varies from 3.3% to 40% with higher rates in elderly & in those requiring intensive care unit (ICU) care. Use of clinical scores like CURB-65, & CRB 65 help to stratify risk of severe disease & need for hospitalisation & ICU care. Early initiation of appropriate antibiotic based upon the knowledge of local resistant patterns of existing pathogens is the key for successful treatment.
This document discusses community-acquired pneumonia (CAP) in both children and adults. It provides information on the definition, most common causes, symptoms, physical exam findings, diagnostic testing, treatment recommendations, and management of CAP. Specifically, it notes that CAP is a significant cause of morbidity and mortality in children and the elderly. It recommends physical exams, labs, chest x-rays, and severity scores to evaluate patients and determine treatment approach. First-line antibiotic treatment depends on patient factors but usually includes macrolides or doxycycline. Hospitalization is advised if severity criteria are met.
This document discusses hospital-acquired pneumonia (HCAP) and the nurse's role in prevention. It describes a case study of a 68-year-old man presenting with symptoms of pneumonia including cough, shortness of breath, and fever. Key risk factors for this patient include age, recent hip fracture, and chronic illnesses like diabetes and hypertension. The document outlines signs and symptoms of HCAP, treatment options including antibiotics and oxygen therapy, and the importance of infection control practices like hand hygiene in prevention.
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
Journal: Approach to Common Bacterial Infections: Community acquired pneumoniaRobin Thomas
1. Community acquired pneumonia (CAP) presents differently in children and adults, with two main challenges being defining CAP in young children who often have viral and bacterial co-infections, and identifying the pathogen to avoid unnecessary antibiotic use.
2. The most prominent bacterial pathogens causing CAP across all age groups are Streptococcus pneumoniae and atypical organisms like Mycoplasma pneumoniae, while viruses account for the majority of CAP in children under 2 years old.
3. Clinical diagnosis and treatment of CAP in children is typically based on age, with guidelines recommending antibiotics for presumed bacterial CAP and observation without antibiotics for presumed viral CAP in preschool aged children.
This document discusses community-acquired pneumonia (CAP). It notes that CAP affects 5-6 million people per year in the US, with 20% hospitalized and 10% requiring ICU admission. Mortality rates are 1-5% for outpatients and 12% for inpatients, rising to 50% for those in the ICU. The document reviews common causative respiratory pathogens and risk factors for multi-drug resistant organisms. It also discusses signs and symptoms, diagnostic testing, imaging findings, severity assessment tools, and treatment guidelines for CAP.
This document discusses community acquired pneumonia (CAP) and severe CAP. It defines severe CAP and notes the most common causative pathogens. It recommends empiric antibiotic therapy covering Streptococcus pneumoniae, Legionella sp, Haemophilus influenzae, and gram-negative rods. It discusses evaluating patients for CAP severity using criteria like CURB-65 score. It also addresses considerations for broader antibiotic coverage of pathogens like Pseudomonas, CA-MRSA, and aspiration pneumonia. Biomarkers and quantitative bacterial load are presented as promising new approaches. The document concludes by noting long-term mortality risks following CAP, potentially due to cardiovascular impacts.
This document discusses community-acquired pneumonia (CAP), including its causes, diagnosis, clinical features, imaging findings, and treatment. It begins by defining CAP and describing its historical significance as a major cause of death. It then covers common, less common, and uncommon infectious and non-infectious causes of CAP. The document outlines approaches to diagnosis including microbiological testing and the roles of imaging like chest X-rays, CT scans, and lung ultrasounds. It details typical patterns seen on imaging for different pathogens. It also discusses clinical features associated with certain causes and poor prognostic factors. The document concludes by addressing empirical outpatient and inpatient treatment of CAP.
The study examined the association between proton pump inhibitor (PPI) prescriptions and the risk of community acquired pneumonia using data from the UK's Clinical Practice Research Datalink. Three methods were used: a cohort study comparing PPI users to non-users adjusted for confounders, a self-controlled case series comparing periods before and after PPI use, and examining event rates before and after the first PPI prescription. All methods suggested the observed association between PPI use and pneumonia was likely due entirely to underlying confounding factors present before PPI use, rather than being caused by PPI use itself.
