Diagnosis Of Bacterial Pneumonia
Tools to assess the severity of disease and risk of death include the PSI/PORT , the CURB-65 system, and the APACHE , among others.
The following laboratory tests are also useful for assessing illness severity:
Serum chemistry panel
Arterial blood gas determination
Venous blood gas determination
Complete blood cell count with differential
Serum free cortisol value
Serum lactate level
Sputum Gram stain and culture should be performed before initiating antibiotic therapy. A single predominant microbe should be noted at Gram staining, although mixed flora may be observed with anaerobic infection caused by aspiration.
Chest radiography: The criterion standard for establishing the diagnosis of pneumonia
Chest computed tomography scanning
Lung tissue can be visually evaluated and bronchial washing specimens can be obtained with the aid of a fiberoptic bronchoscope. Protected brushings and bronchoalveolar lavage can be performed for fluid analysis and cultures.
This is an essential procedure in patients with a parapneumonic pleural effusion. Analysis of the fluid allows differentiation between simple and complicated effusions.
Sputum, serum, and/or urinary antigen tests
Immune serologic tests
Histologic inflammatory lung changes vary according to whether the patient has lobar pneumonia, bronchopneumonia, or interstitial pneumonia.
If I Am Not Sure What Pathogen Is Causing The Infection What Anti
Chronic pneumonia is generally not a medical emergency, and the clinician has adequate time to conduct a reasonable assessment before having to decide on specific therapy. In most circumstances, empirical therapy is initiated once adequate diagnostic studies have been obtained. With the suspicion of aspiration pneumonia due to mixed aerobic and anaerobic bacteria, the combination of pipercillin/tazobactam or ampicillin/sulfabactam plus vancomycin or nafcillin is often utilized. Metronidazole may be added to this regimen if broader anaerobic coverage is desired.
For patients with respiratory samples revealing acid fast organisms, the patient should be placed in respiratory isolation and four-drug therapy with rifampin, isoniazid, pyarzinamide, and ethambutol should be initiated until confirmation of the organism as M. tuberculosis or a nontuberculous mycobacteria. Table I lists agents that typically cause chronic pneumonia.
Pneumonia And Long Covid
In a Q& A about lingering COVID-19 symptoms, the Cleveland Clinic notes that it is seemingly random who experiences long-lasting symptoms and who doesn’t. So, its not quite clear whether having pneumonia in the past is connected with having long COVID.
As a way to find answers, in 2021, the National Institutes of Health launched an ongoing study into the underlying biological causes of prolonged symptoms and what makes some people more likely to get long COVID.
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Viii How Should The Clinician Follow The Child With Cap For The Expected Response To Therapy
56.Children on adequate therapy should demonstrate clinical and laboratory signs of improvement within 4872 hours. For children whose condition deteriorates after admission and initiation of antimicrobial therapy or who show no improvement within 4872 hours, further investigation should be performed.
Things You Should Know About Pneumonia
Pneumonia is an infection that causes the air sacs in the lungs to fill up with fluid or pus, which makes it harder to breathe. The most common symptoms are cough that may be dry or produce phlegm, fever, chills and fatigue. Other symptoms may include nausea, vomiting, diarrhea, and pain in the chest. and shortness of breath. Signs that indicate a more severe infection are shortness of breath, confusion, decreased urination and lightheadedness. In the U.S., pneumonia accounts for 1.3 visits to the Emergency Department, and 50,000 deaths annually.
With the COVID-19 pandemic continuing to affect people around the world, pneumonia has become an even larger health concern. Some people infected with the COVID-19 have no symptoms, while others may experience fever, body ache, dry cough, fatigue, chills, headache, sore throat, loss of appetite, and loss of smell.
The more severe symptoms of COV-19, such as high fever, severe cough, and shortness of breath, usually mean significant lung involvement. The lungs can be damaged by overwhelming COVID-19 viral infection, severe inflammation, and/or a secondary bacterial pneumonia. COVID-19 can lead to long lasting lung damage.
