Community-acquired pneumonia (CAP) refers to pneumonia that develops in people with very less or no contact with any medical setting such as a hospital or clinic. Most of the time, the people who are infected with CAP are healthy individuals.
Background of the Disease
Four million cases of community-acquired pneumonia are reported each year. A cost of about 23 billion dollars is spent just for the community-acquired pneumonia in the medical system.
Community-acquired pneumonia is the 6th leading cause of death in the world. 80% of the cases of community-acquired pneumonia are due to the Streptococcus pneumoniae bacteria.
The Signs and Symptoms
Patients with community-acquired pneumonia develop the following signs and symptoms:
- Dyspnea or difficulty in breathing
- Sputum production
- Pleuritic chest pain (the chest pain that worsens with deep breathing)
- Crackles and consolidation noted during physical examination
All of the above symptoms are not specific of pneumonia, but if you develop these symptoms, pneumonia will always be considered as a differential diagnosis.
When you consult a doctor, your doctor will speak to you and get a detailed history. He/she will also ask about your signs and symptoms and perform a physical exam on you. If the signs and symptoms are consistent with pneumonia, it will be considered as a differential diagnosis, which will be later confirmed by further investigations.
Next, your doctor will order a chest X-ray to confirm the diagnosis. If there are infiltrates or consolidations on the chest X-ray, a diagnosis of pneumonia will be made.
Blood cultures can also be done to make sure that the bacteria have not entered your bloodstream. Additionally, sputum cultures can be done to find out the exact cause of the pneumonia. Once the exact causative organism is found, treatment targeting that bacterium will be started.
Management of community-acquired pneumonia
Before starting the treatment for pneumonia, all patients will be stratified according to the CURB 65 score.
- C- Confusion
- U- Uremia
- R- Respiratory rate of >30/minute
- B - Blood pressure of Systolic <90 mmHg and Diastolic <60mmHg
- Age: 65 years or older
The CURB 65 score helps in the estimation of the mortality rate of community-acquired pneumonia. It also aids in deciding inpatient vs. outpatient treatment. The CURB 65 scoring system assigns one point for each feature, and therefore, the total will add up to 5.
The mode of treatment will be decided depending on the CURB 65 severity score. If the severity score is:
- 0-1: The patient will be given an outpatient treatment.
- 2-3: Here, the patient will either be observed as an outpatient case or admitted and treated as an inpatient.
- 4-5: A score of more than 3 indicates that the mortality is very high. Thus, the patient should be admitted and treated as an inpatient case with the consideration of an ICU admission.
Preventing community-acquired pneumonia
Community-acquired pneumonia can be prevented by the following ways:
- Influenza vaccine - a live vaccine should not be given to immunocompromised individuals. It is also important to wait for at least 30 minutes after administering the vaccine to watch for allergies.
- Pneumococcal vaccine - is the vaccine given for the prevention of Streptococcus pneumoniae infections.