Community-acquired pneumonia risk factors: Difference between revisions

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__NOTOC__
__NOTOC__
{{Community-acquired pneumonia}}
{{Community-acquired pneumonia}}
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; Associate Editor(s)-In-Chief: [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com], [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com]
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com]; {{chetan}}; {{AL}}


==Overview==
==Overview==


The risk factors for pneumonia include: smoking, age, immuno-suppression, exposure to chemicals, underlying lung disease, and exposure to chemicals.
The risk factors for pneumonia include: smoking, age, immunosuppression, exposure to chemicals, underlying lung disease, and exposure to chemicals.


==Risk Factors==
==Risk Factors==
===Risk Factors Related to Specific Causative Pathogens===
{| style="border: 0px; font-size: 85%; margin: 3px; width:500px;" align=center
|valign=top|
|+
! style="background: #4479BA; color:#FFF;  width: 150px;" | Condition
! style="background: #4479BA; color:#FFF;  width: 350px;" | Most Common Pathogens
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Alcoholism
| style="padding: 5px 5px; background: #F5F5F5;" | [[Streptococcus pneumoniae]], oral [[anaerobes]], [[Klebsiella pneumoniae]], [[Acinetobacter spp]], [[Mycobacterium tuberculosis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | COPD
| style="padding: 5px 5px; background: #F5F5F5;" |[[Haemophilus influenzae]], [[Pseudomonas aeruginosa]], [[Legionella spp]], [[S. pneumoniae]], [[Moraxella catarrhalis]], [[Chlamydophila pneumoniae]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Smoking
| style="padding: 5px 5px; background: #F5F5F5;" |[[Haemophilus influenzae]], [[Pseudomonas aeruginosa]], [[Legionella spp]], [[S. pneumoniae]], [[Moraxella catarrhalis]], [[Chlamydophila pneumoniae]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Aspiration
| style="padding: 5px 5px; background: #F5F5F5;" | Oral [[anaerobes]], [[Gram-negative]] enteric bacteria
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Lung Abscess
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired [[MRSA]], [[M. tuberculosis]], oral [[anaerobes]], [[atypical mycobacteria]], endemic fungal infection
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Early HIV infection
| style="padding: 5px 5px; background: #F5F5F5;" | [[S. pneumoniae]], [[H. influenzae]], [[M. tuberculosis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Late HIV infection
| style="padding: 5px 5px; background: #F5F5F5;" | [[S. pneumoniae]], [[H. influenzae]], [[M. tuberculosis]], [[Pneumocystis jirovecii]], [[Cryptococcus]], [[Histoplasma]], [[Aspergillus]], [[atypical mycobacteria]] (especially [[Mycobacterium kansasii]]), [[P.aeruginosa]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | > 2 weeks of cough with whoop or vomiting
| style="padding: 5px 5px; background: #F5F5F5;" | [[Bordetella pertussis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Structural lung disease
| style="padding: 5px 5px; background: #F5F5F5;" | [[P. aeruginosa]], [[Burkholderia cepacia]], [[S. aureus]] 
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | IV drug use
| style="padding: 5px 5px; background: #F5F5F5;" |  [[S. aureus]], [[anaerobes]], [[M. tuberculosis]], [[S. pneumoniae]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Bioterrorism
| style="padding: 5px 5px; background: #F5F5F5;" | [[Bacillus anthracis]] ([[anthrax]]), [[Yersinia pestis]] ([[plague]]), [[Francisella tularensis]] ([[tularemia]])
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Endobronchial obstruction
| style="padding: 5px 5px; background: #F5F5F5;" | [[S. pneumoniae]], [[anaerobes]], [[H influenzae]], [[S. aureus]]
