Community-acquired pneumonia

Pneumonia is an acute inflammation of the respiratory bronchioles, alveolar structures and lung interstitium. The term "community-acquired pneumonia" (CAP) refers to a disease acquired outside the hospital, accounting for 80-90% of all pneumonia.

Pneumonia caused by pyogenic bacteria
It is a purulent type of inflammation. It can affect people of all ages. It typically occurs after a cold, short-term stress or exhaustion.

The most common pathogen causing Pneumonia is  Streptococcus pneumoniae , much more rarely caused by  Haemophilus influenzae ,  Moraxella catarrhalis ,  Klebsiella pneumoniae ,  Staphylococcus aureus , or conditionally pathogenic bacteria inhabiting the digestive tract ( Escherichia coli ,  Proteus spp. ,  Pseudomonas spp. , Anaerobic bacteria). Penicillin or cephalosporin antibiotics are used for therapy.

Pneumonia caused by mycoplasmas and chlamydia
This type is non-purulent interstitial pneumonia. It occurs as small epidemics in healthy people between 5-50 years. Etiological agent:  Mycoplasma pneumoniae, Chlamydophila pneumoniae . Doxycycline or macrolides are used in therapy, treatment time lasts at least 2 weeks.

Pneumonia caused by virus
It affects both adults and children, with the exception of the RS virus, which is typical for infants. Lymphotropic viruses cause pneumonia in people with immunodeficiency. Etiologic agents: respiratory viruses - viruses influenza A and B, parainfluenza virus,  RS virus, adenoviruses, coronaviruses, rarely also animal viruses (coronavirus SARS-CoV), lymphotropic viruses (cytomegalovirus in HIV / AIDS). Therapy requires hospitalization, oxygen therapy, symptomatic and supportive treatment, specific antivirals, corticosteroids (reduce the risk of fibrotic lung remodeling).

Legionella pneumonia
Most often in middle-aged patients with a history of long-term internal disease ( DM...).Etiologic agents:  Legionella pneumophila . Therapy usually requires hospitalization in the ICU, i.v. macrolides (clarithromycin, azithromycin) or fluoroquinolones (ciprofloxacin, ofloxacin).

Pneumonia caused by Mycobacterium tuberculosis
It typically occurs in immigrants from developing countries, in socially disadvantaged people, and exceptionally in properly vaccinated people after long-term stress. Prior to treatment, repeated collection of material for cultivation is required, after finding acid-resistant rods, specific treatment is given, basic antituberculotics: isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol.

Pneumonia caused by Pneumocystis jiroveci
It affects people with severe immunodeficiency. High doses of co-trimoxazole i.v. or pentamidine i.v. are necessary, later by inhalation.

Treatment
Initial treatment is' 'empirical' 'and' 'outpatient', based on knowledge of the local epidemiological situation, predisposing factors and clinical symptoms. In immunocompetent individuals, in whom the course of the disease is usually without complications with typical clinical symptoms, initial empirical treatment is usually successful. The most commonly chosen model is 'oral  antibiotics'  in sufficient doses, well tolerated, with a broader spectrum of efficacy on respiratory pathogens and a prolonged effect (2-3 times daily). Efficacy can be verified in two to three days, in case of failure the antibiotic must be replaced by another treatment group. Because the most common cause of community-acquired pneumonia is Streptococcus pneumoniae, penicillin is the drug of first choice. A problem with this treatment is the increasing resistance of pneumococci to penicillin.

Related links

 * Clinical evaluation of pneumonia severity
 * Pneumonia