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Pneumonia

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Chest x-ray the best diagnostic test.

Among the most common causes of hospitalizations and a leading cause of infectious death.

Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia.

Sixth leading cause of death and tends to be more prevalent in the elderly.

Affects 1.2% of population each year.

Overall mortality rates are generally less than 1%. 

Pneumonia predominantly affects men, with the greatest risk during infancy and in older age.

For hospitalized patients mortality risk varies from 4-23% and is associated with a more diverse group of pathogens than in the outpatient setting.

Patients who recover from pneumonia experience long-term mortality at a substantially higher rate than an age and sex matched controls, primarily due to comorbidities.

Most common medical diagnosis responsible for hospitalizations in the US.

The leading cause of death in children, with most fatal cases occurring in individuals younger than five years in developing countries.

In children, poverty is thought to be the primary cause of pneumonia, as a result of malnutrition and limited access to medical care.

Death rate 30 per 100,000 episodes.

Leading cause of infectious disease-related mortality in the U.S.

Leading cause of severe hospital acquired infections.

The second most common type of infection acquired in the hospital, behind UTI, with 40% of cases being postoperative.

Categorized according to location of onset: Community-acquired pneumonia and hospital-acquired pneumonia on the 2 major categories.

Hospital acquired pneumonia is divided into ventilator-acquired and non-ventilator acquired pneumonia.

5-10 cases of hospital-acquired pneumonia diagnosed in every 1000 patient admissions to a hospital.

The incidence and severity of pneumonia is influenced by the underlying predisposing conditions.

In most cases radiologic clearing of infiltrates occurs within 1 to 3 months.

Patients on immunosuppressive agents have an incidence of complicated pneumonia 12 times that of a normal host.

Pediatric pneumonia diagnosis evaluated by analyzing patient characteristics such as age, immune status, epidemiological exposures, and chest x-ray appearance.

Viruses are the most common causes of pneumonia in infants and young children.

Factors associated with death: male gender, ((diabetes)) mellitus, neoplastic disease, neurologic disease, tachypnea, hypotension, hypothermia, leukopenia, bacteremia, and multilobar infiltrates.

Patients with impairments in swallowing and cough reflexes have an increased risk for the development of pneumonia.

Mortality from infections correlates with decreased IgG levels, cutaneous anergy, and lymphopenia.

Aspiration is possibly the single most important risk factor for pneumonia in old people.

Estimated to occur in about one-third of patients with stroke.

Less than 10% of patients hospitalized with clinical pneumonia have positive blood cultures for bacterial disease.

Routine blood cultures in pneumonia have extremely low yield and usefulness, irrespective of the severity and risk of disease (Zhang D.).

Histopathological evaluation and immunochemistry testing and PCR methods can detect many more bacterial lung infections at autopsy than can usual clinical methods of diagnosis.

A follow-up chest x-ray is recommended four-eight weeks after the treatment of pneumonia, to exclude underlying malignant neoplasms that may have been predisposed to by post obstructive pneumonia.

The recommendation for post-pneumonia chest x-ray a couple of months after treatment is particularly relevant for patients with higher risk for lung cancer, such as the elderly smokers.

The incidence of new lung cancer is low after pneumonia: approximately 1% within 90 days and 2% over five years-suggesting routine chest x-rays after pneumonia for detecting lung cancer is not warranted although patients over the age of 50 years and smokers should be targeted for such follow-up (Tang KL et al).

9.2% incidence of new lung cancer after pneumonia with five-year follow-up (Mortensen EM et al).

Hospitalization with pneumonia in older adults is associated with subsequent increase in risk of cardiovascular disease.

The risk of cardiovascular disease after pneumonia in hospitalized patients is 4 fold in the first 30 days, and progressively declines during the first year, and remains approximately 1.5 fold higher in subsequent years (Corales-Moedina VF et al).

 

 

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