Classification of pneumonia

• Community-acquired
• Hospital-acquired
• Aspiration and anaerobic
• Pneumonia in immunocompromised
• AIDS-related
• Geographically restricted
• Recurrent
 MICROBIOLOGICAL CAUSES (%) OF
COMMUNITY ACQUIRED PNEUMONIA FROM
HOSPITAL BASED STUDIES (N=3,000)
CAP Severe CAP
• No cause found 36 33
• Pneumococcus 25 27
• Influenza virus 8 2.3
• Legionella spp*. 7 17
• Haem. Influenzae 5 5
• Other viruses 5 8
• Psittacosis/Q fever 3 2
• Gram neg. bacilli 2.7 2
• Staph aureus* 2 5
 Streptococcus pneumoniae
(pneumococcus)
• A gram positive coccus that grows in short
chains
• Alpha haemolytic on blood agar
• Identified by its susceptibility to optochin
• Polysaccharide capsule confers
pathogenicity-at least 80 serotypes
• There are multivalent vaccines for
prevention of pneumococcal disease
VIRUSES THAT CAUSE COMMUNTIY
ACQUIRED PNEUMONIA
INFLUENZA
 OTHER VIRAL CAUSES

• Respiratory syncytial virus (RSV)

• Parainfluenza viruses
• Enteroviruses
• (Cytomegalovirus)
CAUSES OF ‘ATYPICAL’
PNEUMONIA

• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Legionella pneumophila
• Coxiella burnetii
 Mycoplasma pneumoniae
• Has no cell wall, therefore doesn’t respond to
beta lactams
• Causes atypical pneumonia in adolescents and
young adults
• Dry hacking cough, low grade fever, headache
feature
• Isolation by culture of the organism is difficult
therefore diagnosis is confirmed by a high CFT
or rising titre of specific antibodies
• Cold agglutinins also typical
• Macrolides or tetracyclines most active
 Chlamydia pneumoniae
• An obligate intracellular bacterium
• Causes mild pneumonia but may cause
protracted symptoms
• Sore throat, hoarseness, URT symptoms
feature
• Serological diagnosis rather than culture
• Tetracyclines, macrolides, quinolones
active
 Legionnaires’ disease
• A severe pneumonia due to Legionella
pneumophila
• Can be community or hospital acquired
• Organism is acquired from environmental
sources eg, humidified air conditioning,
showers
• Usually attacks debilitated individuals
 RISK FACTORS

• Male sex
• Advanced age
• Cigarette smokers
• Alcoholism
• Chronic lung disease
• Immmunosuppression, malignancy
 Legionnaires’ disease
• Hyponatremia, confusion, nausea,
vomiting, abnormal LFT’s a feature
• Diagnosis often confirmed by urinary
antigen test (specific for serogroup 1)
• Can be cultured on special media
• Must be notified to Public Health as it can
cause outbreaks
• Most active antibiotics are: macrolides,
quinolones, rifampicin
COMMUNITY ACQUIRED PNEUMONIA IN
INFANTS AND CHILDREN
• Group B streptococcus and E coli cause
pneumonia in neonates
• RSV an important pathogen in infants
• Bordetella pertussis (cause of whooping
cough) important in young children
• As is Haemophilus influenzae type b