Community-acquired pneumonia (CAP) / Reading and Sharing

Community-acquired pneumonia (CAP) is an infection that begins outside the hospital or is diagnosed within 48 hours after admission to the hospital in a person who has not resided in a long-term care facility for 14 days or more before admission (Grossman, & Porth, 2014). As according to Ferri (2017), the incidence of community-acquired pneumonia (CAP) is 1 in 100 persons. CAP is the most common infectious cause of death in the U.S. (p. 983).

The most common cause of infection is S. pneumoniae. Other common pathogens include H. influenza, S. aureus, and gram-negative bacilli. Less common agents are Mycoplasma pneumoniae, Legionella, Chlamydia species, and viruses, sometimes called atypical agents. Common viral causes of CAP include the influenza virus, RSV, adenovirus, and parainfluenza virus (Grossman, & Porth, 2014).

The methods used in the diagnosis of CAP depend on age, coexisting health problems, and the severity of illness. In people younger than 65 years of age and without coexisting disease, dx is usually based on

• History and physical examination
• Chest radiographs,
• Knowledge of the microorganisms currently causing infections in the community,
• Sputum specimens may be obtained for staining procedures and cultures,
• Blood cultures may be done for people requiring hospitalization
• In general, auscultation of patients with pneumonia reveals crackles and diminished breath sounds.
• Percussion dullness is present if the patient has pleural effusion.

1. S &S of Patient with S. pneumonia (20-60% of CAP cases): high fever, shaking chills, pleuritic chest pain, cough, and copious production of rusty-appearing purulent sputum (Ferri, 2017, p. 983).
2. S &S of Patient with Mycoplasma pneumonia: insidious onset, headache, dry paroxysmal cough that is worst at night, myalgia, malaise, sore throat, extrapulmonary manifestations. (Ferri, 2017, p. 983).
3. S &S of Patient with Chlamydia pneumonia: persistent non-productive sour, low-grade fever, headache, sore throat (Ferri, 2017, p. 983).

Nonpharmacologic therapy as according to Ferri (2017) are: avoidance of tobacco use; use oxygen to maintain partial oxygen pressure in arterial blood > 60 mm Hg; IV hydration for correction of dehydration; and assisted ventilation in patients with significant respiratory failure.

Treatment involves the use of appropriate antibiotic therapy. Empiric antibiotic therapy, based on knowledge regarding an antibiotic’s spectrum of action and ability to penetrate bronchopulmonary secretions, often is used for people with community-acquired pneumonia who do not require hospitalization. Hospitalization and more intensive care may be required depending on the person’s age, preexisting health status, and severity of the infection (Grossman, & Porth, 2014).

Macrolides (azithromycin or clarithromycin or levofloxacin is recommended for empiric outpatient treatment of CAP. Cefotaxime or a beta-lactam/ beta-lactamase inhibitor can be added in patients with more severe presentation who insist on outpatient therapy. Duration of treatment ranges from 7 to 14 days. (Ferri, 2017, p. 984).

Patient should also encourage to follow up with primary care providers regularly, and chest x-ray may be taken 4 to 6 weeks after recovery to evaluate lungs for clearing and detect any tumor or underlying cause.

References:

Ferri, F. F. (2017) Ferri’s clinical advisor, 2017, 5 books in 1

Grossman, S. C. & Porth, C. M. (2014) Porth’s pathophysiology: Concepts of altered health states. (9th. Ed)