|-
| style="padding: 0px 5px; background: #DCDCDC;" colspan= 2|<small>Table adapted from IDSA/ATS Guidelines for CAP in Adults <ref name="MandellWunderink2007">{{cite journal|last1=Mandell|first1=L. A.|last2=Wunderink|first2=R. G.|last3=Anzueto|first3=A.|last4=Bartlett|first4=J. G.|last5=Campbell|first5=G. D.|last6=Dean|first6=N. C.|last7=Dowell|first7=S. F.|last8=File|first8=T. M.|last9=Musher|first9=D. M.|last10=Niederman|first10=M. S.|last11=Torres|first11=A.|last12=Whitney|first12=C. G.|title=Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults|journal=Clinical Infectious Diseases|volume=44|issue=Supplement 2|year=2007|pages=S27–S72|issn=1058-4838|doi=10.1086/511159}}</ref></small>
|}
====Exposure to Animals====
{| style="border: 0px; font-size: 85%; margin: 3px; width:500px;" align=center
|valign=top|
|+
! style="background: #4479BA; color:#FFF;  width: 150px;" | Animals
! style="background: #4479BA; color:#FFF;  width: 350px;" | Most Common Pathogens
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Bat or bird droppings
| style="padding: 5px 5px; background: #F5F5F5;" | [[Histoplasma capsulatum]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Birds
| style="padding: 5px 5px; background: #F5F5F5;" | [[Chlamydophila psittaci]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Rabbits
| style="padding: 5px 5px; background: #F5F5F5;" | [[Francisella tularensis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Farm animals or parturient cats
| style="padding: 5px 5px; background: #F5F5F5;" | [[Coxiella burnetti]] ([[Q fever]])
|-
| style="padding: 0px 5px; background: #DCDCDC;" colspan= 2|<small>Table adapted from IDSA/ATS Guidelines for CAP in Adults <ref name="MandellWunderink2007">{{cite journal|last1=Mandell|first1=L. A.|last2=Wunderink|first2=R. G.|last3=Anzueto|first3=A.|last4=Bartlett|first4=J. G.|last5=Campbell|first5=G. D.|last6=Dean|first6=N. C.|last7=Dowell|first7=S. F.|last8=File|first8=T. M.|last9=Musher|first9=D. M.|last10=Niederman|first10=M. S.|last11=Torres|first11=A.|last12=Whitney|first12=C. G.|title=Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults|journal=Clinical Infectious Diseases|volume=44|issue=Supplement 2|year=2007|pages=S27–S72|issn=1058-4838|doi=10.1086/511159}}</ref></small>
|}
====Travel====
{| style="border: 0px; font-size: 85%; margin: 3px; width:500px;" align=center
|valign=top|
|+
! style="background: #4479BA; color:#FFF;  width: 150px;" | Condition
! style="background: #4479BA; color:#FFF;  width: 350px;" | Most Common Pathogens
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Hotel or cruise ship stay
| style="padding: 5px 5px; background: #F5F5F5;" | [[Legionella spp]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Travel to southwestern US
| style="padding: 5px 5px; background: #F5F5F5;" | [[Coccidioides spp]], [[Hantavirus]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Travel to southeast or east Asia
| style="padding: 5px 5px; background: #F5F5F5;" | [[Burkholderia pseudomallei]], [[avian influenza]], [[SARS]]
|-
| style="padding: 0px 5px; background: #DCDCDC;" colspan= 2|<small>Table adapted from IDSA/ATS Guidelines for CAP in Adults <ref name="MandellWunderink2007">{{cite journal|last1=Mandell|first1=L. A.|last2=Wunderink|first2=R. G.|last3=Anzueto|first3=A.|last4=Bartlett|first4=J. G.|last5=Campbell|first5=G. D.|last6=Dean|first6=N. C.|last7=Dowell|first7=S. F.|last8=File|first8=T. M.|last9=Musher|first9=D. M.|last10=Niederman|first10=M. S.|last11=Torres|first11=A.|last12=Whitney|first12=C. G.|title=Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults|journal=Clinical Infectious Diseases|volume=44|issue=Supplement 2|year=2007|pages=S27–S72|issn=1058-4838|doi=10.1086/511159}}</ref></small>
|}


