Since the timeliness and appropriateness of antibiotics improves outcome in virtually all forms of pneumonia, clinicians should strive to ensure timely antibiotic treatment preferably within 6 hrs of symptom onset or presentation. These antibiotics must also be active against the likely pathogen to optimize outcomes. Emergency management of the patient with pneumonia includes establishing an airway, if needed, and maintaining adequate oxygenation and ventilation, and for those patients in shock rapid fluid resuscitation is crucial.
In all patients, if there is any concern for a significant or growing pleural effusion it should be tapped to determine whether there is an accompanying empyema, since this must be drained urgently. Chest imaging represents the most important diagnostic test for establishing the presence of pneumonia.
Other diagnostic tests focus on identifying the etiologic pathogen. This generally involves cultures of sputum, blood and pleural fluid if present. In patients who cannot produce sputum, inducing sputum with the help of respiratory therapy should be considered.
Blood cultures are recommended for patients with HCAP. In CAP, the evidence supporting routine blood cultures is more limited. Except for critically ill patients with CAP, blood cultures are more likely to grow a contaminant than a true pathogen.
In mechanically ventilated patients, clinicians should consider obtaining lower airway cultures rather than simply tracheal aspirates. Lower airway cultures are more reliable than tracheal aspirates and are less likely to be confounded by upper airway colonization. Examples of lower airway cultures include both bronchoscopic and non-bronchoscopic techniques.
Bronchoscopic approaches include traditional broncheal alveolar lavage BAL and bronchial brush. Mini-BAL and blind-brush are options for non-bronchoscopic alternatives. Both bronchoscopic and non-bronchoscopic means for obtaining culture material are considered to be equivalent for diagnostic purposes in the non-immunocompromised host. Other tools for identifying the pathogen include urinary antigen testing and serum antibody studies.
Urinary antigen tests are commercially available for Streptococcus pneumoniae and selected Legionella species. Measuring specific antibody titers and then re-evaluating the subject weeks later to determine the convalescent titer has no value outside of clinical research.
In immunosuppressed patients, special stains should be ordered to evaluate sputum and BAL specimens for the presence of Pneumocystis jiroveci PJP and selected fungi. In otherwise normal hosts, these tests are of little value. When clinically suspected based on the clinical and epidemiologic scenario, acid fast stains and subsequent cultures are appropriate to rule out mycobacterial disease. Genetic probing of sputum and lower airway material can also prove helpful in the proper setting.
In the end, the diagnosis of pneumonia is a clinical one. The physician must assemble and integrate the information and patient presentation along with results from objective testing to determine if the patient has pneumonia. Again, each aspect of diagnostic testing undertaken in pneumonia has limited sensitivity.
In other words, the differential diagnosis for an elevation in the WBC count is huge, as is the differential for an abnormal chest film. Decision aids exist to help make the diagnosis more objective. For example, the clinical pulmonary infection score CPIS integrates various aspects of the clinical presentation and the objective testing into a score. The higher the score, the more likely the patient is to have infectious pneumonia rather than some alternate process.
The CPIS, though, has very limited utility. It has not been examined outside of use in VAP. A recently developed assay to measure serum procalcitonin appears to identify subjects likely to have a bacterial infection as opposed to either some other syndrome and may be a useful guide for initiating antimicrobial treatment. However, this assay is not widely used in the United States at present and the data are not definitive enough to use for clinical decisions at present.
The differential diagnosis for patients who present with an acute respiratory syndrome along with radiographic evidence of an infiltrate is quite broad. In most instances, the clinical scenario excludes many of these possibilities eg, no history of transfusion, no trauma. In some cases, several of these syndromes may coexist with an acute pneumonia.
For example, pneumonia may often lead to an exacerbation of heart failure. Confirmatory testing in pneumonia includes interventions to better evaluate the pulmonary parenchyma and to obtain more sensitive material. If a question exists about the presence of an infiltrate on a chest radiograph, formal PA and lateral films should be ordered if there has been only an AP portable film.
Physicians should not simply jump to CT scanning. However, if there is a question about the pattern of infiltrates after reviewing a PA and lateral, or if there is a need to better evaluate the mediastinum, then a CT is appropriate. Selected aspects of an infiltrate may also be better appreciated only with the resolution of a CT.
For other people, it can take a month or more. Vaccines can help prevent pneumonia caused by pneumococcal bacteria or the flu virus.
Having good hygiene , not smoking, and having a healthy lifestyle may also help prevent pneumonia. The information on this site should not be used as a substitute for professional medical care or advice.
