10. OTHER TESTS ON SPUTUM -
PNEUMOCOCCAL ANTIGEN DETECTION
LEGIONELLA PNEUMOPHILIA – DFA TEST
PNEUMOCYSTIS – SPECIFIC FLUORESCEIN LABELLED
MONOCLONAL ANTIBODIES
NOT AFFECTED BY PRIOR ANTIBIOTIC USE
RAPID VIRAL DIAGNOSIS BY DFA
11. SPUTUM CULTURE
DELAY IN GIVING RESULT
CONTAMINATION - NORMAL FLORA
PRIOR ANTIBIOTIC USE INHIBITS GROWTH
17. VIRAL ANTIGEN DETECTION
DFA – INFLUENZA A & B, RSV, CMV, HSV
EIA
PCR
ASSOCIATED CLINICAL AND LAB FINDINGS
TO BE TAKEN INTO ACCOUNT FOR DIAGNOSIS
18. SEROLOGICAL TESTS
WHEN CAUSATIVE ORGANISM IS HARD TO ISOLATE
RAPID DIAGNOSIS
HELP IN INITIATION OF TREATMENT
INCREASE IN TITRES 4 FOLD
LEGIONELLA, MYCOPLASMA, Q FEVER PNEUMONIA,
MYCOTIC PATHOGENS, VIRAL (RETROSPECTIVE
DIAGNOSIS)
28. OTHERS
ARTERIAL O2 SATURATION AND BLOOD GAS ANALYSIS
WBC COUNT
HIGH BLOOD UREA
HIGH BILIRUBIN
HIGH ALKALINE PHOSPHATASE
HYPONATREMIA LEGIONELLA
PROTEIN, RBC AND WBC IN URINE
29. MARKERS FOR SEVERE ILLNESS
ALTERED MENTAL STATE / CONFUSION
TACHYPNOEA >/= 30 BREATHS/MIN
HYPOTENSION <90/60 mm Hg
ARTERIAL HYPOXEMIA
CXR -- > 1 LOBE INVOLVED / RAPID PROGRESSION
RENAL INSUFFICIENCY
30. NO MARKERS
OF SEVERE
ILLNESS
SPUTUM FOR
GRAM STAIN
AND CULTURE
BLOOD
CULTURE
MARKERS OF
SEVERE
ILLNESS
SPUTUM FOR
GRAM STAIN
AND CULTURE
BLOOD
CULTURE
URINALYSIS
SEROLOGY
? INVASIVE
LUNG
SAMPLING
COMMUNITY
ACQUIRED
PNEUMONIA
32. PSI
CALCULATES THE PROBABILITY OF MORBIDITY AND
MORTALITY AMONG THE COMMUNITY ACQUIRED
PNEUMONIA PATIENTS.
USES DEMOGRAPHICS, ASSOCIATED CO-MORBIDITIES,
PHYSICAL EXAMINATION, VITAL SIGNS AND LAB
FINDINGS
RISK GROUP I – RX AT HOME
RISK GROUP II AND III – HOME RX WITH IV ANTIBIOTICS
OR 1 DAY HOSPITAL STAY
RISK GROUP IV AND V – INPATIENT RX
33. C – CONFUSION
U – UREMIA > 7 mmol/L
R – RESPIRATORY RATE > 30/min
B – BP < 90/60 mm Hg
65 – years old / more
34. IDSA / ATS GUIDELINES FOR
EMPIRICAL ANTIBIOTIC
THERAPY
35. PSI / CURB
65
OUT-PATIENT
Healthy
No antibiotics in
past 3 months
Macrolide OR
Doxycycline
Comorbidities
Antibiotics in
past 3 months
Fluoroquinolone
OR (B-lactam +
Macrolide)
IN-PATIENT
Non-ICU
ICU
