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* ''[[Streptococcus pneumoniae]]'' is the most common cause of community-acquired pneumonia.
* ''[[Streptococcus pneumoniae]]'' is the most common cause of community-acquired pneumonia.
* Aspiration pneumonia is most commonly caused by anaerobic organisms.
* [[Aspiration pneumonia]] is most commonly caused by [[anaerobic]] organisms.
* Prior to the development of antibiotics and vaccination, it was a leading cause of death.
* Prior to the development of antibiotics and vaccination, it was a leading cause of death.
* Traditionally, it was highly sensitive to [[penicillin]], but during the 1970s resistance to multiple antibiotics began to develop.
* Traditionally, it was highly sensitive to [[penicillin]], but during the 1970s resistance to multiple antibiotics began to develop.
* Current strains of "drug resistant Streptococcus pneumoniae" or DRSP are common, accounting for twenty percent of all streptococcal infections.
* Current strains of "drug resistant ''[[Streptococcus pneumoniae]]''" or DRSP are common, accounting for twenty percent of all streptococcal infections.
* Adults with risk factors for DRSP including being older than 65, having exposure to children in [[day care]], [[alcoholism]], other severe underlying disease, or recent treatment with antibiotics should initially be treated with antibiotics effective against DRSP.{{ref|Ruhe}}
* Adults with risk factors for DRSP including being older than 65, having exposure to children in [[day care]], [[alcoholism]], other severe underlying disease, or recent treatment with antibiotics should initially be treated with antibiotics effective against DRSP.{{ref|Ruhe}}



Revision as of 22:51, 19 February 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]

Overview

Community-acquired pneumonia can be caused by viral, bacterial, and fungal organisms. Causative etiology varies with age, immune status, epidemiologic background, and comorbidity.

General Considerations

Infants and Newborns

Children

Adults

Viruses
Atypical Organisms
  • Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila are often grouped as atypical pneumonia. Community acquired pneumonia caused by these agents present insidiously, with a non-productive cough and prominent extra-pulmonary complaints, such as myalgias and diarrhea (lack the typical pneumonia symptoms of fever, cough, and sputum).
  • Mycoplasma pneumoniae is often referred to as "walking pneumonia." It is transmitted via respiratory droplets and is common among healthy individuals in close contact with one another, such as dormitories or military barracks.
  • Atypical organisms are more difficult to grow, respond to different antibiotics, and were discovered more recently than the typical bacteria discovered in the early twentieth century.
Streptococcus pneumoniae
  • Streptococcus pneumoniae is the most common cause of community-acquired pneumonia.
  • Aspiration pneumonia is most commonly caused by anaerobic organisms.
  • Prior to the development of antibiotics and vaccination, it was a leading cause of death.
  • Traditionally, it was highly sensitive to penicillin, but during the 1970s resistance to multiple antibiotics began to develop.
  • Current strains of "drug resistant Streptococcus pneumoniae" or DRSP are common, accounting for twenty percent of all streptococcal infections.
  • Adults with risk factors for DRSP including being older than 65, having exposure to children in day care, alcoholism, other severe underlying disease, or recent treatment with antibiotics should initially be treated with antibiotics effective against DRSP.[7]
Haemophilus influenzae
  • Haemophilus influenzae used to be a common bacterial cause of CAP.
  • First discovered in 1892, it was initially believed to be the cause of influenza because it commonly causes CAP in people who have suffered recent lung damage from viral pneumonia.
Enteric Gram-Negative Bacteria
  • Enteric bacteria such as Escherichia coli and Klebsiella pneumoniae may cause commnity-acquired penumonia.
  • Adults with risk factors for infection, which include living in a nursing home, serious heart and lung disease, and recent antibiotic use should initially be treated with antibiotics effective against Enteric Gram negative bacteria.
Pseudomonas aeruginosa
Special Situations
Aspiration Pneumonia
  • Incompetent swallowing mechanism, such as in neurological disease (a common cause being strokes) or while a person is intoxicated.
  • Iatrogenic causes such as general anaesthesia for an operation. Patients are therefore instructed to be nil per os (NPO) for at least four hours before surgery.
  • Whether aspiration pneumonia represents a true bacterial infection or a chemical inflammatory process remains the subject of significant controversy.

Infectious Diseases Society of America/American Thoracic Society consensus statement on common etiologies of community-acquired pneumonia in adults. (DO NOT EDIT)

Common Etiologies of Community-Acquired Pneumonia
Location Etiologies of Community-Acquired Pneumonia[2][3][4]
 ▸ Outpatient Streptococcus pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Chlamydophila pneumoniae
Influenza A and B, adenovirus, respiratory syncytial virus, parainfluenza
Inpatient (non-ICU) Streptococcus pneumoniae
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Haemophilus influenzae
Legionella
Aspiration
Influenza A and B, adenovirus, respiratory syncytial virus, parainfluenza
Yersinia enterocolitica
Inpatient (ICU) Streptococcus pneumoniae
Staphylococcus aureus
Legionella
Gram-negative bacilli
Haemophilus influenzae
Acinetobacter baumannii

