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Pneumonia acquired in the community is one of the most frequent entities in the extremes of life, in the newborn and the elderly. Although currently available with methods for diagnosis and treatment of pneumonia, this pathology is a public health problem worldwide, causing high mortality and morbidity in these stages of life, this is given as awareness that the immune system in both the newborn or infant, and in the elderly does not have sufficient capacity to deal with this disease entity.
Entered in subject understood by community-acquired pneumonia that acute infection of the lung parenchyma produced by microorganisms acquired outside the hospital, where it is common for the patient to present on the chest radiograph an opacity in the lung parenchyma, associated with at least one of the following signs or symptoms: cough of recent onset, fever greater than 38.5ºC, and leukocytosis with deviation to the left.
Etiology
The causative agents of this pathology are determined by a large number of pathogens that can cause it, where the severity of the disease at the time of presentation, will be given by the presence or absence of comorbidities, immunodeficiency on the part of the host, place of the infection (if it is an intrahospital environment or not) playing an important role for the response of the organism when fighting the infectious process triggered by a bacterium, virus, fungus or parasite.
Etiology of pneumonia according to different age groups
Physopathology
One of the defense mechanisms of the organism are the lungs, being the lung macrophages responsible for protecting the body from infection. The causative agent reaches the lungs through oxygen inhaled through the mouth and nose. After the virus, bacteria, fungus or parasite has entered the lungs, it begins to invade the lining of the airway cells and alveoli. Once established the invading microorganism begins to multiply and release harmful toxins, which cause inflammation and pulmonary parenchymal edema. This action leads to the accumulation of cellular debris and distillation within the lungs. Soon the absence of air diminishes and the lungs fill with secreted fluids. Obtaining as a response the productive cough that can be with expulsion of purulent secretion or not.
Clinical manifestations
The presentation of symptoms and clinical signs can be very variable. The onset can be acute or insidious, usually starts with;
High fever (80%), Chilliness (40%) Cough with purulent expectoration, Pleuritic pain (30%) and frank commitment of the general state. On more complex occasions with greater commitment we can show tachypnea (45-70%) or tachycardia, which may be accompanied by cyanosis and / or compromise in other organs.
Medical diagnostic
To make the diagnosis of this pathological entity should take several parameters to follow:
a.- Clinical picture (Anamnesis clinical history, personal and family history, physical examination). The clinical signs of pulmonary condensation, other findings at auscultation are rattles and crackles.
b.- Image studies, where two patterns can be observed;
One of them, the presence of a lobar condensation in community acquired pneumonia, at the level of chest radiography typical of bacterial processes, another observable pattern is diffuse interstitial infiltrates are frequently associated with viral infections.
c.- The performance of paraclinical (complete hematology, ESR, CRP) Leukocytosis or elevation of acute phase reactants are data that do not always indicate a bacterial etiology, since they can also be observed in viral respiratory infections, although it is usually unusual, the most common is that during the presence of batteries the leukocytosis is predominantly neutrophils while viridic infections are at the expense of lymphocytes.
d.- Specific studies such as gram cultures, KOH and sputum antibiogram, Serum sputum BK, where we can isolate the causative agent.
Medical treatment
The treatment of pneumonia is fundamentally empirical, and should be taken into account; the age of the patient (close relationship between age and the causative agent), clinical-radiological characteristics of pneumonia, and general patient commitment:
Patient without comorbidity initiate empirical treatment with beta-lactam (amoxicillin) or doxycycline or macrolide.
Patient with comorbidity initiate empirical treatment with A) beta-lactam plus a respiratory macrolide or fluoroquinolone.
Uncomplicated pneumonia:
If the child is vaccinated against H. influenzae:
Outpatient treatment: oral amoxicillin 80 mg / kg / day in 3 doses, 7-10 days Hospital treatment: ampicillin i.v. 200 mg / kg / day in 3-4 doses 2-4 days (> 24 h apirexia), followed by oral amoxicillin at 80 mg / kg / day in 3 doses on an outpatient basis until completing 7-10 days.
In complicated cases or with hospitalization criteria, the treatment will be endovenous, generally with third and fourth generation cephalosporin, fluoroquinolones, betalatamics and even carbapenems depending on the causative agent and its strain.
For more information remember to always visit your treating doctor, I hope you have been pleased, happy night to all.
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References
Community-acquired pneumonia
A. Méndez Echevarría, M.J. García Miguel
F. Baquero Artigao *, F. del Castillo Martín
General Pediatrics Service. Pediatric Infectious Disease Unit.
Children's Hospital La Paz. Madrid.
source
Spanish Association of pediatrics
Etiology and diagnosis of community-acquired pneumonia
and its complicated forms
A. Andrés Martína D. Moreno-Pérez
Source
Community-acquired pneumonia. Review and
update with a quality-oriented perspective
of medical care
Renata Báez-Saldaña
Source
By Dr Johana Albarran