| Community Acquired Pneumonia (CAP) is a common | | | | patient I had years ago whose only symptoms were |
| and potentially serious infection of the lungs. It can | | | | flank pain and fever. He was convinced he had |
| lead to hospitalization and death in the elderly or | | | | kidney stones but the clinical exam and other tests |
| those who have significant, pre-existing illnesses. | | | | did not match the picture. |
| Bacteria, viruses and fungus can all cause pneumonia. | | | | So despite the importance of listening to the patient's |
| Viral and fungal causes of pneumonia are not typical. | | | | symptoms, the diagnosis can't be made without a |
| This is important because the antibiotic chosen for | | | | thorough clinical exam and when appropriate, |
| treatment depends on the causative agent. Since | | | | diagnostic tests. |
| X-rays and typical out-patient lab work do not | | | | X-rays |
| identify the causative agent, treatment is based on | | | | It may take several days for a pneumonia to show |
| the most likely cause. Typically, CAP is caused by | | | | up on x-ray. That's why x-rays may not be ordered |
| bacteria of which the most common is Streptococcus | | | | by your provider. |
| pneumoniae. | | | | Blood work |
| Who needs to be hospitalized? | | | | Depending on the clinical exam, your age and any |
| For the most part, otherwise healthy individuals with | | | | other chronic illnesses, your provider may decide to |
| no significant pre-existing illness can be treated for | | | | order blood work. |
| pneumonia as an outpatient. | | | | In the early stages of pneumonia, these tests may |
| Hospitalization depends on the following factors: | | | | come back normal so that's why in an otherwise |
| - Age >65 years | | | | healthy adult, your provider may decide to treat you |
| - Presence of other chronic illnesses (heart, kidney or | | | | with antibiotics, rather than order these tests. |
| lung problems, poorly controlled diabetes are the main | | | | Treatment |
| ones) | | | | Certain classes of antibiotics are ordered depending |
| - People on immunosuppressants (cancer or HIV | | | | on the likely causative agent, your age and whether |
| patients) | | | | you've been treated with an antibiotic within the last |
| - Cognitive or physical disabilities | | | | three months. |
| - Severity of presenting symptoms (breathing rate, | | | | With the exception of azithromycin, treatment with |
| blood pressure, confusion etc) | | | | traditional antibiotics lasts anywhere from 7-14 days |
| What are the symptoms of CAP? | | | | depending on the type of antibiotic used. |
| - Fever >100.4 | | | | Azithromycin is generally a 5 day course but it |
| - Cough with or without sputum | | | | continues to work in your system for about 10 days. |
| - Wheezing | | | | Recovery |
| - Pleuritic chest pain (sharp, stabbing pain with | | | | Over 70% of people with pneumonia continue to |
| breathing) | | | | report fatigue one month after being treated. |
| - Heart rate >100 beats/minute | | | | Although usual activities may resume a week or so |
| - Respiration rate >20 breaths/minute | | | | after treatment finishes, don't expect to be back to |
| - Fatigue | | | | your usual self. This does not mean that you still |
| - Body aches, chills, nausea, vomiting or diarrhea can | | | | have pneumonia unless your symptoms continue to |
| also be associated with CAP | | | | persist. In the vast majority of cases, it just means |
| Diagnosis | | | | that it takes time to fully return to your baseline. |
| The more symptoms present, the more likely the | | | | Remember - don't self diagnose. See your provider if |
| diagnosis. However, you don't need to have every | | | | you have any concerns. |
| one of them to have pneumonia. I'm reminded of a | | | | |