Here are other important facts you should know about pneumonia:,
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What Laboratory Studies Should You Order And What Should You Expect To Find
Results consistent with the diagnosis
Routine laboratory studies provide important clues to the diagnosis of chronic pneumonia. Pancytopenia may suggest disseminated histoplasmosis, metastatic tumor, or miliary tuberculosis. Isolated anemia is commonly associated with chronic pneumonia and not particularly helpful in discerning a cause. A normal leukocyte count does not exclude infection, and, in particular, chronic fungal pneumonia may be associated with a normal or minimally elevated leukocyte count. Leukopenia or lymphopenia should raise suspicion of co-existing HIV infection and is also consistent with diagnosis of sarcoidosis, systemic lupus erythematosus, and histoplasmosis. Leukocytosis with polymorphonuclear cell predominance is suggestive of, but not diagnostic of, a bacterial infection.
C-reactive protein and an erythrocyte sedimentation rate can also be helpful studies. Both of these assays are typically elevated among patients with chronic pneumonia, but they are nonspecific abnormalities. Serologic tests for connective tissue disorders, including anti-nuclear antibodies , rheumatoid factor, and anti-neutrophil cytoplasmic autoantibodies can also be useful in this setting. Finally, angiotensin-converting enzyme is a useful, but nonspecific, assay with levels elevated in several granulomatous disorders, including sarcoidosis.
Results that confirm the diagnosis
Xvii How Should Nonresponders With Pulmonary Abscess Or Necrotizing Pneumonia Be Managed
76.A pulmonary abscess or necrotizing pneumonia identified in a nonresponding patient can be initially treated with intravenous antibiotics. Well-defined peripheral abscesses without connection to the bronchial tree may be drained under imaging-guided procedures either by aspiration or with a drainage catheter that remains in place, but most abscesses will drain through the bronchial tree and heal without surgical or invasive intervention.
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Patient Introduction Mona Hernandez Assessment Answers
Patient Introduction Mona Hernandez
Location: Medical Unit 1600
Report from day shift nurse:
Situation: Mrs. Hernandez is a 72-year-old Hispanic female who was admitted to the medical unit yesterday afternoon with a diagnosis of pneumonia in her right lobe. Chest X-ray shows infiltrates in right lower lobe, indicative of pneumonia. She was started on antibiotics after a sputum specimen for Gram stain culture was obtained. We are monitoring her respiratory status closely.
Background: Mrs. Hernandez was experiencing symptoms of dry cough, fever, and malaise, and was diagnosed with influenza 10 days prior to admission. Her symptoms got progressively worse, and yesterday she had a temperature of 38.4 °C , shaking, chills, and a productive cough of rust-colored sputum. Her primary care provider saw her yesterday and decided to admit her for treatment of pneumonia.
Assessment: Mrs. Hernandez is alert and oriented ×3, but appears tired. She reports sharp chest pain with coughing and shortness of breath with activity. She rated the pain as a 6 on a scale of 010 and was given acetaminophen 650 mg at 1400. Vitals signs were taken at 1200. Her temperature has been elevated since this morning and was 38.1 °C . Pulse is 104/min, respirations 24/min, and blood pressure 112/72 mm Hg. Her saturation was 95% on nasal cannula with oxygen at 3 L/min. Her respirations were labored when she came back from the bathroom, but improved when she settled back in bed.
Which Types Of Doctors Treat Pneumonia
In some cases, primary care physicians, including pediatricians, internists, and family medicine specialists, may manage the care for patients with pneumonia. In more severe cases, other types of specialists may be involved in treating the patient with pneumonia. These include infectious-disease specialists, pulmonologists, critical care specialists, and hospitalists.
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Early Lung Growth And Development
Respiratory infections with consequent inflammatory responses may interrupt the critical alveolarisation phase of lung development, restricting alveolar numbers and/or size and leading to often mild, but impaired lung growth. The association between pneumonia and obstructive lung disease is possibly through similar mechanisms to those leading to bronchiectasis, which is an obstructive lung disease. Lung infections at the peak periods of somatic lung growth may also alter the programming of lung development at a local or systemic level. The effects of early infection, especially viral lower respiratory tract infections, upon lung growth, programming and future lung function disease types are beyond the scope of this review and readers are referred to the respiratory literature .
