Community-Acquired Pneumonia

Community-acquired pneumonia occur in people who have little or no contact with medical facilities or nursing homes. The most commonly identified pathogens are Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (eg. As Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella sp.) And viruses. Symptoms and signs include fever, cough, sputum, pleuritic chest pain, dyspnea, tachypnea and tachycardia. The diagnosis is made based on the clinical findings and chest X-ray. Treatment is with antibiotics empirically selected. The prognosis is excellent at very young or healthy patients, many pneumonias, particularly that caused by S. pneumoniae, Legionella, Staphylococcus aureus, or influenza viruses, however, run in older sicker patients lethal.

Community-acquired pneumonia occur in people who have little or no contact with medical facilities or nursing homes. The most commonly identified pathogens are Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (eg. As Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella sp.) And viruses. Symptoms and signs include fever, cough, sputum, pleuritic chest pain, dyspnea, tachypnea and tachycardia. The diagnosis is made based on the clinical findings and chest X-ray. Treatment is with antibiotics empirically selected. The prognosis is excellent at very young or healthy patients, many pneumonias, particularly that caused by S. pneumoniae, Legionella, Staphylococcus aureus, or influenza viruses, however, run in older sicker patients lethal. Community-acquired pneumonia etiology caused by numerous microorganisms, including bacteria, viruses and fungi. The pathogens vary depending on the patient’s age and other factors (see Table: Community-acquired pneumonia in adults). However, the importance of each pathogen as a trigger of community acquired pneumonia is unclear, because most patients are not thoroughly investigated microbiologically, and there can be identified even in the present testing specific pathogens only in <50% of cases (overview of pneumonia (pneumonia) ). S. pneumoniae, H. influenzae, M. pneumoniae and C. pneumoniae are the most common bacterial pathogens. Pneumonia caused by chlamydia and mycoplasma can be clinically often indistinguishable from other pneumonias. Common viral triggers include respiratory syncytial virus (RSV), adenoviruses, influenza viruses, parainfluenza viruses and metapneumoviruses. Bacterial superinfection can make it difficult to distinguish between viral and bacterial infections. C. pneumoniae causes 2-5% of community-acquired pneumonia, and is the second leading cause of lung infections in otherwise healthy patients between 5 and 35 years. C. pneumoniae often triggers respiratory infections within families, as well as boarding schools, homes, and military installations Schullandheim out. This pathogen causes a relatively harmless form of pneumonia that has to be treated rarely stationary. Pneumonia caused by Chlamydia psittaci (psittacosis) are rare and occur in patients who keep the birds or coming into contact with birds. Since 2000, the incidence of community-acquired and hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) has drastically increased. This pathogen can rarely cause serious, cavitating pneumonia and tends to affect young adults. P. aeruginosa is a very common cause of pneumonia in patients with cystic fibrosis, neutropenia, advanced stages of AIDS and bronchiectasis. A variety of other organisms causes a lung infection in immunocompetent patients. In patients with pneumonia, a thorough history of stress, travel, pets, hobbies, and other exposures is important to raise the suspicion of less common organisms. Q fever, tularemia, anthrax and the plague are rarely occurring systemic bacterial diseases in which pneumonia may be a prominent feature. Tularemia (Tularemia), anthrax (Anthrax) and Pest (Pest and Other Yersinia infections) should raise the suspicion of bioterrorism (biological agents as weapons). Adenoviruses EBV and coxsackie viruses are common viruses that cause but rarely pneumonia. Seasonal influenza can cause a direct viral pneumonia in rare cases, but is often a predisposition to the development of severe secondary bacterial pneumonia. Varicella-zoster virus (VZV) and hantaviruses cause lung inflammation as part of a chickenpox infection in adults and pulmonary Hantavirussyndroms. A coronavirus causes severe acute respiratory syndrome (SARS) and the "Middle East Respiratory Syndrome" (MERS- coronaviruses and acute respiratory syndrome (MERS and SARS)). Among the most common fungal pathogens include Histoplasma capsulatum (histoplasmosis histoplasmosis) and Coccidioides immitis (Kokzidioidomykose- coccidioidomycosis). Among the rare fungal pathogens include Blastomyces dermatitidis (Blastomykose- Blastomycosis) and Paracoccidioides braziliensis (Parakokzidioidomykose- paracoccidioidomycosis). Pneumocystis jirovecii often leads to pneumonia in patients who have HIV infection or immunosuppression (pneumonia in immunocompromised patients). Among the parasites that cause pneumonia in industrialized countries include Toxocara canis or T. Catis (visceral larva migrans infection- Toxocariasis), Dirofilaria immitis (heartworm Dirofilariasis-) and Paragonimus westermani (Paragonimiasis- Paragonimiasis). (. For a detailed presentation of pulmonary tuberculosis or specific microorganisms, mycobacteria) In children, the most common causes of age depend: <5 years: The most common viruses; among bacteria are S. pneumoniae, S. aureus and S. pyogenes common ? 