Contact a health care provider if you have questions about your health. Pneumonia Also called: Bronchopneumonia. Learn More Related Issues Specifics. See, Play and Learn No links available. Resources Reference Desk Find an Expert. What is pneumonia?
What causes pneumonia? Several different types of bacteria can cause pneumonia, including Streptococcus pneumoniae Legionella pneumophila; this pneumonia is often called Legionnaires' disease Mycoplasma pneumoniae Chlamydia pneumoniae Haemophilus influenzae Viruses that infect the respiratory tract may cause pneumonia.
Some of the types include Pneumocystis pneumonia PCP Coccidioidomycosis, which causes valley fever Histoplasmosis Cryptococcus Who is at risk for pneumonia? Anyone can get pneumonia, but certain factors can increase your risk: Age; the risk is higher for children who are age 2 and under and adults age 65 and older Exposure to certain chemicals, pollutants, or toxic fumes Lifestyle habits, such as smoking , heavy alcohol use , and malnourishment Being in a hospital, especially if you are in the ICU.
Having a lung disease Having a weakened immune system Have trouble coughing or swallowing , from a stroke or other condition Recently being sick with a cold or the flu What are the symptoms of pneumonia? What other problems can pneumonia cause? Sometimes pneumonia can cause serious complications such as Bacteremia, which happens when the bacteria move into the bloodstream.
It is serious and can lead to septic shock. Lung abscesses , which are collections of pus in cavities of the lungs Pleural disorders , which are conditions that affect the pleura.
The pleura is the tissue that covers the outside of the lungs and lines the inside of your chest cavity. Kidney failure Respiratory failure How is pneumonia diagnosed? Your health care provider may use many tools to make a diagnosis: A medical history, which includes asking about your symptoms A physical exam, including listening to your lungs with a stethoscope Various tests, such as A chest x-ray Blood tests such as a complete blood count CBC to see if your immune system is actively fighting an infection A Blood culture to find out whether you have a bacterial infection that has spread to your bloodstream If you are in the hospital, have serious symptoms, are older, or have other health problems, you may also have more tests, such as Sputum test, which checks for bacteria in a sample of your sputum spit or phlegm slimy substance from deep in your lungs.
Chest CT scan to see how much of your lungs is affected. It may also show if you have complications such as lung abscesses or pleural effusions. Pleural fluid culture , which checks for bacteria in a fluid sample that was taken from the pleural space Pulse oximetry or blood oxygen level test, to check how much oxygen is in your blood Bronchoscopy, a procedure used to look inside your lungs' airways What are the treatments for pneumonia?
A small sensor is taped or clipped onto a finger. When the machine is on, a small red light can be seen in the sensor. The test is painless and the red light does not get hot. Chest CT scan. This imaging procedure uses a combination of X-rays and computer technology to produce sharp, detailed horizontal, or axial, images often called slices of the body.
A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays. This is direct exam of the bronchi the main airways of the lungs using a flexible tube called a bronchoscope. Pleural fluid culture. In this test, a sample of a fluid sample is taken from the pleural space. This is the space between the lungs and chest wall.
A long, thin needle is put through the skin between the ribs and into the pleural space. Fluid is pulled into a syringe attached to the needle. Treatment depends on the type of pneumonia you have. Most of the time, pneumonia is treated at home, but severe cases may be treated in the hospital.
Antibiotics are used for bacterial pneumonia. Antibiotics may also speed recovery from mycoplasma pneumonia and some special cases.
They usually get better on their own. Other treatment may include eating well, increasing fluid intake, getting rest, oxygen therapy, pain medicine, fever control, and maybe cough-relief medicine if cough is severe.
Check with your healthcare provider about getting immunizations. The flu is a common cause of pneumonia. Because of that, getting a flu shot every year can help prevent both the flu and pneumonia.
There is also a pneumococcal vaccine. It will protect you from a common form of bacterial pneumonia. Children younger than age 5 and adults ages 65 and older should get this shot. The pneumococcal shot is also recommended for all children and adults who are at increased risk of pneumococcal disease due to other health conditions.
Most people with pneumonia respond well to treatment, but pneumonia can be very serious and even deadly. You are more likely to have complications if you are an older adult, a very young child, have a weakened immune system, or have a serious medical problem like diabetes or cirrhosis.
Complications may include:. Acute respiratory distress syndrome ARDS. This is a severe form of respiratory failure.
0コメント