How Did The Patient Develop Chronic Pneumonia What Was The Primary Source From Which The Infection Spread
Most cases of chronic pneumonia due to an infectious etiology result from inhalation of aerosolized organisms or aspiration of oral contents. As it relates to noninfectious causes of the chronic pneumonia syndrome, the lungs may be the primary target of disease , or the lungs may simply be innocent bystanders of a systemic disease .
Knowledge of the demographics and relevant epidemiology is key in trying to narrow ones focus to the potential etiologic agents in determining the specific cause of chronic pneumonia. Age, gender, and race may play important roles in the development of chronic pneumonias.
Occupation and hobbies are also important in the evaluation of these patients. For instance, tuberculosis is an important consideration among healthcare workers, incarcerated individuals, and recent immigrants from high incidence regions. Coccidioidomycosis is an important consideration among rock collectors, laboratory technicians, archeologists conducting excavations, and construction workers exposed to desert dust in endemic areas histoplasmosis is an important consideration in persons exposed to pigeon, starling, or bat roosts, or among those who clean old chicken houses with dirt floors and blastomycosis is an important consideration in forestry workers, heavy equipment operators, and campers and hunters from endemic areas.
Left Ventricular Dysfunction And Reversible Pulmonary Hypertension Secondary To Severe Pneumonia In A Background Of Sepsis: A Case Report And Review Of The Literature
Elaine N. Gitonga1, Junwu Wang1, Shengwei Yu1, Na Wu2, Haitao Shen1
1Department of Emergency Medicine, Shengjing Hospital of China Medical University , Shengjing Hospital of China Medical University , , China
Keywords: Pulmonary hypertension severe pneumonia sepsis sepsis-induced cardiomyopathy left ventricular dysfunction
Submitted Apr 21, 2020. Accepted for publication Sep 08, 2020.
Other Health Impacts And Risks
More generally, small particulate matter and other pollutants in indoor smoke inflame the airways and lungs, impairing immune response and reducing the oxygen-carrying capacity of the blood.
There is also evidence of links between household air pollution and low birth weight, tuberculosis, cataract, nasopharyngeal and laryngeal cancers.
Mortality from ischaemic heart disease and stroke are also affected by risk factors such as high blood pressure, unhealthy diet, lack of physical activity and smoking. Some other risks for childhood pneumonia include suboptimal breastfeeding, underweight and second-hand smoke. For lung cancer and chronic obstructive pulmonary disease, active smoking and second-hand tobacco smoke are also main risk factors.
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What Tests Diagnose Pneumonia
The diagnosis of pneumonia always begins with taking a medical history and performing a physical examination to look for characteristic signs. In particular, listening to the lungs may reveal areas where sound is diminished, wheezing, or crackling sounds in affected areas. Some commonly performed diagnostic tests are as follows:
- A chest X-ray is able to illustrate whether or not pneumonia is present, but it does not provide information about the organism responsible for the infection.
- In some cases, a chest CT scan may be performed. This will reveal more detail than the chest X-ray.
- Pulse oximetry measures the amount of oxygen in the bloodstream. The test involves a painless sensor attached to the finger or ear. Blood levels of oxygen may be reduced in pneumonia.
- Microbiology tests to identify the causative organism. Tests may be performed on blood or sputum. Rapid urine tests are available to identify Streptococcus pneumoniae and Legionella pneumophila. Cultures of blood or sputum not only identify the responsible organism but can also be examined to determine which antibiotics are effective against a particular bacterial strain.
- Bronchoscopy is a procedure in which a thin, lighted tube is inserted into the trachea and major airways. This allows the doctor to visualize the inside of the airways and take tissue samples if needed. Bronchoscopy may be performed in patients with severe pneumonia or if pneumonia worsens despite antibiotic treatment.
What Are The Symptoms And Signs Of Pneumonia
Infants and newborns may not show specific symptoms of pneumonia. Instead, the baby or child may appear restless or lethargic. A baby or child with pneumonia may also have a fever or cough or vomit. Older adults or those who have weak immune systems may also have fewer symptoms and a lower temperature. A change in mental status, such as confusion, can develop in older adults with pneumonia.
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How Serious Is Pneumonia In Older Adults
Adults 65 and older are more susceptible to pneumonia than younger people are. Seniors with pneumonia are also at increased risk for hospitalization, complications, and death.