====Obstruction====
====Obstruction====


* When part of the airway ([[bronchi]]) leading to the alveoli is obstructed, the lung is not able to clear fluid when it accumulates. This can lead to infection of the fluid resulting in CAP.
* Airway obstruction may cause fluid accumulation in the lungs and result in CAP if the fluids become infected.


* One cause of obstruction, especially in young children, is inhalation of a foreign object such as a marble or toy. The object is lodged in the small airways and pneumonia can form in the trapped areas of lung.
* One cause of obstruction, especially in young children, is inhalation of a foreign object such as a marble or toy. The object is lodged in the small airways and [[pneumonia]] can form in the trapped areas of lung.


* Another cause of obstruction is [[lung cancer]], which can grow into the airways blocking the flow of air.
* Another cause of obstruction is [[lung cancer]], which can grow into the airways blocking the flow of air.
Line 22: Line 108:


* In children, recurrent episodes of CAP may be the first clue to diseases such as [[cystic fibrosis]] or [[pulmonary sequestration]].
* In children, recurrent episodes of CAP may be the first clue to diseases such as [[cystic fibrosis]] or [[pulmonary sequestration]].
* [[Hypoxemia]]
* [[Hypoxemia]]
* [[Pulmonary edema]]
* [[Pulmonary edema]]
* [[Chronic obstructive pulmonary disease|Chronic obstructive pulmonary disease (COPD)]]
* [[Chronic obstructive pulmonary disease|Chronic obstructive pulmonary disease (COPD)]]
* Previous episode of [[pneumonia]] or [[chronic bronchitis]]
* Previous episode of [[pneumonia]] or [[chronic bronchitis]]


====Immune Problems====
====Immune Problems====


* People who have [[Immunodeficiency|immune system problems]] are more likely to get CAP.
* People who have [[Immunodeficiency|immune disorders]] are more likely to acquire CAP.


* Risk factors for increased mortality from community acquired pneumonia are active [[malignancy]], immunosuppression, neurological disease, [[congestive heart failure]], [[coronary artery disease]], and [[diabetes mellitus]].
* Risk factors for increased mortality from community-acquired pneumonia are: active [[malignancy]], immunosuppression, neurological disease, [[congestive heart failure]], [[coronary artery disease]], and [[diabetes mellitus]].


* People who have [[AIDS]] are much more likely to develop CAP. Pneumonia could be the first manifestation of an underlying undiagnosed [[HIV]]. It is thus recommended by the Center for Disease Control (CDC) that all patients aged 13 to 64 in a medical setting regardless of known risk factors be screened for HIV. The American College of Physicians and HIV Medicine Association recommends expanding screening for HIV from age 13 to 75 <ref name="pmid19047021">{{cite journal |author= |title=Summaries for patients. Screening for HIV infection in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association |journal=[[Annals of Internal Medicine]] |volume=150 |issue=2 |pages=I–44 |year=2009 |month=January |pmid=19047021 |doi= |url=http://www.annals.org/article.aspx?volume=150&page=I |accessdate=2012-09-04}}</ref>, <ref name="pmid19047022">{{cite journal |author=Qaseem A, Snow V, Shekelle P, Hopkins R, Owens DK |title=Screening for HIV in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association |journal=[[Annals of Internal Medicine]] |volume=150 |issue=2 |pages=125–31 |year=2009 |month=January |pmid=19047022 |doi= |url=http://www.annals.org/article.aspx?volume=150&page=125 |accessdate=2012-09-04}}</ref>.
* People who have [[AIDS]] are much more likely to develop CAP. Pneumonia could be the first manifestation of an underlying undiagnosed [[HIV]]. It is, thus, recommended by the Center for Disease Control (CDC) that all patients aged 13 to 64 in a medical setting, regardless of known risk factors, be screened for HIV. The American College of Physicians and HIV Medicine Association recommends expanding screening for [[HIV]] from age 13 to 75 <ref name="pmid19047021">{{cite journal |author= |title=Summaries for patients. Screening for HIV infection in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association |journal=[[Annals of Internal Medicine]] |volume=150 |issue=2 |pages=I–44 |year=2009 |month=January |pmid=19047021 |doi= |url=http://www.annals.org/article.aspx?volume=150&page=I |accessdate=2012-09-04}}</ref>, <ref name="pmid19047022">{{cite journal |author=Qaseem A, Snow V, Shekelle P, Hopkins R, Owens DK |title=Screening for HIV in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association |journal=[[Annals of Internal Medicine]] |volume=150 |issue=2 |pages=125–31 |year=2009 |month=January |pmid=19047022 |doi= |url=http://www.annals.org/article.aspx?volume=150&page=125 |accessdate=2012-09-04}}</ref>.