What to Do When a Patient with Community Acquired Pneumonia Fails to improve?Gamal Agmy
This document discusses the evaluation and management of patients with community-acquired pneumonia (CAP) who fail to improve with initial treatment. It defines treatment failure as a lack of clinical response or worsening after at least 72 hours of antimicrobial therapy. For patients who fail to respond, the document recommends repeating diagnostic tests, performing further tests like chest imaging and bronchoscopy, and considering infections by resistant or unusual pathogens, non-infectious conditions, or complications like empyema as potential causes. Careful re-evaluation of these patients is important given increased risks of morbidity and mortality associated with treatment failure in CAP.
This document provides information about pneumonia, including:
- Pneumonia is an infection of the lungs that can be caused by bacteria or viruses. It is characterized by inflammation and consolidation of the lungs.
- The pathology of pneumonia involves an inflammatory response that leads to fluid build up in the lungs, visible on scans as infiltrates. This progresses from edema to red and gray hepatization as immune cells fight the infection.
- Community-acquired pneumonia has many potential causes and symptoms may include fever, cough, chest pain, and difficulty breathing. Treatment focuses on oxygen, intravenous fluids, and identifying the cause. Prevention involves vaccination, smoking cessation, and improving nutrition.
VAP/HAP management guidelines by IDSA/ATS (2016) -: Dr.Tinku JosephDr.Tinku Joseph
This document discusses ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP). It defines VAP and HAP and outlines their incidence and impact. Guidelines for diagnosing VAP/HAP using microbiologic methods and biomarkers like CPIS are presented. The document reviews controversies around defining healthcare-associated pneumonia (HCAP) and its inclusion in future guidelines. Empiric and pathogen-directed treatment options for VAP/HAP are discussed, along with optimizing antibiotic dosing and the potential role of inhaled antibiotics.
HAP/VAP 2016 ATS/IDSA Guidelines. Our Data available at: https://rdcu.be/Mx8EDr Sandeep Kumar
Management of Adults With Hospital-acquired and
Ventilator-associated Pneumonia: 2016 Clinical Practice
Guidelines by the Infectious Diseases Society of America
and the American Thoracic Society.
To see our study results on HCAP and HAP, VISIT https://link.springer.com/article/10.1007/s00408-018-0117-7
This document summarizes the key changes to COPD treatment guidelines between GOLD 2001, 2011, and 2017. It discusses the evolution from a unidimensional to multidimensional approach. The 2017 guidelines classify patients into groups A-D based solely on symptoms and exacerbation history. Treatment is tailored to the group, starting with bronchodilators and escalating to dual/triple therapy as needed. The guidelines emphasize LAMA/LABA combination therapy and provide guidance on adding or withdrawing ICS.
Pathology of Pneumonia:
Broncho- pneumonia,
Lobar Pneumonia,
Lung Abscess,
Lung Fungal Absces,
Normal Lung
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This document discusses community-acquired pneumonia (CAP), including etiology, pathogenesis, clinical presentation, diagnosis, treatment recommendations, and management based on risk stratification. Key points include:
- CAP is usually caused by Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae. Atypical pathogens and respiratory viruses are also common.
- Clinical features may include cough, fever, tachypnea, and findings on chest exam. Chest x-ray is needed to confirm pneumonia.
- Treatment depends on patient risk factors and severity, ranging from outpatient oral antibiotics for low risk to intravenous antibiotics plus macrolide for high risk or
Community aquired pneumonia : Dr. Devawrat Buche MD (FNB )Renuka Buche
Community acquired pneumonia is an acute lung infection that develops outside of a hospital setting. It is defined as an infiltrate seen on chest imaging along with symptoms of fever, cough, sputum production and shortness of breath. In India, the most common causes are Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae. Treatment involves initial empirical antibiotic therapy guided by risk stratification scores and local antibiotic resistance patterns, with options including respiratory fluoroquinolones, beta-lactams plus macrolides, or monotherapy in lower risk patients. Outcomes include 30-day mortality rates of 10-12% in hospitalized patients and increased long-term mortality risk.
