Community-acquired pneumonia

Resident Survival Guide

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Overview
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Classification
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Differentiating Community-acquired pneumonia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Severity Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
Ultrasound
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Treatment
Hospital Admission Decision
Medical Therapy
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Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Nazma Hanif, MD[3]

Assistant Editor-In-Chief: Simran Singh

Synonyms and keywords: CAP

Classification

There is no established system for the classification of community-acquired pneumonia. However it can be classified according to severity using the Pneumonia Severity Index (PSI) score and CURB-65 Score.

The PSI score is calculated using factors like age, demographic factors, comorbid illnesses, physical exam findings, radiographic and laboratory findings. Based on these factors, the severity of the disease can be classified into five risk categories. Patients in Risk Class 1 to II can be managed in outpatient settings with oral antibiotics. Patients in Risk Class III can be managed in outpatient or inpatient settings after evaluation of risk factors. Patients in class IV and V should be admitted in the hospital for treatment. Risk Class I - III represents mortality of 0.1 - 0.9% whereas risk class V represent a 27% probability of mortality.

The CURB-65 score is also used to categorize patients according to disease severity. It is calculated using the following factors:

New onset of Confusion.
Blood Urea Nitrogen > 7 mmol/L or > 20 mg/dL.
Respiratory Rate > 30 breaths/minute.
Blood pressure less than 90 mmHg SBP or less than 60 DBP.
Age > 65 years.

Patients can be treated as outpatient with a score of 0 - 1, whereas score of 3 - 5 requires hospitalization. CRB-65 is a simplified version of the score which is sometimes used in primary care settings for decision making. Hospitalization is recommended if one or more points are present.

Screening

There is insufficient evidence to recommend routine screening for pneumonia.

Diagnosis

Severity Criteria | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | Ultrasound | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1