Pneumonia in elderly adults can often be serious and progress quickly. In fact, pneumonia is the second leading cause for hospitalization of Medicare beneficiaries, and most of the people who die from pneumonia each year are elderly adults, according to the American Lung Association . The death rate among elderly adults with severe pneumonia is as high as 20%.
Researchers and doctors dont fully understand why pneumonia is more aggressive in seniors. They believe it has to do with the normal aging process, which weakens the immune system and decreases lung function. Older adults also often have other underlying health conditions that can make pneumonia more severe, including asthma, chronic obstructive pulmonary disease , and heart disease.
What Consult Service Or Services Would Be Helpful For Making The Diagnosis And Assisting With Treatment
If you decide the patient has chronic pneumonia, what therapies should you initiate immediately?
If the patient with chronic pneumonia is unable to produce adequate sputum samples, then a pulmonologist is most helpful in obtaining a deep specimen. Less commonly, a thoracic surgeon is needed to obtain tissue from an open lung biopsy, often using the video-assisted thorascopic surgery procedure. An infectious disease specialist can be very helpful with respect to considering less common diagnoses, especially those not evident following routine diagnostic studies.
For most patients presenting with chronic pneumonia, the condition does not constitute a medical emergency. Accordingly, there is usually time to establish a presumptive diagnosis before initiating antimicrobial therapy. As such, the patient with a clinical diagnosis of chronic pneumonia based on symptoms and abnormal imaging studies should undergo testing of expectorated sputum, if possible, immediately. Routine, acid fast, and fungal smears should be obtained on available specimens.
For suspected non-tuberculous mycobacterial disease, empiric therapy for nontuberculous infection requires considerable knowledge of the patients history for instance, a history of Mycobacterium avium infection in a patient with ongoing immunosuppression might warrant re-initiation of therapy directed at this organism.
1. Anti-infective agents
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Guidelines For Indoor Air Quality: Household Fuel Combustion
To ensure healthy air in and around the home, WHOâs Guidelines for indoor air quality: household fuel combustion provide health-based recommendations on the types of fuels and technologies to protect health as well as strategies for the effective dissemination and adoption of such home energy technologies. These build upon existing WHO outdoor air quality guidelines and WHO guidance on levels of specific indoor pollutants.
Emergent Pandemics And Superbugs
One of the worst worldwide pandemics was the Spanish flu that started in 1918. It killed about 3% of the world population and infected about 1/6 of all people. The bubonic plague in the 1300s infected about 1/4 of the Earths human population and killed an estimated 13%. The swine flu started in 2009 and infected about 1/4 of humanity but killed less than a hundredth of 1% of our population. Scientists have traced the first widespread series of cases of HIV/AIDS to 1981, but the disease probably jumped into humans in the early 1900s. Since then, about 1% of people on Earth are living with HIV, and about 1.5 million people per year die because of AIDS. About 2% of the human population deaths each year is from AIDS-related causes worldwide. Waves of disease are a regular occurrence throughout human history and becoming more common.
Disease epidemics that do not kill a large proportion of the human population are common. In the 1700s there were 13 epidemics and in the 1800s 12, with 5 pandemic influenza epidemics in the 1900s. The data suggest that roughly every 1020 years, there are epidemics with some mortality that infect a quarter to a third of the worlds population.
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Xviwhat Is The Appropriate Management Of A Child Who Is Not Responding To Treatment For Cap
72.Children who are not responding to initial therapy after 4872 hours should be managed by one or more of the following:
a. Clinical and laboratory assessment of the current severity of illness and anticipated progression in order to determine whether higher levels of care or support are required.
b. Imaging evaluation to assess the extent and progression of the pneumonic or parapneumonic process.
c. Further investigation to identify whether the original pathogen persists, the original pathogen has developed resistance to the agent used, or there is a new secondary infecting agent.
73.A BAL specimen should be obtained for Gram stain and culture for the mechanically ventilated child.
74.A percutaneous lung aspirate should be obtained for Gram stain and culture in the persistently and seriously ill child for whom previous investigations have not yielded a microbiologic diagnosis.
75.An open lung biopsy for Gram stain and culture should be obtained in the persistently and critically ill, mechanically ventilated child in whom previous investigations have not yielded a microbiologic diagnosis.