The word "pneumonia" originates from the ancient Greek word "pneumonia", which means "lung", hence the word "pneumonia" becomes "lung disease". Clinically, it is an inflammation of the parenchyma in one or both lungs caused by an infection, but not always. Many causes of pneumonia are bacteria, viruses, fungi and parasites. This article focuses on bacterial pneumonia as it is the leading cause of discoloration and mortality. According to the new classification of pneumonia, there are four classes: community-acquired (CAP), hospital-acquired (HAP), healthcare (HCAP), and ventilator-related pneumonia (VAP).
Types of bacterial pneumonia cap: Acute lung tissue infection in a patient who received it from the community or within 48 hours of hospitalization. Hep: Acute lung tissue infection in a non-intubated patient that develops 48 hours after hospitalization. VAP: A type of pulmonary infection of the lung tissue that usually progresses to mechanical ventilation 48 hours or more after intubation. HCAP: Acute infection of lung tissue obtained from a hospitalized patient in the last three months in healthcare facilities such as nursing homes, dialysis centers and outpatient departments. Some articles include both HAP and VAP in the HCAP category, so the definition of HCAP is problematic and controversial.
The lower respiratory tract is not sterile and is always exposed to environmental pathogens. Bacterial pneumonia is caused by the invasion and spread of the above bacteria in the parenchyma of the lungs at the alveolar level, and in the inflammatory response of the body it causes clinical pneumonia syndrome. To prevent this proliferation of microorganisms, a number of host defense mechanisms exist in the lungs, such as mechanical (e.g., in the hair follicles and mucus in the nasopharynx and oropharynx) and chemical (e.g., alveolar epithelial cells produced by alveolar epithelial cells). And d). Which has the intrinsic property of son ponizing bacteria). The second component of the lung defense system consists of immune cells, such as alveolar macrophages, which consume and destroy the multiplier bacteria, but as soon as the bacteria overcome the host's defenses, they begin to multiply. In this case, the alveolar macrophages respond to inflammation to enhance the defense of the lower respiratory tract. This inflammatory response is the main cause of the clinical presentation of bacterial pneumonia. Cytokines are released in response to an inflammatory response and cause constitutional symptoms, for example IL-1 (interleukin-1) and TNF (tumor necrosis factor) cause fever. Colony-stimulating factors such as IL-8 (interleukin-8) and G-CSF (granulocyte colony-stimulating factor) such as chemokines promote chemotaxis and maturation, respectively, resulting in leukocytosis in serological laboratories. These cytokines are responsible for leakage of the alveolar capillary membrane at the site of inflammation, leading to a decrease in adherence and dyspnea. Sometimes even red blood cells overcome this barrier and cause hemoptysis.
When taking a medical history, it is important to evaluate possible patient exposures, aspiration risk, host factors, and symptoms. Exposure: A detailed history of possible exposures should be sought, as this can be helpful in identifying possible causes. Some relationships between exposure and causes of bacterial pneumonia are listed below: Contaminated air conditioning and water systems can cause Legionella pneumonia. Crowded places like prisons, shelters, etc. expose a person to streptococcal pneumonia, mycobacteria, mycoplasmas, and chlamydia. Various animals, such as cats, sheep, and cattle, can become infected with Coxiella burnetii. Some birds such as chickens, turkeys, and ducks can expose a person to Chlamydia psittaci.
Aspiration risks: Patients at increased risk of aspiration are more likely to develop secondary aspiration pneumonia. The associated risks are as follows: Changes in Thinking Drug Abuse Dysphagia Gastroesophageal Reflux Disease (GERD) Alcoholism Seizures Host Mechanisms: A detailed history is essential to find clues to the etiology of pneumonia. For example, a history of asthma, COPD, smoking, and an immunodeficiency disorder may indicate H. influenzae infection. Influenza H occurs most often during the winter. Likewise, social, sexual, medical, and family history can be helpful in determining the cause of an illness. A history of bacterial pneumonia can range from slow to severe. Clinical manifestations include both constitutional features and signs of damage to the lung and associated tissues. The following are important findings from the story: Fever with tachycardia and / or chills and sweat. The cough may be unproductive or productive with mucus, purulent or bloody sputum. Thoracic pleurisy with pleural involvement. Shortness of breath during normal daily work.