* Other immune problems range from severe immune deficiencies of childhood such as [[Wiskott-Aldrich syndrome]] to less severe deficiencies such as [[common variable immunodeficiency]].{{ref|Mundy}}
* Other immune problems range from severe immune deficiencies from childhood, such as [[Wiskott-Aldrich syndrome]], to less severe deficiencies, such as [[common variable immunodeficiency]].{{ref|Mundy}}


* Elderly people are affected with increased incidence and severity of community acquired pneumonia. It is the fifth most common cause of death among individuals who are > 65 years of age, and fourth in individuals who are 85 years or older. The clinical picture in elderly could be subtle and could present only as delirium without any fever, cough or sputum. Therefore, a high index of suspicion should be kept in these groups of people.
* Elderly people are affected with increased incidence and severity of community-acquired pneumonia. It is the fifth most common cause of death amongst individuals who are greater than 65 years of age, and it is the fourth most common cause of death in individuals who are 85 years or older. The clinical picture in elderly could be subtle and it could be present only as [[delirium]] without any [[fever]], [[cough]] or [[sputum]]. Therefore, a high index of suspicion should be kept in these groups of people.


* [[Immotile cilia syndrome]]
* [[Immotile cilia syndrome]]
 
* [[Kartagener's syndrome]] (ciliary dysfunction, [[situs inversus]], [[sinusitis]], [[bronchiectasis]])
* [[Kartagener's syndrome]] (ciliary dysfunction, situs inversus, [[sinusitis]], [[bronchiectasis]])
* [[Young's syndrome]] ([[azoospermia]], [[sinusitis]], [[pneumonia]])
* [[Young's syndrome]] ([[azoospermia]], [[sinusitis]], [[pneumonia]])


====Other Risk factors====
====Other Risk Factors====


A few other conditions can lead to pneumonia due to altered normal mechanism of lung defense.<ref name="Almirall-1999">{{Cite journal  | last1 = Almirall | first1 = J. | last2 = Bolíbar | first2 = I. | last3 = Balanzó | first3 = X. | last4 = González | first4 = CA. | title = Risk factors for community-acquired pneumonia in adults: a population-based case-control study. | journal = Eur Respir J | volume = 13 | issue = 2 | pages = 349-55 | month = Feb | year = 1999 | doi =  | PMID = 10065680 }}</ref>
A few other conditions may lead to [[pneumonia]] due to altered pulmonary defense mechanisms.<ref name="Almirall-1999">{{Cite journal  | last1 = Almirall | first1 = J. | last2 = Bolíbar | first2 = I. | last3 = Balanzó | first3 = X. | last4 = González | first4 = CA. | title = Risk factors for community-acquired pneumonia in adults: a population-based case-control study. | journal = Eur Respir J | volume = 13 | issue = 2 | pages = 349-55 | month = Feb | year = 1999 | doi =  | PMID = 10065680 }}</ref>


* [[Dysphagia]] due to esophageal lesions and motility problems
* [[Dysphagia]] due to esophageal lesions and motility problems
* [[HIV]] infection (especially for pneumococcal pneumonia)  
 
* [[HIV]] infection (especially for [[pneumococcal]] pneumonia)


