DR Medhat MRCP

1- General constitutional symptoms :
- (Fever), (headache),(malaise), (joins, ms &bone aches),(loss of appetite).
2- Chest symptoms :
- Cough with(or without) sputum.
- SOB.
- Pleuritic chest pain.
- May hemoptysis.
‣ Signs :
1- Tachypnoea with tachycardia.
2- + Cyanosis & cold clamy skin.
3- Dullness on percussion.
4- Bronchial breathing & crackles on auscultation.
5- Whispering pectoriloquy.
6- + Friction pleural rub.
Causative organisms
Streptococcus pneumoniae (most common cause of CAP , around 80% of cases)
Haemophilus influenzae
Staphylococcus aureus:
commonly after the Influenza infection
Atypical pneumonias (e.g. Due to Mycoplasma pneumonia,Chlamydia pneumonae/
psittaci, legionella)
Viruses (Rhinovirus ,adenovirus ,influenza ,respiratory syncytial vius & CMV ).
- Streptococcus pneumoniae commonly causes reactivation of the herpes simplex
virus resulting in “cold sores” and associated with foreign travel.
- Klebsiella pneumoniae (Friedlander's pneumonia) is classically in alcoholics
(aspiration) & immunosuppressed patients . CXR features may include abscess
formation in the middle/upper lobes and empyema. Mortality approaches 30-50%
- Staphylococcus aureus: normally causes pneumonia only AFTER a preceding
influenza viral infection. Characteristically causes multiple abscesses in up to 25%
of patients and empyema in 10%. Septicemia develops with metastatic abscess in
other organs such as brain and bones → TTT : Flucloxacillin (or ticoplanin if allergy)
& /or rifampicin
→ If MRSA → vancomycin
خد بالك مهم (CURB-65) - As long as the pathogen is not identified by C/S → treat as CAP
-
Community acquired pneumonia(CAP)