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Pathology

Inflammation of the lung parenchyma as a result of an infection. Community acquired (CAP) or hospital acquired (HAP) developing 48hrs after admission  

Aetiology

Certain groups are at increased risk of pneumonia: diabetics, COPD, previous splenectomy, underlying cardiorespiratory disease, elderly and HIV patients. 

Common Causes of CAP Common Causes of HAP
Streptococcus Pneumonia Gram Negative Bacteria
Haemophilus Influenza Staphylococcus Aureus
Mycoplasma Pneumonia Streptococcus Pneumonia

Signs

Pyrexia, dyspnea, tachypnoea, confusion, cough with purulent sputum. Auscultation may reveal crackles and bronchial breathing. A dull percussion note may be present

Symptoms

Pleuritic pain, productive cough, rigors and shortness of breath. 
Atypical Pneumonias cause atypical symptoms. 
Mycoplasma: Erythema multiforme (‘target lesions’), erythema nodosum and DIC. Legionella: Flu-like symptoms. Urine tested for antigen

Investigations

Chest X-Ray: Consolidation and potentially pleural effusions
Bloods: FBC, U&E, CRP and liver function tests, ABG, blood cultures. 
Sputum culture and gram stain: Suspected cases of TB - Acid Fast Bacilli.
Urine antigen: Pneumococcal (moderate to high severity), legionella (high severity)
Bronchoscopy: in persistent cases post course of antibiotics

Treatment

Oxygen: Aim for oxygen saturations of 94-98%
IV Fluids: Fluid balance should be assessed and supplemented as required
IV/PO Antibiotics: Amoxicillin for non-severe, Tazocin for Severe Pneumonia.  
Legionella Pneumonia - Clarithromycin & Rifampicin

Prognosis

Dependent on CURB-65 Score.
Post discharge, patients should have a follow up Chest X-Ray at 6 weeks
Septicaemia, para-pneumonic effusions, empyema and cavity  formation

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