View source for Pneumonia (main)

''For pediatrics see [[Pneumonia (peds)|pediatric pneumonia]]''
==Background==
*Definition: infection of lung parenchyma 
*Empirically classified based upon location/risk factors

===Health care–associated pneumonia risk factors===
*Hospitalized for 2 or more days within past 90 days
*Nursing home/long-term care residents
*Receiving home IV antibiotics
*Dialysis
*Receiving chronic wound care
*Receiving chemotherapy
*Immunocompromised

===[[Pseudomonas]] risk factors===
*Alcoholism
*Immunosuppression (including steroids)
*Structural lung disease
*Malnutrition
*Recent antibiotics
*Recent hospital stay

{{Causes of pneumonia}}

===Commonly Encountered Pathogens by Risk Factor===
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Risk Factor'''
| align="center" style="background:#f0f0f0;"|'''Associated Organism'''
|-
| [[Alcoholism]]||
*[[Streptococcus pneumoniae]]
*[[Anaerobes]] (e.g. [[Klebsiella pneumoniae]]) 
*[[Mycobacterium tuberculosis]]
|-
| [[COPD]] and/or Smoking||
*[[S. pneumoniae ]]
*[[Haemophilus influenzae]] 
*[[Moraxella ]]
*[[Legionella]]
|-
| Nursing Home||
*[[S. pneumoniae ]]
*[[Gram-negative]] bacilli 
*[[H. influenzae ]]
*[[Staphylococcus aureus ]]
*[[Anaerobes]] 
*[[Chlamydophila pneumoniae]]
|-
| Exposure to bird droppings||[[Histoplasma capsulatum]]
|-
| Exposure to birds||[[Chlamydophila psittaci]]
|-
| Exposure to rabbits||[[Francisella tularensis]]
|-
| Exposure to farm animals||[[Coxiella burnetii]] (Q fever)
|-
| Exposure to southwestern US||[[Coccidiomycosis]] (Valley fever)
|-
| Early [[HIV]]||
*[[S. pneumoniae ]]
*[[H. influenzae ]]
*[[M. tuberculosis]]
|-
| Late [[HIV]] (as above, plus:)||
*[[Pneumocystis jiroveci]] 
*[[Cryptococcus ]]
*[[Histoplasma]]
|-
| Aspiration||[[Anaerobes]]
|-
| Structural Lung Disease (CF, bronchiectasis)||
*[[Pseudomonas aeruginosa ]]
*[[Burkholderia cepacia ]]
*[[S. aureus]]
|-
| [[Injection drug use]]||
*[[S. aureus ]]
*[[Anaerobes ]]
*[[M. tuberculosis ]]
*[[S. Pneumo]]
|-
| [[Influenza]]||
*Influenza 
*[[S. pneumoniae ]]
*[[S. aureus ]]
*[[H. influenzae]]
|-
| Ventilator Associated Pneumonia||
*[[Pseudomonas aeruginosa ]]
*[[Acinetobacter]] sp. 
*[[Stenotrophomonas maltophilia]]
|}

==Clinical Features==
*[[Fever]], chills, pleuritic [[chest pain]], productive [[cough]]
**Fever is seen in 80%
*Tachypnea
**Most sensitive sign in elderly 
*[[Abdominal pain]], [[nausea and vomiting]], [[diarrhea]] may be seen with [[Legionella]] infection
*Myalgia, fatigue and headache especially in cases of atypical organism involvement.

==Differential Diagnosis==
{{SOB DDX}}

==Evaluation==
[[File:PneumonisWedge09.jpg|thumb|[[CXR]] showing prominent wedge-shape area of airspace consolidation in the right lung, characteristic of bacterial [[pneumonia]].]]
[[File:CT scan of the chest, demonstrating right-sided pneumonia.jpg|thumb|CT chest showing right sided pneumonia]]
*[[CXR]]
*CBC 
*Chemistry

If patient will be admitted: 

*[[Blood Cultures]] are '''ONLY''' indicated for CAP patients with:
**ICU (required)
**Multi-lobar
**Pleural effusion
**Consider for higher-risk patients admitted with CAP 
***Liver disease
***Immunocompromised
***Significant comorbidities
***Other risk factors
*Sputum staining 
**If concern for particular organism
===Chest X-Ray Mimics===
*Malignancy
*Tuberculosis
*[[Pulmonary embolism]] - Hampton's hump
*Atelectasis
*[[ARDS]]
*[[Diffuse alveolar hemorrhage]]
*Multiple "cannonball" infiltrates
**Metastatic disease
**Septic emboli
**Right sided [[endocarditis]]

==Management==
{{Pneumonia Antibiotics}}

==Disposition==
{{Port score}}

==See Also==
*[[Pneumonia (Pathogens)]]
*[[Pneumonia (Peds)]]
*[[Ventilator associated pneumonia]]

==External Links==
*[http://www.mdcalc.com/curb-65-severity-score-community-acquired-pneumonia/ MDCalc - CURB-65 Severity Score]
*[http://www.mdcalc.com/psi-port-score-pneumonia-severity-index-adult-cap/ MDCalc - PSI/PORT Score]

==References==
<references/>

[[Category:ID]]
[[Category:Pulmonary]]