5 years: The most common bacteria S. pneumoniae, M. pneumoniae, Chlamydia pneumoniae S. pneumoniae and MRSA can cause necrotizing pneumonia. In pneumonia in newborns pneumonia in newborns. Symptoms and signs The symptoms include malaise, chills, rigors, cough, dyspnea and chest pain. Cough in older children and adults typically productive and in infants, young children and elderly patients dry. Dyspnoea is usually mild and load dependent and rarely present at rest. Chest pain have a pleuritic character and are usually the focus of inflammation adjacent. Pneumonia may manifest itself in the form of epigastric pain when inflammation irritate the diaphragm in the lower lobes. Gastrointestinal symptoms (nausea, vomiting, diarrhea) The symptoms vary with age. Pneumonia in infants may manifest as nonspecific irritability and restlessness; in elderly patients as confusion and clouding of consciousness. Among the symptoms include fever, tachypnea, tachycardia, RG, bronchial breath sounds, Ägophonie (E to A change occurs when during auscultation a spoken by the patient "I" is perceived by the examiner as "A") and head of sound at percussion , Also signs of pleural effusion may be present (pleural effusion: symptoms and complaints). Nostrils, use of respiratory muscles and cyanosis are common in infants. Fever is often missing in the elderly. Previously it was assumed that the symptoms are in different depending on the type of pathogen. Factors such. As suggestive of viral pneumonia include gradual onset, preceded symptoms of infection of the upper respiratory tract, diffuse findings on auscultation and absence of a toxic appearance. Atypical pathogens are considered likely if the start was less acute and are more likely during the well-known large outbreaks. However, manifestations in patients with typical and atypical pathogens overlap considerably. In addition, no symptom or clinical examination finding is sensitive or specific enough to be able to predict the causative pathogens for sure. Symptoms and complaints are even similar to other non-infectious inflammatory lung diseases such as allergic alveolitis and organizing pneumonia. Chest x-ray diagnostics considering alternative diagnoses (z. B. heart failure, pulmonary embolism) Sometimes identification of pathogens The diagnosis is suspected based on the clinical symptoms and confirmed by visible on the chest x-ray infiltrate. At high clinical suspicion of lung inflammation and when the chest x-ray showed no infiltrate, a CT or repetition of the chest x-ray in 24 to 48 hours is recommended. For the differential diagnosis in patients with pneumonia-like symptoms include heart failure (heart failure) and COPD exacerbation (Chronic Obstructive Pulmonary Disease (COPD)). Other diseases should be considered, especially if findings are inconsistent or not typical. The most serious mistake misdiagnosis is the pulmonary embolism in patients with minimal emission without accompanying infection of the upper respiratory tract and in the presence of risk factors for thromboembolism: may be more likely (see Table risk factors for deep vein thrombosis and pulmonary embolism). Therefore, a test for pulmonary embolism should be considered. Quantitative cultures bronchoscopy or sucked samples when they were taken before the administration of antibiotics, can help between bacterial colonization (d. E. The presence of micro-organisms at a level that causes no symptoms nor an immune response) to distinguish and infections. However, a bronchoscopy usually is performed only in patients who are receiving mechanical ventilation or in people with other risk factors for exceptional microorganisms or complicated pneumonia (for example, immune deficiency, failure empirical therapy) have. The distinction between bacterial and viral pneumonia is a challenge. Many studies have investigated the benefits of clinical, imaging and routine blood tests, but no test is reliable enough to make this distinction. The use of serum biomarkers, such as procalcitonin and C-reactive protein (CRP), to assist in the distinction between bacterial and non-bacterial pneumonia, is currently under investigation. In outpatients with mild or moderate pneumonia, no further diagnosis is required (see table: risk stratification of community-acquired pneumonia (Pneumonia Severity Index)). In patients with moderate or severe pneumonia blood count, electrolytes, urea and creatinine are useful to quantify the overall risk and dehydration. In addition, a BGA should be performed to assess oxygenation in patients with moderate or severe pneumonia, for which hospitalization is necessary, two sets of blood cultures are taken to evaluate bacteremia and sepsis. The IDSA provides a guide to recommended tests prepared based on demographic factors of patients and risk factors (Infectious Diseases Society of America Clinical Guideline on community-acquired pneumonia). Identification of pathogens The identification of the pathogen may be useful to guide therapy and to check bacterial sensitivity to antibiotics. But because of the limitations of current diagnostic tests and the success of the empirical antibiotic therapy, experts recommend limiting testing in the microbiological identification (z. B. cultures specific antigen tests), unless patients are at high risk or complications (eg. As severe pneumonia, immunodeficiency, asplenia, no response to empirical therapy). In general - the milder pneumonia, the less these diagnostic tests are needed. Critically ill patients need the most intensive tests, as well as patients in whom antibiotic resistance or unusual organisms are suspected (z. B. TB, P. jirovecii) and in patients whose condition is deteriorating or not h within 72 to treatment speak to. Chest x-ray findings can not usually distinguish one type of infection from another, even if the following findings are suggestive: ENTERPRISES pneumonia of the right lower lobe LIVING ART, LLC / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: '/ - / media / ? manual / professional / images / m2400651_pneumonia_of_the_right_lower_lobe_science_photo_library_high_de.jpg lang = en & thn = 0 & mw = 350 ', imageUrl:' /-/media/manual/professional/images/m2400651_pneumonia_of_the_right_lower_lobe_science_photo_library_high_de.jpg?la=de&thn=0 ', title:' pneumonia of the right lower lobe 'description:' u003Ca id = "v38395456 " class = ""anchor "" U003e u003c / a u003e u003cdiv class = "" para "" u003e u003cp u003eDieser chest x-ray showing an infiltrate the right heart border not covered (d. H. there is no Silhouette characters). Since the silhouette sign occurs when two coherent structures have a similar radiopacity

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