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Community Acquired Community Acquired PneumoniaPneumonia
Peter Valenzuela, MD, MBA, FAAFPPeter Valenzuela, MD, MBA, FAAFP
Assistant Dean for Clinical AffairsAssistant Dean for Clinical Affairs
Assistant Professor/Dept. of Family MedicineAssistant Professor/Dept. of Family Medicine
ObjectivesObjectives
Identify the pathogens common to CAPIdentify the pathogens common to CAP
Describe the signs and symptoms of CAPDescribe the signs and symptoms of CAP
Describe the diagnostic criteria for CAPDescribe the diagnostic criteria for CAP
Discuss treatment options for CAPDiscuss treatment options for CAP
BackgroundBackground
Total annual cost of health care for CAP in Total annual cost of health care for CAP in U.S. is $8.4 billionU.S. is $8.4 billion
5.6 million cases of CAP in U.S. each year5.6 million cases of CAP in U.S. each year J Respir Dis 2002; 23:10-7J Respir Dis 2002; 23:10-7
Pneumonia and influenza combined are 7Pneumonia and influenza combined are 7thth leading cause of death in U.S.leading cause of death in U.S.– 21.8 deaths per 100,000 21.8 deaths per 100,000 Natl Vital Stat Rep 2003; 52:1-115Natl Vital Stat Rep 2003; 52:1-115
DefinitionDefinition
Community-Acquired Pneumonia (CAP)Community-Acquired Pneumonia (CAP)--lower respiratory tract infection in a non-lower respiratory tract infection in a non-hospitalized person associated with hospitalized person associated with symptoms of acute infection symptoms of acute infection with or with or withoutwithout new infiltrate on chest radiograph new infiltrate on chest radiograph
Types-PathogensTypes-Pathogens
Typical CAP (60-70%)Typical CAP (60-70%)– Streptococcus pneumoniaeStreptococcus pneumoniae
Atypical CAP (30-40%)Atypical CAP (30-40%)– Influenza virusInfluenza virus– MycoplasmaMycoplasma– ChlamydiaChlamydia– LegionellaLegionella
Signs & SymptomsSigns & Symptoms
Clinical symptoms Clinical symptoms – Cough (productive or non-productive)Cough (productive or non-productive)– Fever (>100.4)Fever (>100.4)– Chills/RigorsChills/Rigors– DyspneaDyspnea– Fatigue/MyalgiaFatigue/Myalgia– Gastrointestinal (Legionella)Gastrointestinal (Legionella)
Signs & SymptomsSigns & Symptoms
Physical examPhysical exam– Dullness to percussion of chestDullness to percussion of chest– Crackles or rales on auscultationCrackles or rales on auscultation– Bronchial breath soundsBronchial breath sounds– Egophony (“E” to “A” changes)Egophony (“E” to “A” changes)
Diagnosis- LabsDiagnosis- Labs
All patients with suspected CAP should All patients with suspected CAP should have chest radiographhave chest radiograph
Leukocyte countLeukocyte count
Sputum Gram stainSputum Gram stain
Blood cultures x 2Blood cultures x 2
Serum/urine antigensSerum/urine antigens
Radiograph findingsRadiograph findings
Lobar consolidation is Lobar consolidation is common in typical common in typical pneumoniapneumonia
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Radiograph findingsRadiograph findings
Diffuse or patchy Diffuse or patchy infiltrates are more infiltrates are more common in atypical common in atypical pneumoniapneumonia
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ManagementManagement
Inpatient cost for CAP Inpatient cost for CAP is $7,500is $7,500
Outpatient cost for Outpatient cost for CAP is $150-$350CAP is $150-$350
Pneumonia Severity Pneumonia Severity Index- assesses need Index- assesses need for hospitalization for hospitalization
This index can be This index can be accessed at accessed at http://www.medscape.http://www.medscape.com/content/2004/00/com/content/2004/00/49/50/495094/art-jags49/50/495094/art-jags495094.app.gif495094.app.gif
Management AlgorithmManagement Algorithm
This algorithm can be accessed at This algorithm can be accessed at http://www.aafp.org/afp/20060201/442_f1.http://www.aafp.org/afp/20060201/442_f1.gifgif
TreatmentTreatment
Preferred outpatient management is single Preferred outpatient management is single therapy with one of the followingtherapy with one of the following– MacrolideMacrolide– FluoroqunoloneFluoroqunolone– DoxycyclineDoxycycline
Preferred inpatient managementPreferred inpatient management– Beta-lactam + macrolideBeta-lactam + macrolide– Fluoroquinolone Fluoroquinolone
SummarySummary
Identify the pathogens common to CAPIdentify the pathogens common to CAP
Describe the signs and symptoms of CAPDescribe the signs and symptoms of CAP
Describe the diagnostic labs for CAPDescribe the diagnostic labs for CAP
Discuss treatment options for CAPDiscuss treatment options for CAP
Questions?Questions?
ReferencesReferences
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.