Causes

Common Causes

Neonates
  • Bacteria
  1. Listeria monocytogenes
  2. Mycobacterium tuberculosis
  • Viruses
  1. Herpes simplex virus
  2. Adenovirus
  3. Mumps
  4. Enterovirus
Children
  • Bacteria
  1. Mycoplasma pneumoniae
  2. Chlamydophila pneumoniae
  3. Legionella pneumophila
  4. Chlamydia trachomatis
  • Viruses
  1. Respiratory syncytial virus (RSV)
  2. Metapneumovirus
  3. Adenovirus
  4. Parainfluenza
  5. Influenza
  6. Rhinovirus
Adults
  • Typical Bacteria
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Escherichia coli
  4. Klebsiella pneumoniae
  5. Pseudomonas aeruginosa
  • Atypical Bacteria
  1. Mycoplasma pneumoniae
  2. Chlamydophila pneumoniae
  3. Legionella pneumophila
  • Viruses
  1. Influenza
  2. Parainfluenza
  3. Respiratory syncytial virus (RSV)
  4. Metapneumovirus
  5. Adenovirus
  • Newborn infants, children, and adults are at risk for different spectrums of disease causing microorganisms.
  • In addition, adults with chronic illnesses, who live in certain parts of the world, who reside in nursing homes, who have recently been treated with antibiotics, or who are alcoholics are at risk for unique infections.

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying cause
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying cause
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying cause
Gastroenterologic No underlying cause
Genetic No underlying cause
Hematologic No underlying causes
Iatrogenic General anaesthesia
Infectious Disease Acinetobacter baumannii, Actinomycosis, Adenovirus (serotype 1, 2, 3, 4, 5, 7, 14, 21, 35), AIDS-related opportunistic infections, Aspergillosis, Aspiration, Bacillus anthracis, Bird flu (avian influenza), Blastomycosis, Burkholderia cepacia, Burkholderia pseudomallei, Chlamydophila pneumoniae, Chickenpox, Coccidioides immitis, Coronavirus, Coxiella burnetii (Q fever), Cryptococcus neoformans, Cytomegalovirus, Escherichia coli, Enterovirus, Francisella tularensis, Gram-negative bacilli, Haemophilus influenzae, H1N1 flu, Hantavirus, Herpes simplex virus, Histoplasma capsulatum, Histoplasmosis, Human bocavirus, Human parechovirus types 1, 2, and 3, Influenza, Klebsiella pneumoniae, Legionella micdadei, Legionella pneumophila (Legionnaires' disease), Listeria monocytogenes, Mycoplasma pneumoniae, Measles, Melioidosis, Metapneumovirus, Middle east respiratory syndrome coronavirus, Moraxella catarrhalis, Mumps, Mycobacterium avium-intracellulare, Mycobacterium haemophilum, Mycobacterium kansasii, Neisseria meningitidis, New Haven coronavirus, Nocardia, Paragonimiasis, Parainfluenza, Pneumocystis jiroveci, Pneumonic plague, Proteus, Pseudomonas aeruginosa, Chlamydophila psittaci (psittacosis), Rat-bite fever, Respiratory syncytial virus (RSV), Rhinovirus, Rhodococcus equi, Streptococcus pneumoniae (pneumococcus), SARS, Serratia, Severe acute respiratory syndrome, Sporotrichosis , Staphylococcus aureus, Streptococcus agalactiae (group B streptococcus), Streptococcus pyogenes (group A streptococcus), Streptococcus pneumoniae, Swine flu, Toxocariasis , Toxoplasma gondii, Trichosporon , Trypanosomiasis, Typhus, Varicella-zoster virus, Yersinia enterocolitica, Yersinia pestis, Zygomycosis
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying cause
Obstetric/Gynecologic No underlying causes
Oncologic No underlying cause
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying cause
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying cause
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying cause

Causes in Alphabetical Order

References

  1. Shachor-Meyouhas, Y.; Arad-Cohen, N.; Zaidman, I.; Gefen, A.; Kassis, I. (2012). "[Legionella pneumonia in a child with leukemia]". Harefuah. 151 (8): 479–82, 496. PMID 23350295. Unknown parameter |month= ignored (help)
  2. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083. Unknown parameter |month= ignored (help)
  3. Wong, KK.; Fistek, M.; Watkins, RR. (2013). "Community-acquired pneumonia caused by Yersinia enterocolitica in an immunocompetent patient". J Med Microbiol. 62 (Pt 4): 650–1. doi:10.1099/jmm.0.053488-0. PMID 23242642. Unknown parameter |month= ignored (help)
  4. Oh, YJ.; Song, SH.; Baik, SH.; Lee, HH.; Han, IM.; Oh, DH. (2013). "A case of fulminant community-acquired Acinetobacter baumannii pneumonia in Korea". Korean J Intern Med. 28 (4): 486–90. doi:10.3904/kjim.2013.28.4.486. PMID 23864808. Unknown parameter |month= ignored (help)