The presence of a productive cough is the most common and noticeable symptom. Some bacterial causes have specific manifestations, such as: S. pneumoniae - Rusty sputum pseudomonas, Haemophilus - green sputum Klebsiella - jelly-like sputum red currant anaerobes - sputum odor and unpleasant taste. Manifests itself as mutations and gastrointestinal symptoms. Physiological findings also vary from patient to patient and are mainly based on lung aggregation, type of organism, degree of infection, host factors, and presence or absence of purulent flow. The main clinical signs are: fever (usually above 38 ° C or above 100.4 C).
The enhanced CURB-65 or CURB-65 pneumonia severity score can be used to quantify risk. These include C = confusion, U = hematuria (BUN greater than 20 mg / dL), R = respiratory rate (greater than 30 per minute), B = BP (BP less than 90/60 mmHg), and Includes ages over 65. .. Points are created for each of these risk factors. Outpatient treatment is recommended if the score is 0 to 1. If the total score is 2 or more, it indicates hospitalization in the ward. A total score of 3 or higher indicates admission to ICU. The recommended treatments for different settings are: Outpatient settings: For patients with comorbidities (eg, diabetes, malignancies, etc.), the regimen is fluoroquinolone or beta-lactam + macrolides. Macrolides or doxycycline can be used empirically in patients without comorbidities. Tests are usually not performed because empirical diets are almost always successful. Inpatient settings (non-ICU): The recommended treatment is fluoroquinolone or macrolide + beta-lactam. Inpatient Settings (ICU): The recommended treatment is beta-lactam + macrolide or beta-lactam + fluoroquinone. MRSA: You can add vancomycin or linezolid. After obtaining a culture-positive test result, it is necessary to change the treatment method according to the culture-specific pathogen. Patients may also benefit from smoking cessation, counseling, and vaccination against influenza and pneumococcus. All patients treated at home should schedule a follow-up visit within 2 days to assess complications from pneumonia. The role of corticosteroids remains controversial and can be used in patients assuming prescribed adrenal insufficiency.
The etiology of community pneumonia (CAP) has evolved since the beginning of the antibiotic era. Recent guidelines recommend experimental antibiotic treatment as soon as CAP is diagnosed. On the one hand, treatment recommendations, and on the other, concerns about the administration of antibiotics, this review of the medical literature sheds light on Cape's etiology. Methodology The systematic review of the English literature on the etiology of CAP was conducted using the methods described in the guidelines for the systematic review and meta-analysis of Priority Report Items (PRISMA). We searched for PubMed by combining the words "pneumonia", "CAP", "pathogenesis", "microbiological", "bacteriology", and "pathogen". I searched for articles on antibiotics developed to treat pneumonia. We've reviewed "all related articles" and studies referenced in the search. After excluding articles for which sufficient microbiological data was not available or did not meet other prescribed criteria, 146 studies remain. According to the microbiological studies conducted, the data were divided into diagnostic categories. The results are presented as a percentage in each of the categories with established etiology.
Streptococcus pneumoniae is a common cause of CAP, although the incidence is declining. This decline is even greater in the United States. Haemophilus influenzae is the second most common cause of CAP, followed by Staphylococcus aureus and Gram-negative bacilli. The incidence of all bacteria due to CAP is low, as with the routine use of PCR for viruses, cases of notorious, established etiology have increased. Viruses are reported in an average of 10% of cases, but recent PCR-based studies have identified respiratory viruses in about 30% of CAP cases, with significant incidences of viral / bacterial synapses. ۔ Conclusion The results of this study support current guidelines for early medical treatment of CAP. With the prevalence of pneumococci and Haemophilus, efforts to increase antibiotic stewardship can be stepped up by focusing more on the normal use of sputum and culture. Because viral / bacterial synapses are relatively common, identifying the virus by PCR itself does not allow the elimination of antibiotic therapy.