====Drugs====
====Drugs====


=====Acid suppressing drugs=====
=====Acid-Suppressing Drugs=====


* Usage of H2 blockers, proton pump inhibitors, and antacids may increase the pH and hence as a result may increase the risk of pneumonia.<ref name="Laheij-2004">{{Cite journal  | last1 = Laheij | first1 = RJ. | last2 = Sturkenboom | first2 = MC. | last3 = Hassing | first3 = RJ. | last4 = Dieleman | first4 = J. | last5 = Stricker | first5 = BH. | last6 = Jansen | first6 = JB. | title = Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. | journal = JAMA | volume = 292 | issue = 16 | pages = 1955-60 | month = Oct | year = 2004 | doi = 10.1001/jama.292.16.1955 | PMID = 15507580 }}</ref><ref name="Gulmez-2007">{{Cite journal  | last1 = Gulmez | first1 = SE. | last2 = Holm | first2 = A. | last3 = Frederiksen | first3 = H. | last4 = Jensen | first4 = TG. | last5 = Pedersen | first5 = C. | last6 = Hallas | first6 = J. | title = Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. | journal = Arch Intern Med | volume = 167 | issue = 9 | pages = 950-5 | month = May | year = 2007 | doi = 10.1001/archinte.167.9.950 | PMID = 17502537 }}</ref><ref name="Hermos-2012">{{Cite journal  | last1 = Hermos | first1 = JA. | last2 = Young | first2 = MM. | last3 = Fonda | first3 = JR. | last4 = Gagnon | first4 = DR. | last5 = Fiore | first5 = LD. | last6 = Lawler | first6 = EV. | title = Risk of community-acquired pneumonia in veteran patients to whom proton pump inhibitors were dispensed. | journal = Clin Infect Dis | volume = 54 | issue = 1 | pages = 33-42 | month = Jan | year = 2012 | doi = 10.1093/cid/cir767 | PMID = 22100573 }}</ref>
* Usage of [[H2 blocker]]s, [[proton pump inhibitor]]s, and [[antacid]]s may increase the pH and, as a result, may increase the risk of [[pneumonia]].<ref name="Laheij-2004">{{Cite journal  | last1 = Laheij | first1 = RJ. | last2 = Sturkenboom | first2 = MC. | last3 = Hassing | first3 = RJ. | last4 = Dieleman | first4 = J. | last5 = Stricker | first5 = BH. | last6 = Jansen | first6 = JB. | title = Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. | journal = JAMA | volume = 292 | issue = 16 | pages = 1955-60 | month = Oct | year = 2004 | doi = 10.1001/jama.292.16.1955 | PMID = 15507580 }}</ref><ref name="Gulmez-2007">{{Cite journal  | last1 = Gulmez | first1 = SE. | last2 = Holm | first2 = A. | last3 = Frederiksen | first3 = H. | last4 = Jensen | first4 = TG. | last5 = Pedersen | first5 = C. | last6 = Hallas | first6 = J. | title = Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. | journal = Arch Intern Med | volume = 167 | issue = 9 | pages = 950-5 | month = May | year = 2007 | doi = 10.1001/archinte.167.9.950 | PMID = 17502537 }}</ref><ref name="Hermos-2012">{{Cite journal  | last1 = Hermos | first1 = JA. | last2 = Young | first2 = MM. | last3 = Fonda | first3 = JR. | last4 = Gagnon | first4 = DR. | last5 = Fiore | first5 = LD. | last6 = Lawler | first6 = EV. | title = Risk of community-acquired pneumonia in veteran patients to whom proton pump inhibitors were dispensed. | journal = Clin Infect Dis | volume = 54 | issue = 1 | pages = 33-42 | month = Jan | year = 2012 | doi = 10.1093/cid/cir767 | PMID = 22100573 }}</ref>
*A similiar study showed increase risk of pneumonia after starting PPI especially 48 hrs ago.<ref name="Laheij-2004">{{Cite journal  | last1 = Laheij | first1 = RJ. | last2 = Sturkenboom | first2 = MC. | last3 = Hassing | first3 = RJ. | last4 = Dieleman | first4 = J. | last5 = Stricker | first5 = BH. | last6 = Jansen | first6 = JB. | title = Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. | journal = JAMA | volume = 292 | issue = 16 | pages = 1955-60 | month = Oct | year = 2004 | doi = 10.1001/jama.292.16.1955 | PMID = 15507580 }}</ref><ref name="Gulmez-2007">{{Cite journal  | last1 = Gulmez | first1 = SE. | last2 = Holm | first2 = A. | last3 = Frederiksen | first3 = H. | last4 = Jensen | first4 = TG. | last5 = Pedersen | first5 = C. | last6 = Hallas | first6 = J. | title = Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. | journal = Arch Intern Med | volume = 167 | issue = 9 | pages = 950-5 | month = May | year = 2007 | doi = 10.1001/archinte.167.9.950 | PMID = 17502537 }}</ref><ref name="Hermos-2012">{{Cite journal  | last1 = Hermos | first1 = JA. | last2 = Young | first2 = MM. | last3 = Fonda | first3 = JR. | last4 = Gagnon | first4 = DR. | last5 = Fiore | first5 = LD. | last6 = Lawler | first6 = EV. | title = Risk of community-acquired pneumonia in veteran patients to whom proton pump inhibitors were dispensed. | journal = Clin Infect Dis | volume = 54 | issue = 1 | pages = 33-42 | month = Jan | year = 2012 | doi = 10.1093/cid/cir767 | PMID = 22100573 }}</ref>


