Evaluation and Management

Abstract

Community-Acquired Pneumonia (CAP) is a serious medical problem affecting mostly the young healthy adults, children and elderly population all over the globe and is associated with considerable mortality and morbidity. CAP is the 6th leading cause of death. Millions of people are affected by CAP world over every year from developed to developing countries, most of them needs hospitalized treatment and hence the economic burden on the society is huge. Although diagnostic techniques and antibiotic therapy have improved to a great extent yet optimal management of the disease is still problematic. Lower respiratory tract infection by atypical intracellular pathogens have made the problem of CAP more complicated. This article reviewed the current trends in the evaluation and management of CAP. INTRODUCTIONCommunity acquired pneumonia is defined as pneumonia acquired in the patients home or in non hospital environment being diagnosed within 48 hours of hospital admission. Despite the availability of various diagnostic methods and potent newer antimicrobial agents and effective vaccines CAP occur throughout the globe and stands as the 6th leading cause of death. The mortality rate in hospitalized patients is 14% and in outpatient population is 1% . The morbidity rate is significantly high, lower respiratory tract infection by atypical intracellular pathogens have made the management of CAP more complicated. 1 The disease affects the people of all age group but is more in healthy young adults, children and elderly. Infection is mostly spread by droplet inhalation and most patients affected are previously well. 2 Cigarette smoking, alcoholism, corticosteroid therapy and immune suppression, all impair mucociliary clearance and predispose to infection.The epidemiology of CAP is not clear, because few population based statistics on the condition alone are available. 3 It is estimated that 4 million American adults suffer from CAP each year imposing a significant economic burden on the society with an annual expenditure of approximately 10 million $. 4 The incidence of CAP requiring hospitalization is estimated to be 258 cases per 100,000 population and 926 cases per 100,000 persons > 65 years of age. 5 The incidence of CAP is highest in winter months. EVALUATION ClinicalClinical presentation depends on the micro-biologic agent and host factors such as age, immune status and other comorbid conditions. A detailed history of exposure, travel, hobbies and past medical history is helpful in suggesting a microbiologic etiology. Severity and presenta-tion of CAP ranges from mild to life threatening, although the symptoms may vary. Symptoms of CAP Commonly Include 6• Difficulty in breathing.• Cough that produces yellow or greenish sputum.• Sharp or stabbing chest pain.• High fever that may be accompanied with sweating, chills and uncontrollable shaking.• Rapid, shallow breathing that is often painful. Physical Examination CAP should be suspected in patients with newly acquired lower respiratory symptoms (cough, sput...