This document discusses community-acquired pneumonia (CAP), including etiology, pathogenesis, clinical presentation, diagnosis, treatment recommendations, and management based on risk stratification. Key points include: - CAP is usually caused by Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae. Atypical pathogens and respiratory viruses are also common. - Clinical features may include cough, fever, tachypnea, and findings on chest exam. Chest x-ray is needed to confirm pneumonia. - Treatment depends on patient risk factors and severity, ranging from outpatient oral antibiotics for low risk to intravenous antibiotics plus macrolide for high risk or

5. Pattern Possible Diagnosis Lobar S. pneumo, Kleb, H. flu, GN Patchy Atypicals, viral, Legionella Interstitial Viral, Legionella Cavitary Anaerobes, Kleb, TB, S. aureus, fungi Large effusion Staph, anaerobes, Kleb

18. Broncho Pneumonia

26. Hospitalization Patients Outpatients Non-ICU ICU Streptococcus pneumoniae S. pneumoniae S. pneumoniae Mycoplasma pneumoniae M. pneumoniae Staphylococcus aereus Haenophilus influenzae Chlamydophila Legionella spp. C. Pneumoniae pneumoniae Gram-negative bacilli Respiratory viruses H. influenzae H. influenzae Legionella spp. Respiratory viruses

29. TEN LEADING CAUSES OF MORBIDITY Rate/100,000 Population PHILIPPINES, 1999 Cause Number Rate 1. Diarrheas 908,454 1189.9 2. Bronchitis/Bronchiolitis 717,214 939.4 3. Pneumonia 693,334 908.1 4. Influenza 514,198 673.5 5. Hypertension 208,248 272.8 6. T.B. Respiratory 144,932 189.8 7. Malaria 68,155 89.3 8. Diseases of the Heart 63,167 82.7 9. Chickenpox 35,699 46.8 10. Typhoid Fever 17,675 23.1 Source: FHSIS Annual Report 1999

30. TEN LEADING CAUSES OF MORTALITY Number and Rate/100,000 Population PHILIPPINES, 1997 CAUSES NUMBER RATE* 1. Diseases of the Heart 49,962 69.8 2. Diseases of the Vascular System 38,693 54.1 3. Pneumonia 30,811 43.1 4. Accidents 28,563 39.9 5. Malignant Neoplasm 26,842 37.5 6. Tuberculosis, All Forms 23,056 32.2 7. Chronic Obstructive Pulmonary Diseases and Allied Condition 11,807 16.5 8. Other Diseases of the Respiratory System 6,961 9.7 9. Diabetes Mellitus 6,749 9.4 10. Nephritis, Nephrotic Syndrome and Nephrosis 6,704 9.4 Source: Philippine Health Statistics 1997

37. 2004 Philippine Consensus Guideline

47. 2004 Philippine Consensus Guideline

80. Table 251-7 Clinical Pulmonary Infection Score (CPIS) Criterion Score Fever (°C) 38.5 1 >39 or < 36 2 Leukocytosis <4000 or >11,000/ L 1 Bands > 50% 1 (additional) Oxygenation (mmHg) Pa O2 /FI O2 <250 and no ARDS 2

81. a The progression of the infiltrate is not known and tracheal aspirate culture results are often unavailable at the time of the original diagnosis; thus, the maximal score is initially 8–10. Chest radiograph Localized infiltrate 2 Patchy or diffuse infiltrate 1 Progression of infiltrate (no ARDS or CHF) 2 Tracheal aspirate Moderate or heavy growth 1 Same morphology on Gram's stain 1 (additional) Maximal score a 12

90. Table 251-6 Pathogenic Mechanisms and Corresponding Prevention Strategies for Ventilator-Associated Pneumonia Pathogenic Mechanism Prevention Strategy Oropharyngeal colonization with pathogenic bacteria Elimination of normal flora Avoidance of prolonged antibiotic courses Large-volume oropharyngeal aspiration around time of intubation Short course of prophylactic antibiotics for comatose patients a Gastroesophageal reflux Postpyloric enteral feeding b ; avoidance of high gastric residuals, prokinetic agents Bacterial overgrowth of stomach Avoidance of gastrointestinal bleeding due to prophylactic agents that raise gastric pH b ; selective decontamination of digestive tract with nonabsorbable antibiotics b

91. Cross-infection from other colonized patients Hand washing, especially with alcohol-based hand rub; intensive infection control education a ; isolation; proper cleaning of reusable equipment Large-volume aspiration Endotracheal intubation; avoidance of sedation; decompression of small-bowel obstruction Microaspiration around endotracheal tube Endotracheal intubation Noninvasive ventilation a

92. Prolonged duration of ventilation Daily awakening from sedation, a weaning protocols a Abnormal swallowing function Early percutaneous tracheostomy a Secretions pooled above endotracheal tube Head of bed elevated a ; continuous aspiration of subglottic secretions with specialized endotracheal tube a ; avoidance of reintubation; minimization of sedation and patient transport Altered lower respiratory host defenses Tight glycemic control a ; lowering of hemoglobin transfusion threshold; specialized enteral feeding formula