Community aquired pneumonia : Dr Devawrat BucheDevawrat Buche
Dr. Devawrat Buche discusses community acquired pneumonia (CAP). CAP is an acute lung infection that develops in persons outside of a hospital setting. The document defines CAP and discusses its epidemiology, etiology, risk factors, diagnostic testing, risk stratification, and treatment guidelines. Treatment involves initial empirical antibiotic therapy based on severity and risk factors, with options including macrolides, fluoroquinolones, and beta-lactams. Duration of treatment is typically 5 days or longer until symptoms resolve.
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
respiratory inspections are common in elderly people and often times,that tickles into the lungs.More often than not they have comorbiidites,like Diabetes,hypertension etc.Hence,the treatment has to be different and some times the prognosis is guarded
This document defines non-resolving pneumonia and discusses its causes and diagnostic evaluation. Non-resolving pneumonia is defined as persistence of clinical symptoms and radiographic abnormalities for longer than expected despite adequate antibiotic therapy. Common causes include inappropriate antibiotic therapy, complications of the initial infection, host factors, and presence of resistant or unusual pathogens. A thorough diagnostic evaluation includes assessing treatment response, looking for complications or superinfections, evaluating for unusual organisms, and examining host immune function. Radiological imaging, bronchoscopy with protected specimen brushing or biopsy, and CT-guided biopsies can help identify causative organisms or underlying conditions.
Prof:
Faculty of Community Medicine & Public Health
Sciences
Liaquat University of Medical & Health Sciences
(LUMHS)
Jamshoro, Sind, Pakistan
e mail mnajeeb80@gmail.com
Sputum Cultures
Culture is the gold standard for confirming
active TB disease
Can identify M. tuberculosis and determine
drug susceptibility
Sensitivity is higher than smear microscopy
(60-80% vs. 50-70%)
Takes 6-8 weeks for growth on solid media
Newer liquid culture systems reduce time to
detection to 2-4 weeks
Pneumonia is an acute lung infection that can be caused by bacteria, viruses, or other pathogens. It can be diagnosed based on clinical signs and symptoms as well as tests like chest x-rays. Severity is assessed using scoring systems like CURB-65 which evaluate factors like confusion, blood urea levels, respiratory rate, blood pressure, and age. Empiric antibiotic treatment for pneumonia depends on the likely causative organisms, which vary geographically, and the patient's characteristics and severity of illness. Tests are important for confirming diagnosis and guiding targeted therapy.
Pneumonia is an acute lung infection that can be caused by bacteria, viruses, or other pathogens. It can be diagnosed based on clinical signs and symptoms as well as tests like chest x-rays. Severity is assessed using scoring systems like CURB-65 which evaluate factors like confusion, blood urea levels, respiratory rate, blood pressure, and age. Empiric antibiotic treatment for pneumonia depends on the likely causative organisms, which vary geographically, and the patient's characteristics and severity of illness. Tests are important for confirming diagnosis and guiding targeted therapy.
Se mencionan los mecanismos que favorecen el desarrollo de Infecciones respiratorias bajas (IRB), identificando los factores de riesgo para cada uno de los principales cuadros clínicos, se identifican los principales patógenos asociados a las IRB y los principales aspectos en el enfoque diagnóstico y terapéutico inicial de las IRB
The document summarizes the case of a 72-year-old female presenting with fever, cough, chest pain, and increased sleepiness for 2 days. Her history includes smoking and alcohol use. On examination, she has decreased consciousness and signs of right lower lobe pneumonia with sepsis and organ dysfunction. Investigations show community-acquired pneumonia and she is admitted to the ICU for management including antibiotics, oxygen therapy, and vasopressor support. The document then reviews topics on community-acquired pneumonia including definitions, epidemiology, pathogenesis, clinical features, diagnosis, and treatment guidelines.