* Several other conditions were also associated with usage of PPI whcih would lead us to believe that there may be some confounding factor.<ref name="Jena-2013">{{Cite journal  | last1 = Jena | first1 = AB. | last2 = Sun | first2 = E. | last3 = Goldman | first3 = DP. | title = Confounding in the association of proton pump inhibitor use with risk of community-acquired pneumonia. | journal = J Gen Intern Med | volume = 28 | issue = 2 | pages = 223-30 | month = Feb | year = 2013 | doi = 10.1007/s11606-012-2211-5 | PMID = 22956446 }}</ref>
* A similiar study showed increase risk of pneumonia after starting [[PPI]], especially within the first 48 hours.<ref name="Laheij-2004">{{Cite journal  | last1 = Laheij | first1 = RJ. | last2 = Sturkenboom | first2 = MC. | last3 = Hassing | first3 = RJ. | last4 = Dieleman | first4 = J. | last5 = Stricker | first5 = BH. | last6 = Jansen | first6 = JB. | title = Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. | journal = JAMA | volume = 292 | issue = 16 | pages = 1955-60 | month = Oct | year = 2004 | doi = 10.1001/jama.292.16.1955 | PMID = 15507580 }}</ref><ref name="Gulmez-2007">{{Cite journal  | last1 = Gulmez | first1 = SE. | last2 = Holm | first2 = A. | last3 = Frederiksen | first3 = H. | last4 = Jensen | first4 = TG. | last5 = Pedersen | first5 = C. | last6 = Hallas | first6 = J. | title = Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. | journal = Arch Intern Med | volume = 167 | issue = 9 | pages = 950-5 | month = May | year = 2007 | doi = 10.1001/archinte.167.9.950 | PMID = 17502537 }}</ref><ref name="Hermos-2012">{{Cite journal  | last1 = Hermos | first1 = JA. | last2 = Young | first2 = MM. | last3 = Fonda | first3 = JR. | last4 = Gagnon | first4 = DR. | last5 = Fiore | first5 = LD. | last6 = Lawler | first6 = EV. | title = Risk of community-acquired pneumonia in veteran patients to whom proton pump inhibitors were dispensed. | journal = Clin Infect Dis | volume = 54 | issue = 1 | pages = 33-42 | month = Jan | year = 2012 | doi = 10.1093/cid/cir767 | PMID = 22100573 }}</ref> However, the association between [[PPI]] and [[CAP]] may be cofounded.<ref name="Jena-2013">{{Cite journal  | last1 = Jena | first1 = AB. | last2 = Sun | first2 = E. | last3 = Goldman | first3 = DP. | title = Confounding in the association of proton pump inhibitor use with risk of community-acquired pneumonia. | journal = J Gen Intern Med | volume = 28 | issue = 2 | pages = 223-30 | month = Feb | year = 2013 | doi = 10.1007/s11606-012-2211-5 | PMID = 22956446 }}</ref>


======Antipsychotic drugs======
======Antipsychotic Drugs======


* A case control study has shown a significant correlation between using antipsychotic drugs and community acquired pneumonia. A 60 percent increase in the rate of pneumonia can be seen in elderly patients on anti-psychotic medications.<ref name="Knol-2008">{{Cite journal  | last1 = Knol | first1 = W. | last2 = van Marum | first2 = RJ. | last3 = Jansen | first3 = PA. | last4 = Souverein | first4 = PC. | last5 = Schobben | first5 = AF. | last6 = Egberts | first6 = AC. | title = Antipsychotic drug use and risk of pneumonia in elderly people. | journal = J Am Geriatr Soc | volume = 56 | issue = 4 | pages = 661-6 | month = Apr | year = 2008 | doi = 10.1111/j.1532-5415.2007.01625.x | PMID = 18266664 }}</ref>
* A case control study has shown a significant correlation between the use of [[antipsychotic]] drugs and community-acquired pneumonia. A 60 percent increase in the rate of [[pneumonia]] can be seen in elderly patients who utilize antipsychotic medications.<ref name="Knol-2008">{{Cite journal  | last1 = Knol | first1 = W. | last2 = van Marum | first2 = RJ. | last3 = Jansen | first3 = PA. | last4 = Souverein | first4 = PC. | last5 = Schobben | first5 = AF. | last6 = Egberts | first6 = AC. | title = Antipsychotic drug use and risk of pneumonia in elderly people. | journal = J Am Geriatr Soc | volume = 56 | issue = 4 | pages = 661-6 | month = Apr | year = 2008 | doi = 10.1111/j.1532-5415.2007.01625.x | PMID = 18266664 }}</ref>


* Atypical antipsychotic was associated with an increases risk of community acquired pneumonia.
* The use of atypical antipsychotics was associated with an increases risk of community-acquired pneumonia.