Community-acquired pneumonia (CAP) is a term used to describe acute lung infections that occur outside the hospital of recently unhospitalized patients. Symptoms 2 or less with pulmonary infiltrates on chest X-ray or computer tomography (CT): New or worsening cough, sputum formation or shortness of breath; purulent chest pain; fever or hypothermia; oxygen dehydration; confusion; leukocytosis Suppuration or leukopenia [1,2,3]. In older patients, KAP may present with less obvious symptoms [4, 5]. Until 2019, the commonly used definition of caps excluded those who had frequent contact with the healthcare system, such as those undergoing dialysis or being hospitalized from nursing homes [ 1]. In such patients, health-related pneumonia (HCAP) was diagnosed. These patients are currently included in the definition of CAP. Capees are a major cause of illness and death in the United States, with 649 to 7,847 adults per 100,000 population and approximately 1.6 million hospitalized each year. McLaughlin etc.
We checked the title and abstract of the articles for relevance and accessed the full text of the relevant articles to check eligibility. The bibliography of eligible articles was further examined for potentially relevant studies. Study selection We have limited this systematic review to original articles in English on cases of confirmation of GAP in adults in developed countries (see https://isge2018.isgesociety.com/registration/list-of-developing-countries/ ) That provide sufficient information to determine a microbial etiology by laboratory diagnostic techniques available at the time of study. A qualified study was included in the data synthesis only if the total number of cases and the number of confirmed pathogens were extractable and if at least 25 of them. Etiologic diagnosis of cases% We did not restrict our study to hospital patients, although most subjects were actually inpatients, and microbiological studies are generally not performed on an outpatient basis.
PE is a heterogeneous formation with a different clinical picture and a wide range of causative pathogens, which differ according to age, geography and recent exposure. In its deliberations, the committee that drafted the American Thoracic Society and the American Society of Infectious Diseases Official Clinical Practice Guidelines for 2019 paid surprisingly little attention to the etiology of CAP (Daniel Musher, communication personal). In light of these recently published guidelines for the initial empirical treatment of CAP, on the one hand, and growing public concern about the rational use of antibiotics, on the other hand, a review of the etiology seems quite appropriate. To our knowledge, this topic has not been addressed in this way in recent years. This exam is much more difficult than it looks. There is no doubt that the etiology of CAP has undergone a significant evolution since the pre-antibiotic era. Streptococcus pneumoniae (pneumococcus) is less common, new pathogens have been identified, modern diagnostic methods have been developed, and the reliability of some of the methods described has been questioned. Additionally, despite careful efforts to identify the cause, in most studies the etiology has not been determined in half or more of patients hospitalized for CAP. Comprehensive molecular tests or quantitative bacteriological studies can significantly increase efficacy, but these methods are generally not available, and the studies in which they have been used were limited to patients who received specimens of reliable sputum before long-term or necessary antibiotic therapy.
A systematic review was conducted in accordance with the preferred reporting factors for systematic reviews and meta-analyzes (Prisma) . Two researchers independently conducted a literature review and screened articles for eligibility and eligibility. Any conflict is resolved by consensus. Search Strategy From January 1945 to March 2020, we asked Medline / PubMed to identify the studies that reported on the etiology of CAP using,,,, and,,,, or a combination of search terms. We've seen "Related Articles" and articles cited by those in search. We have searched for many antibiotics that have been developed to treat this infection over the past 6 decades. These include ciprofloxacin, moxifloxacin, ofloxacin, levofloxacin, delafloxacin, omadacyclin, doxycycline, tigecycline, ceftriaxone, cefuroxime, clarithromycin, azithromycin / azithromycin.