This document discusses the diagnosis of pulmonary tuberculosis. It emphasizes that diagnosis requires a combination of clinical presentation, medical history, physical examination, chest radiography, and bacteriological examination. Sputum smear microscopy and mycobacterial culture are important for laboratory confirmation, with culture being the gold standard. A presumptive diagnosis of tuberculosis can be made if acid-fast bacilli are seen on smear, but treatment should not be initiated solely on this basis without further evaluation.
Septic shock, updated presentation, including latest guidelines from Intensive care societies and how to approach to the diagnosis with few notes about Early Goal Directed Therapy and role of steroids
This case report describes an adult female patient presenting with fever, cough, joint pain, and skin rash. Laboratory tests revealed elevated white blood cell count with neutrophilia. Imaging showed pulmonary nodules. She fulfilled criteria for adult onset Still's disease (AOSD), which can involve the lungs in 50% of cases. AOSD is diagnosed based on Yamaguchi or Fautrel criteria, which this patient met. Treatment involves corticosteroids and immunosuppressants to control the abnormal cytokine levels caused by AOSD. Pulmonary involvement requires close monitoring for serious complications like acute respiratory distress syndrome.
Breakout 1.2 Assessing competence in practice: Quality assured diagnostic spirometry - Monica Fletcher
Chief Executive Education for Health Chair European Lung Foundation
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
This document summarizes the key steps in diagnosing pulmonary tuberculosis (TB), including:
1) Screening high-risk individuals with the Mantoux tuberculin skin test.
2) Obtaining a thorough medical history and physical exam to identify symptoms and risk factors.
3) Performing a chest x-ray, which can show abnormalities suggestive of TB but is not definitive.
4) Examining sputum samples under a microscope for acid-fast bacilli, which is rapid but not highly sensitive, and culturing samples, which is more sensitive but takes longer.
3) Integrating clinical, radiological and laboratory findings to make a presumptive or confirmed diagnosis of TB
This document discusses tuberculosis (TB) in children. It begins with an overview of the clinical spectrum of TB in children, which can include pulmonary, visceral, cutaneous, neuro, and perinatal manifestations. Pulmonary TB lesions in children typically include primary complexes and intrathoracic lymphadenopathy. Extrapulmonary TB involves sites like bone, joints, the gastrointestinal tract, and the central nervous system. The document then covers the diagnosis of TB in children, which involves clinical judgment based on exposure history and symptoms, the tuberculin skin test, chest x-ray, and bacteriological confirmation via sputum sampling or gastric aspiration. Interpretation of diagnostic tests and their limitations are also discussed.
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Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
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Enable children to articulate their thoughts, feelings, and experiences.
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Help children identify and understand their own emotions and the emotions of others.
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Develop children’s ability to listen attentively and respond appropriately.
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Strengthen the bond between children and caregivers, peers, and other adults.
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Aid cognitive and language development through engaging and meaningful conversations.
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Encourage polite, respectful, and empathetic interactions with others.
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Provide tools and guidance for children to handle disagreements constructively.
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Support children in making decisions and solving problems on their own.
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Offer comfort and understanding during times of distress or uncertainty.
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Acknowledge and encourage positive actions and behaviors.
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Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
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NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
3. Impact
• Sixth most common cause of death
• Second biggest cause of DALY(disability
adjusted life years)
• Most common infectious cause of death
• Most common cause of intravenous antibiotic
use in hospitals
ATS Global Scholars program, Pneumonia in children and adults, 2016
11. Pneumonia
• Inflammation of the pulmonary parenchyma
plus clinical evidence that the infiltrate is of an
infectious origin, which include new onset of
– Fever(< 7 days)
– Purulent sputum
– Leukocytosis
– Decline in oxygenation
ATS 2005 HAP/VAP Guildelines
14. Condition Organism
In almost all cases Strep and H. influenzae are predisposed as they are most common.