======ACE inhibitors======
======ACE Inhibitors======


* A randomized trial has shown that ACE inhibitors when used reduces the risk of pneumonia.<ref name="Caldeira-2012">{{Cite journal  | last1 = Caldeira | first1 = D. | last2 = Alarcão | first2 = J. | last3 = Vaz-Carneiro | first3 = A. | last4 = Costa | first4 = J. | title = Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis. | journal = BMJ | volume = 345 | issue =  | pages = e4260 | month =  | year = 2012 | doi =  | PMID = 22786934 }}</ref>
* A randomized trial has shown that [[ACE inhibitor]]s reduce the risk of [[pneumonia]].<ref name="Caldeira-2012">{{Cite journal  | last1 = Caldeira | first1 = D. | last2 = Alarcão | first2 = J. | last3 = Vaz-Carneiro | first3 = A. | last4 = Costa | first4 = J. | title = Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis. | journal = BMJ | volume = 345 | issue =  | pages = e4260 | month =  | year = 2012 | doi =  | PMID = 22786934 }}</ref>


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:primary care]]

Latest revision as of 21:02, 29 July 2020

Pneumonia Main Page

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]; Philip Marcus, M.D., M.P.H.[3]; Chetan Lokhande, M.B.B.S [4]; Alejandro Lemor, M.D. [5]

Overview

The risk factors for pneumonia include: smoking, age, immunosuppression, exposure to chemicals, underlying lung disease, and exposure to chemicals.

Risk Factors

Risk Factors Related to Specific Causative Pathogens
Condition Most Common Pathogens
Alcoholism Streptococcus pneumoniae, oral anaerobes, Klebsiella pneumoniae, Acinetobacter spp, Mycobacterium tuberculosis
COPD Haemophilus influenzae, Pseudomonas aeruginosa, Legionella spp, S. pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae
Smoking Haemophilus influenzae, Pseudomonas aeruginosa, Legionella spp, S. pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae
Aspiration Oral anaerobes, Gram-negative enteric bacteria
Lung Abscess Community-acquired MRSA, M. tuberculosis, oral anaerobes, atypical mycobacteria, endemic fungal infection
Early HIV infection S. pneumoniae, H. influenzae, M. tuberculosis
Late HIV infection S. pneumoniae, H. influenzae, M. tuberculosis, Pneumocystis jirovecii, Cryptococcus, Histoplasma, Aspergillus, atypical mycobacteria (especially Mycobacterium kansasii), P.aeruginosa
> 2 weeks of cough with whoop or vomiting Bordetella pertussis
Structural lung disease P. aeruginosa, Burkholderia cepacia, S. aureus
IV drug use S. aureus, anaerobes, M. tuberculosis, S. pneumoniae
Bioterrorism Bacillus anthracis (anthrax), Yersinia pestis (plague), Francisella tularensis (tularemia)
Endobronchial obstruction S. pneumoniae, anaerobes, H influenzae, S. aureus
Table adapted from IDSA/ATS Guidelines for CAP in Adults [1]

Exposure to Animals
Animals Most Common Pathogens
Bat or bird droppings Histoplasma capsulatum
Birds Chlamydophila psittaci
Rabbits Francisella tularensis
Farm animals or parturient cats Coxiella burnetti (Q fever)
Table adapted from IDSA/ATS Guidelines for CAP in Adults [1]

Travel
Condition Most Common Pathogens
Hotel or cruise ship stay Legionella spp
Travel to southwestern US Coccidioides spp, Hantavirus
Travel to southeast or east Asia Burkholderia pseudomallei, avian influenza, SARS
Table adapted from IDSA/ATS Guidelines for CAP in Adults [1]

Obstruction

  • Airway obstruction may cause fluid accumulation in the lungs and result in CAP if the fluids become infected.
  • One cause of obstruction, especially in young children, is inhalation of a foreign object such as a marble or toy. The object is lodged in the small airways and pneumonia can form in the trapped areas of lung.
  • Another cause of obstruction is lung cancer, which can grow into the airways blocking the flow of air.

Lung Disease

  • Smoking, and diseases such as emphysema, result in more frequent and severe bouts of CAP.

