Pneumonia PNA

• Facts:
  Children 6wks to 18yrs
  Viruses (RSV), Mycoplasma, C. pneumoniae, S. pneumoniae
  
  Adults 18 to 40 yrs
  Mycoplasma, C. pneumoniae, S. pneumoniae
  
  Adults 40 to 65 yrs
  S. pneumoniae, H. influenzae, Anaerobes, Viruses, Mycoplasma
  
  Elderly
  S. pneumoniae, viruses, anaerobes, H. influenzae, Gram + rods
  
  
• History / PE:
  PORT criteria
  Sudden onset, fever, productive cough (typical)
  Gradual onset, dry cough, HA, myalgia, sore throat (atypical)
• Diagnosis:
  Order CXR!!!
  
  Legionella
  Urine Legionella antigen test (detects only serogroup 1), sputum staining with direct fluorescent antibody (DTA), culture
  
  Chlamydia
  Serologic testing, culture, PCR
  
  Mycoplasma
  Usually clinical; serum cold agglutinins and serum Mycoplasma antigen
  
  S. pneumoniae
  Urine pneumococcal antigen test, culture
  
  Viral
  Nasopharyngeal aspirate, rapid tests for pathogens (eg. influenza , RSV), DFA, viral culture
• Treatment:
  Outpatient CAP, pts < 65, otherwise healthy
  Macrolide (azithromycin), doxycycline, or fluoroquinolone
  
  Pts > 65 or with comorbidities
  Macrolide or fluoroquinolone
  Plus consider adding second generation cephalosporin or beta-lactam to macrolide
  
• Notes:
  Atypical (Mycoplasma, Legionella, Chlamydia )
  Aspiration (Anaerobes)
  Alcoholics (S. pneumoniae, Klebsiella, Staphylococcus)
  Neonate (Group B Streptococci (GBS), E.coli)
• Differential Diagnosis:
  Acute bronchitis (afebrile)