There are two types of pneumonia: community-acquired pneumonia and hospital-acquired pneumonia. The so-called community-acquired pneumonia refers to pneumonia acquired outside the hospital, including the infection lesions in the lungs within 48 hours after admission, and community-acquired pneumonia is one of the most common infectious diseases in clinical practice, and it is also a common infectious disease with high morbidity and mortality worldwide.
01
What causes community-acquired pneumonia?
Pneumonia is usually secondary to cold, exertion, and upper respiratory tract infection. Young adults are prone to fever, cough, sputum and other symptoms after cold, fatigue and alcoholism, and the elderly are prone to aspiration, especially cerebrovascular accidents. Older people who have not been vaccinated against Streptococcus pneumoniae, especially those with immunocompromised function, such as other chronic diseases, tumors, and long-term immunosuppressive drugs, are susceptible to community-acquired pneumonia.
People with lung lesions, such as chronic obstructive pulmonary disease, bronchiectasis, chronic left heart failure, etc., are also prone to pneumonia. Patients with underlying medical conditions, such as older men with chronic obstructive pulmonary disease, diabetes, and hypertension, are prone to viral pneumonia when they have influenza, when they have a weakened respiratory defense.
Therefore, the occurrence of community-acquired pneumonia is mainly related to the respiratory defense function of the patient and the virulence of the pathogen.
02
What are the pathogens that cause community-acquired pneumonia?
Atypical pathogens, including mycoplasma and chlamydia, are common among the pathogens that cause community-acquired pneumonia, and viral infections are also common. Common bacteria are Streptococcus pneumoniae and Haemophilus influenzae.
Secondly, Klebsiella pneumoniae, Staphylococcus aureus, Legionella, Escherichia coli, Pseudomonas aeruginosa and Moraxella catarrhalis are also more common. Some patients have dual or multiple infections.
03
What are the clinical manifestations of community-acquired pneumonia?
Community-acquired pneumonia varies in different populations and under different conditions of pathogenic microbial infection. In general, the symptoms are obvious in young people, and atypical in older people. The main manifestations include chills, fever, cough, sputum production, chest pain, etc.
Viral infection, especially influenza virus infection, can cause high fever, cough, chest pain, muscle aches, headache, etc. after an incubation period of 2-7 days; lobar pneumonia can appear chills, cough, sputum production, fever, etc. after cold, exertion; Legionella pneumonia often has a rapid onset, local outbreaks, body temperature exceeds 40 degrees Celsius, lasts for several days, and muscle aches and other symptoms occur.
The symptoms of fungal infection are atypical, such as low-grade fever, cough, and sputum production, and the systemic symptoms are not obvious; Haemophilus influenzae pneumonia is more likely to occur in the elderly, while mycoplasma pneumonia is more likely to occur in young people, mainly dry cough, which can be accompanied by retrosternal pain; viral pneumonia is more common in children, and Staphylococcus aureus pneumonia can occur after influenza infection.
Pneumonia in the elderly may have no obvious clinical manifestations, or only fatigue, decreased appetite, low-grade fever, and psychoneurological symptoms. Pneumonia in immunocompromised patients can manifest as increased respiratory rate, shortness of breath after exertion, and dyspnea.
Patients with community-acquired pneumonia often present with sputum production. Diagnosis is helpful based on the color, smell, and amount of sputum. Rust-colored sputum suggests lobar pneumonia, dark red jelly-like sputum suggests Klebsiella pneumoniae infection, yellowish-green sputum suggests Pseudomonas aeruginosa infection, and foul-smelling sputum may occur in anaerobic infection, and purulent and bloody sputum may occur in Staphylococcus aureus infection. Bloody sputum may occur in viral infections with severe pneumonia or respiratory distress syndrome.
Pneumonia can manifest in different parts of the country. Lesions at the apex of the lungs can reflexively cause pain in the shoulder and arm area, which may be exacerbated by respiratory exercises. Dorsal lung lesions can irritate the posterior pleura and cause low back pain, while lower lobe lung infection stimulates the diaphragm and causes epigastric pain that radiates to the shoulder. Therefore, sometimes the possibility of lung infection cannot be completely ignored when fever is accompanied by abdominal pain.
A number of complications can occur when a patient develops pneumonia if left untreated or if there is bacterial resistance. Common complications include pleurisy, empyema, pleural effusion, otitis media, sinusitis, peritonitis, arthritis, etc.
04
How is community-acquired pneumonia treated?
Community-acquired pneumonia is primarily treated with anti-infectives, but also general and supportive care. Depending on the severity of the condition, it can be divided into general outpatient treatment, inpatient treatment or ICU treatment. Clinicians treat different pathogenic microorganisms accordingly.
05
What is the prognosis for community-acquired pneumonia?
The prognosis is worse for alcoholism, asthma, immunosuppression, advanced age, and smokers. In addition, patients with drug-resistant bacteria, underlying lung diseases and comorbidities, and many complications often have a poor prognosis.
06
How can community-acquired pneumonia be prevented?
Injection of pneumococcal 23-valent vaccine can reduce the incidence of pneumonia in the community and reduce overall mortality. Anyone over the age of 60 can be vaccinated if there are no clear contraindications. Patients with fever, critical illness, and allergies to vaccine components should not be vaccinated during cancer chemotherapy, acute infectious diseases, fever, critical illness, and allergies.