Immune Problems

  • People who have AIDS are much more likely to develop CAP. Pneumonia could be the first manifestation of an underlying undiagnosed HIV. It is, thus, recommended by the Center for Disease Control (CDC) that all patients aged 13 to 64 in a medical setting, regardless of known risk factors, be screened for HIV. The American College of Physicians and HIV Medicine Association recommends expanding screening for HIV from age 13 to 75 [2], [3].
  • Elderly people are affected with increased incidence and severity of community-acquired pneumonia. It is the fifth most common cause of death amongst individuals who are greater than 65 years of age, and it is the fourth most common cause of death in individuals who are 85 years or older. The clinical picture in elderly could be subtle and it could be present only as delirium without any fever, cough or sputum. Therefore, a high index of suspicion should be kept in these groups of people.

Other Risk Factors

A few other conditions may lead to pneumonia due to altered pulmonary defense mechanisms.[4]

  • Dysphagia due to esophageal lesions and motility problems

Drugs

Acid-Suppressing Drugs
  • A similiar study showed increase risk of pneumonia after starting PPI, especially within the first 48 hours.[5][6][7] However, the association between PPI and CAP may be cofounded.[8]
Antipsychotic Drugs
  • A case control study has shown a significant correlation between the use of antipsychotic drugs and community-acquired pneumonia. A 60 percent increase in the rate of pneumonia can be seen in elderly patients who utilize antipsychotic medications.[9]
  • The use of atypical antipsychotics was associated with an increases risk of community-acquired pneumonia.
ACE Inhibitors

References

  1. ↑ 1.0 1.1 1.2 Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). "Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults". Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.
  2. ↑ "Summaries for patients. Screening for HIV infection in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association". Annals of Internal Medicine. 150 (2): I–44. 2009. PMID 19047021. Retrieved 2012-09-04. Unknown parameter |month= ignored (help)
  3. ↑ Qaseem A, Snow V, Shekelle P, Hopkins R, Owens DK (2009). "Screening for HIV in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association". Annals of Internal Medicine. 150 (2): 125–31. PMID 19047022. Retrieved 2012-09-04. Unknown parameter |month= ignored (help)
  4. ↑ Almirall, J.; Bolíbar, I.; Balanzó, X.; González, CA. (1999). "Risk factors for community-acquired pneumonia in adults: a population-based case-control study". Eur Respir J. 13 (2): 349–55. PMID 10065680. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 Laheij, RJ.; Sturkenboom, MC.; Hassing, RJ.; Dieleman, J.; Stricker, BH.; Jansen, JB. (2004). "Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs". JAMA. 292 (16): 1955–60. doi:10.1001/jama.292.16.1955. PMID 15507580. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 Gulmez, SE.; Holm, A.; Frederiksen, H.; Jensen, TG.; Pedersen, C.; Hallas, J. (2007). "Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study". Arch Intern Med. 167 (9): 950–5. doi:10.1001/archinte.167.9.950. PMID 17502537. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 Hermos, JA.; Young, MM.; Fonda, JR.; Gagnon, DR.; Fiore, LD.; Lawler, EV. (2012). "Risk of community-acquired pneumonia in veteran patients to whom proton pump inhibitors were dispensed". Clin Infect Dis. 54 (1): 33–42. doi:10.1093/cid/cir767. PMID 22100573. Unknown parameter |month= ignored (help)
  8. ↑ Jena, AB.; Sun, E.; Goldman, DP. (2013). "Confounding in the association of proton pump inhibitor use with risk of community-acquired pneumonia". J Gen Intern Med. 28 (2): 223–30. doi:10.1007/s11606-012-2211-5. PMID 22956446. Unknown parameter |month= ignored (help)
  9. ↑ Knol, W.; van Marum, RJ.; Jansen, PA.; Souverein, PC.; Schobben, AF.; Egberts, AC. (2008). "Antipsychotic drug use and risk of pneumonia in elderly people". J Am Geriatr Soc. 56 (4): 661–6. doi:10.1111/j.1532-5415.2007.01625.x. PMID 18266664. Unknown parameter |month= ignored (help)
  10. ↑ Caldeira, D.; Alarcão, J.; Vaz-Carneiro, A.; Costa, J. (2012). "Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis". BMJ. 345: e4260. PMID 22786934.
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