In Indian settings, most conditions also pre dispose to Tuberculosis
Bat exposures, Bird droppings Histoplasma, Cryptococcus
Paddy fields, farmers, rodent exposure Leptospira
Hilly areas(Himalyan belt) Scrub typhus
Birds Chlamydia psittaci
Farm animals Q fever(Coxiella)
North America travel
Aspiration risk/Alcohol Anaerobes
Structural lung disease Pseudomonas, Burkholderia, NTM, fungal
Injection drug users Staphylococcus, Anaerboes
Influenza outbreak Influenza, Staphylococcus
Air conditioners, cooling towers, pot
water
Leigionella
COPD Moraxella, Pseudomonas
Fishmans Pulmonary Medicine 5th edition
18. Procalcitonin
• Precursor of calcitonin – Thyroid and K cells of lung
• CAP – Only role may be to differentiate from decompensated
heart failure and non infective causes
• HAP/VAP – Not used for diagnosis and initiation of antibiotics
but clinical as well as Procalcitonin may be used to stop
antibiotics
• Sequential use of Procalcitonin for levels maybe useful
Sensitivity Specificity False Positive False negative
67% 83% 33% 17%
Negative Positive Sepsis Severe sepsis
<0.05ng/ml >0.5ng/ml >2 ng/ml > 5 ng/ml
Gilbert N. D. , Procalcitonin in Respiratory Tract Infections d CID 2011:52 S347
Kidney
dysfunction??
19. Sputum examination
• Collection
– Morning before breakfast
– Induced or spontaneous
– Deep breath
– Direct into container
• Adequacy
– <10 squamous ep. Cells/lpf
– >25 or more PMNL/lpf
• Processing
Washington Murray grading system
30. Other samples
ET aspirate**
• Non invasive
• No special
equipment
required
Mini BAL(mBAL)
• Advantage:
Possible
bedside,
cheaper
• Disadv: Blind
procedure
PSB
• Newer
technique
• Less chances
of
contamination
ET- Endotracheal
PSB – Protected specimen brush
31. Clinical syndromes
• Community Acquired pneumonia
– Typical and atypical
• Hospital acquired pneumonia
• Ventilator acquired pneumonia
• Health care associated pneumonia
34. Etiology
Gupta D et al. Guidelines for diagnosis and management of community-and hospital-acquired
pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India. 2012
0
10
20
30
40
50
60
40-71% had a microbiological diagnosis
35. B. A. Cunha et al. Clin Microbiol Infect 2006; 12 (Suppl. 3): 12–24
Atypical pneumonia
• Walking pneumonia
• Difference:
– Systemic manifestations**
– Minimal sputum
– Sub acute progression
– Chest X ray pattern
– Fever and leukocytosis less common
• Mycoplasma(25%), Chlamydia(12-21%), Legionella, Q
fever
36. Admission decision
CURB 65(BTS)
Confusion
Urea(>20mg/dL)
Respiratory rate >30
Blood pressure <90
systolic ; or < 60 diastolic
Age>65 years
Pneumonia Severity Index
Gender
Demography
Co morbidities
Physical examination
Lab and radiographic findings
Scored in points
I – 0-50
II – 51-70
III – 71-90
IV – 91-130
V – 131-395
Fine MJ et al. N Engl J Med. 1997;336:243-250.
Capelastegui A et al. Eur Respir J. 2006;27:151-157
Each gets one point
BTS – British Thoracic society
37. Severity Assessment
Pneumonia
Severity Index
30 day
mortality(%)
CURB-65 30 day
mortality(%)
Where to
manage?
I 0.1 0 0.7 Outpatient
II 0.6 1 2.1 Outpatient
III 0.9 2 9.2 Inpatient
(Short
observation)
IV 9.3 3 15 Inpatient
V 27 4 40 Inpatient-ICU
Fine MJ et al. N Engl J Med. 1997;336:243-250.
