Community Acquired Pneumonia

Question 1

What is the definition of CAP?

Answer 1

Occurring less than 48hrs after hospital admission

Question 2

What are some risk factors for CAP?

Answer 2

DM, COPD, renal failure, pneumonia

Question 3

What is the most common CAP pathogen?

Answer 3

Strep pneumoniae; Frequently follows a URI

Question 4

What is the age correlation with the species of CAP causing organism?

Answer 4

Newborn: Group B Strep, chlamydia
 Children: viral (RSV)
 Young adults: mycoplasma
 Middle age: Pneumococcus
 Elderly: bacterial

Question 5

What is the pathogen correlation with certain organisms and pre-existing diseases?

Answer 5

COPD/CB: Strep pneumo, H.flu, Klebsiella pneumo

 Alcoholism: Klebsiella pneumo, S. aureus

Question 6

What is the presentation of TYPICAL CAP?

Answer 6

fever, chills, sputum

confusion in the elderly

Question 7

How does typical CAP from pneumococcus present?

Answer 7

ABRUPT onset of single shaking chill, fever, cough w/ rust-colored sputum, pleuritic chest pain

Question 8

How does typical CAP present from H. influenzae?

Answer 8

INSIDIOUS worsening of baseline cough & sputum production

Question 9

How does Atypical CAP generally present?

Answer 9

modest WBC elevation, lack of alveolar exudate, fever, HA, malaise, non-productive cough

Illness out of proportion to symptoms and CXR

Question 10

Typical pathogens of CAP

Answer 10

S. pneumoniae, H. flu, S. aureus, Klebisella, PSA

Question 11

What are the drugs used for typical CAP?

Answer 11

typicals: β-lactams +/- β-lactamase inhibitors, cephalosporins, macrolides, tetracyclines, respiratory fluoroquinolones (NOT Cipro)

 Tigecycline (a tetracycline) for penicillin resistant Strep pneumo (PRSP)

Question 12

What are the atypical CAP organsims?

Answer 12

Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella

NO Cell walls intracellular pathogens

Question 13

Drugs for Atypical CAP

Answer 13

Macrolides, fluoroquinlones, tetracyclines

Question 14

Which viruses cause atypical CAP?

Answer 14

Influenza A/B, RSV, parainfluenza, adenovirus, coronavirus, rhinovirus

Question 15

What are some clues to CAP causing organisms?

Answer 15

Klebsiella: lobar enlargement & fissure bulging

o Staph: empyema common

o Anaerobic: posterior segment of RUL or superior segment of RLL w/ cavitation

Question 16

What are the indications for hospitilization?

Answer 16

Age >65

RR>30, temp > 101

Question 17

Histologically, how can you distinguish causes of pneumonia?

Answer 17

Fibrinopurulent alveolar exudates: acute bacterial
Mononuclear interstitial infiltrates: viral, atypical
Granulomatous, cavitary: TB, fungal

Question 18

Distinguish bronchopneumonia from lobar pneumonia

Answer 18

Lobar pneumonia: Congestion, Red, Gray, resolution

Bronchopneumonia: Patchy consolidation, adjacent hyperemia