Community-acquired pneumonia (CAP) is a common cause of illness worldwide with a wide range of clinical presentations from mild to severe. CAP refers to an acute lung infection acquired outside of a hospital setting, while nosocomial pneumonia is hospital-acquired. Common causative pathogens include Streptococcus pneumoniae, Haemophilus influenzae, Legionella pneumophila, and respiratory viruses. Risk factors include older age, smoking, and chronic medical conditions. Diagnosis involves physical exam, chest imaging, and laboratory tests to identify the pathogen to guide antibiotic treatment based on severity.

1. Community acquired pneumonia
2/1/2019 CAP BY DR.BAKUNDA 1

2. INTRODUCTION
Community-acquired pneumonia
(CAP) is a leading cause of morbidity
and mortality worldwide.
2/1/2019 CAP BY DR.BAKUNDA 2

3. The clinical presentation of CAP varies, ranging
from mild pneumonia characterized by fever and
productive cough to severe pneumonia
characterized by respiratory distress and sepsis.
Because of the wide spectrum of associated clinical
features, CAP is a part of the differential diagnosis
of nearly all respiratory illnesses.
2/1/2019 CAP BY DR.BAKUNDA 3

4. DEFINITIONS
Community-acquired pneumonia (CAP) refers to an
acute infection of the pulmonary parenchyma acquired
outside of a health care setting
Nosocomial pneumonia refers to an acute infection of
the pulmonary parenchyma acquired in hospital
settings and encompasses both hospital-acquired
pneumonia (HAP) and ventilator-associated
pneumonia (VAP)
2/1/2019 CAP BY DR.BAKUNDA 4

5. HAP refers to pneumonia acquired ≥48 hours
after hospital admission.
VAP refers to pneumonia acquired ≥48 hours
after endotracheal intubation.
2/1/2019 CAP BY DR.BAKUNDA 5

6. Pathogens involved
Typical bacteria
S. pneumoniae (most common bacterial cause)
 Haemophilus influenza
Moraxella catarrhalis
Staphylococcus aureus
 Group A streptococci
Aerobic gram-negative bacteria
2/1/2019 CAP BY DR.BAKUNDA 6

7. Atypical bacteria
Atypical" refers to the intrinsic
resistance of these organisms to beta-
lactams and their inability to be visualized
on Gram stain or cultured using traditional
techniques)
2/1/2019 CAP BY DR.BAKUNDA 7

8. like
Legionella pneumophila
Mycoplasma pneumonia
Chlamydia pneumonia
Chlamydia psittaci
Coxiella burnetii
2/1/2019 CAP BY DR.BAKUNDA 8

9. Respiratory viruses
Influenza A and B viruses
Rhinoviruses
Parainfluenza viruses
Adenoviruses
Respiratory syncytial virus
2/1/2019 CAP BY DR.BAKUNDA 9

10. Risk factor
Older age >65 years
Chronic comorbidities
Upper respiratory tract infaction(primary viral
pneumonias or secondary bacterial pneumonia
Immunosuppresion
Smoking
2/1/2019 CAP BY DR.BAKUNDA 10

11. Clinical features
Typical pneumonia presents with a sudden
onset of symptoms caused by lobar
infiltration.
Severe malaise
High fever and chills
Productive cough with purulent sputum
(yellow-greenish)
2/1/2019 CAP BY DR.BAKUNDA 11

12. Tachypnea and dyspnea (nasal
flaring, thoracic retractions)
chest pain when breathing, often
accompanying pleural effusion
2/1/2019 CAP BY DR.BAKUNDA 12

13. Crackles, bronchial, and decreased breath
sounds on auscultation
Enhanced bronchophony, egophony,
and tactile fremitus
Dullness on percussion
2/1/2019 CAP BY DR.BAKUNDA 13

14. Atypical pneumonia
 Typically takes an indolent course (slow
onset) with an emphasis on extrapulmonary
symptoms.
Low-grade fever
Non-productive, dry cough
Dyspnea
Common extrapulmonary features include fatigue,
headaches, sore throat, myalgias, malaise
Auscultation often unremarkable
2/1/2019 CAP BY DR.BAKUNDA 14

15. Investigation
Blood
↑ CRP, ↑ EST, leucocytosis,
ABG to rule out respiratory failure
 ↓ PaO2, pH < 7.35, PaCO2 > 45 mm Hg
Pathogen detection always recommended
Sputum for Gram stain, culture and sensitivity tests.
Blood Culture
Urea and creatinine
2/1/2019 CAP BY DR.BAKUNDA 15

16. Chest x ray
Lobar pneumonia :extensive opacity restricted to one
pulmonary lobe, possible air bronchogram is visible
Bronchopneumonia :poorly defined patchy infiltrates
scratted throughtout the lungs,air bronchogram is
unusual
Atypical or interstitial pneumonia :duffuse reticular
opacity, absent or minimal consolidation
2/1/2019 CAP BY DR.BAKUNDA 16

17. Management
It is important to assess the severity to
decide about the right treatment
criteria for admission or not based on
CURB-65.
2/1/2019 CAP BY DR.BAKUNDA 17

18. Confusion (disoriented, altered mental status)
Urea>7mmol/l(20mg/dl)
Respiratory rate>30/min
Blood pressure SBP<90mmHg or DBP<60mmHg
Age >65
2/1/2019 CAP BY DR.BAKUNDA 18

19. Interpretation
2/1/2019 CAP BY DR.BAKUNDA 19

20. General measures
Sufficient bedrest(not absolute bedrest)and physical
therapy
High fluid intake (prevent dehydration, reduces
bronchial secretion viscosity)
Pulse oximetry monitoring
Oxygen via nasal tube in case of hypoxia
Antipyretics ,analgesics (paracetamol ,ibuprofen)
2/1/2019 CAP BY DR.BAKUNDA 20

21. Antibiotics
First choice: Amoxycillin 1g tds po X 7days
Second choice: Amoxy-clavulinic acid po or
IV1g bid
or Cefuroxime IV 750 mg bid X 7 days.
If staphylococcus suspected: Cloxacillin
500mg quid
po or IV X 7 day
If atypical pneumonia suspected:
Erythromycin 500mg qid po for 7 days
2/1/2019 CAP BY DR.BAKUNDA 21

22. References
Toronto Notes 34th Edition Comprehensive medical reference and
review for the Medical Council of Canada Qualifying Exam (MCCQE)
Part I and the United States Medical Licensing Exam (USMLE) Step 2
Essentials of Kumar & Clark’s clinical medicine sixth edition
www.uptodate.com
www.amboss.com
http://www.moh.gov.rw/fileadmin/templates/Clinical/Internal-
Medicine-Clinical-Treatment-Guidelines-9-10-2012-1.pdf
2/1/2019
CAP BY DR.BAKUNDA
22