Capelastegui A et al. Eur Respir J. 2006;27:151-157
Physicians decision
38. IDSA 2007 severity assessment
1 MAJOR
OR
3 MINOR
ICU/HDU
IDSA/ATS Guidelines for CAP in Adults, Mandell A. L et al CID 2007:44 (Suppl 2)
39. Treatment
Clinical Profile Antibiotic
Outpatient
Previously healthy and no antibiotic in last 90
days
Macrolide(Aithromycin/Clarithromycin/Eryth
romycin) OR Doxycycline
Comorbidity or antibiotic in 90 days Respiratory
Fluoroquinolone(Gemifloxacin/Moxifloxacin/
Levofloacin)
Or β-lactam + macrolide
Inpatient
Non ICU Same as above
ICU admission β-lactam + Fluoroquinolone/Azithromycin
Or Aztreonam + Fluoroquinolone
ICU with ? Pseudomonas Antipneumococcal, antipseudomonal β-
lactam plus Ciprofloxacin/Levofloxacin
Or Aminoglycoside + Azithromycin
ATS/IDSA Guidelines 2007
40. Clinical response of pneumonia
Pneumonia
Tachycardia and
hypotension
Fever, tachypnea and
arterial oxygenation
Cough and fatigue
Radiological
resolution
2 days
3 days
14 days
3-4 weeks
Highly variable
1. Co morbidity
2. Age
3. Severity
Marrie TJ, et al. Resolution of symptoms in CAP on ambulatory basis, J Infect 2004; 49:302
41. Other considerations
• Role of steroids
• IV to oral shifting
• Duration of antibiotics
1.No role in non severe(2A)
2. Role in severe CAP with severe
inflammation(CRP>15mg/dL),
septic shock or ARDS
2. Mortality risk reduction
3. Contraindications to be ruled out
4. Dose regimen
5-7 days, if MRSA/Leigionella/ pneumococcal
sepsis; may require for longer time, but clinical
stability and 48-72 hours afebrile
Patient is cinically better
ATS 2007 Guidelines and 2012 Lung India guidelines
43. Healthcare associated pneumonia
• Hospitalization for more than 48 hours in the last 90 days
• residence in a nursing home or extended care facility
• home infusion therapy
• chronic dialysis within one month
• home wound care
• a family member with a multi-drug resistant organism.
Controversy
Next guidelines of CAP will likely include it
ATS /IDSA HAP/VAP Guidelines 2005
44. Etiology
Incidence of VAP is much higher in developing countries
Study at AIIMS, 478 BAL samples tested, 192(40%) showed isolates
Ritu Singhal, Srujana Mohanty. Profile of bacterial isolates from patients with VAP. Indian J Med Res 121, January 2005,
pp 63-64
Khilnani GC, Jain N. Ventilator-Associated pneumonia. Indian J Crit Care Med 2013;17:331-2.
Organism Number
Acinetobacter 86(44.8%)
Psudomonas 77(40.1%)
Others- E. Coli 8(4.2%) ; Citrobater 4(2.1%) ; Enterobacter – 3(1.6%)
Staph. Aureus 2 (1.1%)
45. Diagnosis of HAP/VAP
Radiology Sign/Symptoms/Lab
2 or more serial X-rays with at least one of
the following:
1. New or Progressive and persistent
infiltrates
2. Consolidation
3. Cavitation
At least one :
1. Fever
2. Leukopenia or leucocytosis
3. If age>70; altered mental status
At least 2 of the following:
1. Sputum ( new onset/ change in
character) or increased secretions
increased suctioning requirement
2. Worsening gas
exchange(desaturation/increased oxygen
requirement/ increased ventilatory
requirements)
3. New onset dyspnea/cough/tachypnea
4. Rales or bronchial breath sounds
2013 CDC definitions for Healthcare associated infections
At least 2/3
Persistent infiltrates
+
1. Leucocytosis
2. Change in oxygen/ventilatory
requirement
3. Secretions
46. Risk factors for MDR VAP
1. Prior antibiotic use in 90 days
2. Septic shock at time of VAP
3. ARDS preceding VAP
4. >5 days of admission before VAP
6. Dialysis before VAP
Risk factors for MDR HAP/MRSA or MDR Pseudomonas in HAP or VAP
Injectable antibiotic use in last 90 days
Risk of death in HAP
1. Ventilatory support
2. Septic shock
ATS Guidelines for HAP/VAP Management, 2016
48. Prevention of VAP
Nancy Munro et al. Ventilator-Associated Pneumonia Bundle, AACN 2014 Vol 25 175-183
49. Changes in 2016 guidelines
• Removal of HCAP
• Equal efficacy of non invasive sampling(like
endotracheal aspirate) and semiquantitative culture
• Systemic colistin used only with inhaled colistin
• Use dual antibiotics(for Pseudomonas) even after
culture if patient has septic shock or high risk of
death.
51. Pneumocystis jiroveci(PJP)
• Immunocompromised
• (A-a) gradient
• Induced sputum (Variable), BAL(90% yield)
• Treatment needs to be started empirically
• Treatment – 15-20mg/kg/day of
Cotrimoxazole QID (2tab DS TDS) x 21 days
• Steroids-PaO2<70, A-a gradient>35, hypoxia
52. Aspergillus
ABPA
• Refractory
asthma
• Mucus plugs
• NOT A TRUE
INFECTION
Aspergilloma
• Patients
withprior co
morbidities
• Sub acute
pneumonia
with
constitution
al
symptoms
CNPA
• History of
disease
suggestive
of cavity
?TB
• Asymptoma
tic or
hemoptysis
• Rarely fever
Invasive
Aspergillosis
• Immunoco
mpromised
patients
• Rapidly
progressive
pneumonia
ABPA- Allergic bronchopulmonary aspergillosis
CNPA- Chronic Necrotizing Pulmonary Aspergillosis
53. • Specific
criteria
• Fleeting
opacities,
HAM
• Treat with
steroids and
if reuired
Itraconazole
• Chest X ray
and CT
shows cavity
with soft
tissue
density
• Itraconazole
, inhaled
KTZ
• Other
antifungals
• Tissue and sputum needs to
demonstrate Aspergillus (GMS
stain)
• Serial Galactomannan
monitoring
• CT signs – Halo sign
• DOC- Voriconazole
ABPA Aspergilloma CNPA
Invasive
Aspergillosis
55. Mycobacteria
• As community acquired pneumonia 3-16% but
even as high as 30%
• Fluoroquinolones – Do not use as earlly
resistance(5-10 days)
• Clues – Endemic, co morbidities, pleural
effusion, chronicity of symptoms, upper lobe,
cavity, norrmal TLC
L.M. Pinto et al. / Respiratory Medicine (2011) 138e140
R.F. Grossman et al. / International Journal of Infectious Diseases 18 (2014) 14–21
56. TAKE HOME MESSAGES
• Investigate in a planned way
• Know the interpretation
• Lung USG is a must
• “Pneumonia” or “LRTI” is not the complete
diagnosis
• Evidence based management and de
escalation
• Never forget “TB” and avoid Levofloxacin
Editor's Notes
Although some disagreement exists on the exact boundary between the upper and lower respiratory tracts, the upper respiratory tract is generally considered to be the airway above the glottis or vocal cords. This includes the nose, sinuses, pharynx, and larynx.
Typical infections of the upper respiratory tract include tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, certain types of influenza, and the common cold
::LRTI more dangerous in all parameters.
Acute bronchitis - An acute respiratory tract infection that may last up to 3 weeks in which cough, with or without phlegm, is a predominant feature and alveolar inflammation is not present
The two most common LRIs are bronchitis and pneumonia
Conjunctivits and myalgia(inflenza)
Nasal congestion and mucous discharge, facial pressure, post-nasal discharge, Clinical diagnosis and treatment with local decongestant +/- steroids
If bacterial, Strep is the cause and rx is amox/clav or penicillin
Tab Cephalexin, cephadroxil, Azithromycin
(v/s pneumonitis)
Mention – Parasitic, Tubercular ; Healthcare associated
Special mention to Influenza, CMV, Aspergillus
Paragonimus, also PCP
Staph, TB, Endocarditis, Aspiration, Mycoplasma(Bullous myringitis), otitis media with H influenzae
Myringitis – Blood filled bubbles on surface of TM and burst with it
Check new data
Add sensitivity, specificity and yeild... Induced sputum no of air exchanges
Within 2 hours if at room temperature and 24 hours at 4oC except H inflenzae
Brushing – not to be donne
Tbsample processing – d/t mucolytics and decontamination required. Modified ppetroffs method
Adv?? Culture plate
Leigionella is recommended in sever CAP
Serology may be non specific, IgM paired for confirmatory , but may help,
For confirmatory diagnosis, paired sera are required
Pneumatocele(more common inyounger age group)
Staph, Strep, Kleb, H. Influ
According to the Fleischner society pulmonary cavities are defined "gas-filled space, seen as a lucency or low-attenuation area, within pulmonary consolidation, a mass, or a nodule
Level
Atipcal pneumonia with interseptal thickening, ground glassing and not limited to one lobe
Lobar consolidation andair bronchogram clearly visible
PCP with diffuse infiltrates with perihilar predominance and multiple cysts
Soft tissue ball in caity in lung
Probe....
Limited by learning curve, repeatability and operator dependency
ConsolidationA standard ultrasound probe is used to image consolidations. Water is a good transmitter of ultrasound and a consolidated lung is water rich. Alveolar consolidation usually reaches the lung surface. Collapsed lung segments can resemble consolidation sonologically. It appears as poorly defined hypoechoic lung tissue structure. In contrast, the tissue structure of normal lung cannot be seen. What is seen is the artifacts that arise at the pleural line.
Within the consolidation, hyperechoic puntiform images can be seen corresponding to air in the bronchi - a so called ultrasound air bronchogram (figs. 7 and 8). These air bubbles can be seen to move in the bronchi during respiration. The size of a consolidation does not change with respiration, in contrast to a pleural effusion.
Flexible as end can change direction.
World vsindia in casuses of vap/hap
Lei – Na and more multisystem involvement, Myco – Cold Aglittinin
Why so many scores??? Cost of patient care....restearly recovery anddecreased risk of HAP
admit- no support, rapid onset, immune deficit?(slower onset and less clinical signs)
The point is CURB 65 is a bedside score and easily calculated
PSI on the other hand is complex but takes into account imp factors left in CURB like age and prior co morbidities (Heavily weighed in PSI)
One way is CURB 65 in OPD and PSI in ward patients
Other criteria;;;, CRB-65 SMART-COP SMRT-CO
Major definitely ICU, if 3 minor then HLMU or ICU both acceptalbe
Reasons for ealy point of care=no delay in transfer, adequate tests and emperical therpay, requirement of immunomodulatory therapy
Amox clav(H influ) /Amox/ Cefexime
B lactam in ICU – ceftriaxone, cefotaxime, cefepime,
Pseu – pip taz , cefoperazonem ceftazidimme, mero or imipenam
When to suspect pseudomonas in cap
MRSA coverage in CAP when non responder?
FQ difference
20-30 % comorbid will heal
Age - >50 only 30%
Sever – 10 weeks
Duration – 5-7 days, if MRSA may require for longer time, but clinical stability and 48-72 hours afe
Ther for long – IE, abscess, empyema,
Ceftaroline
Tigecycline
HCAP- hospitalised for 2 or more days within 90 days of the infection, nursing home, chemotherapy or hemodialysis
72hrs – cutoff for VAP
Early and late VAP nearly same organisms and mortlaity but duration of ICU and ventilation changes
Many studies evaluated individual risk factors, and organism based risk factors were found to be a better predictor
XDR – Res to all except Colistin, Tigecycline and aminoglycoside
Find % of MRSSA and pseudomonas
Upper is systemic and lower is respiratory
Simpler definition – infiltrates + 2/3 : fever, TLC, respi secretions
Highlight
HAP and VAP may need shorter or longer courses as required . Based on clinicall + PCT