Community-acquired pneumonia (CAP) refers to a lower respiratory tract infection, primarily involving the lungs, that is acquired outside the hospital. The usual organisms associated with CAP are respiratory tract pathogens, i.e., Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.3 Bartlett J.G., Mundy L.M. Community-acquired pneumonia N Engl J Med 1995 ; 333 : 1618-1624 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 21 Garibaldi R.A. Epidemiology of community-acquired respiratory tract infections in adults: Incidence, etiology, and impact Am J Med 1985 ; 78 : 32-37 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 24 Hirschmann J.V., Everett E.D. Haemophilus influenzae infections in adults: Report of nine cases and review of the literature Medicine 1979 ; 58 : 80-94 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 46 Wallace R.J., Musher D.M., Martin R.R. Hemophilus influenzae pneumonia in adults Am J Med 1978 ; 64 : 87-93
Haga clic aquí para ir a la sección de Referencias, 47 Wallace R.J., Musher D.M. In honor of Dr. Sarah Branham. A star is born: The realization of Branhamella catarrhalis as a respiratory pathogen Chest 1986 ; 90 : 447-450 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 48 Woodhead M.A., Radvan J., Macfarlane J.T. Adult community-acquired staphylococcal pneumonia in the antibiotic era: A review of 61 cases Q J Med 1987 ; 64 : 783-790
Haga clic aquí para ir a la sección de Referencias Less commonly, other organisms may cause CAP under special circumstances. These include Staphylococcus aureus pneumonia following viral influenza pneumonia, Klebsiella pneumonia in alcoholics, and only rarely other aerobic gram-negative pathogens. Aspiration pneumonia is also included under the broad general category of CAP. Community-acquired aspiration pneumonia is caused by the aspirated polymicrobial oropharyngeal flora, which are primarily anaerobic.2 Bartlett J.G. Anaerobic bacterial pneumonitis Am Rev Resp Dis 1979 ; 119 : 19-23
Haga clic aquí para ir a la sección de Referencias The most common anaerobic organisms associated with community acquired aspiration pneumonia include anaerobic streptococci and the so-called oral-pigmented Bacteroides, i.e., B. melaninogenicus as well as Peptococcus vianella, etc.14 Fang G.D., Fine M., Orloff J. , y al. New and emerging etiologies for community-acquired pneumonia with implication for therapy: A prospective multicenter study of 359 cases Medicine 1990 ; 69 : 307-316
Haga clic aquí para ir a la sección de Referencias, 16 Fekety F.R., Caldwell J., Grump D. , y al. Bacteria, viruses, and mycoplasmas in acute pneumonia in adults Am Rev Resp Dis 1971 ; 104 : 499-507
Haga clic aquí para ir a la sección de Referencias, 22 Gleckman R., DeVita J., Hibert D. , y al. Sputum Gram's stain assessment in community-acquired bacteremic pneumonia J Clin Microbiol 1988 ; 26 : 846-849
Haga clic aquí para ir a la sección de Referencias, 25 Holmberg H. Aetiology of community-acquired pneumonia in hospital-treated patients Scand J Infect Dis 1987 ; 19 : 491-501 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 37 MacFarlane J.T., Finch R.G., Ward M.J. , y al. Hospital study of adult community-acquired pneumonia Lancet 1982 ; 2 : 255-258 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 39 Moine P., Vercken J.-P., Chevret S. , y al. Severe community-acquired pneumonia Chest 1994 ; 105 : 1487-1495 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 49 Woodhead M.A., Arrowsmith J., Chamberlain-Webber R. , y al. The value of routine microbial investigation in community-acquired pneumonia Respir Med 1991 ; 85 : 313-317 [cross-ref]
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Atypical pneumonias are caused by atypical rather than unusual pathogens. Depending on geographical factors, the organisms responsible for atypical pneumonia are quite varied. Community-acquired atypical pneumonias may be viewed as consisting of two groups of organisms, primarily nonzoonotic or zoonotic in their mode of transmission.13 Cunha B.A. Atypical pneumonias Current Diagnosis 9 Philadelphia: WB Saunders (1997).
311-312
Haga clic aquí para ir a la sección de Referencias Zoonotic atypical pneumonias include psittacosis, Q fever, and tularemia; the nonzoonotic atypical pneumonias consist of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionnaires' disease. It is important to appreciate that coinfections with one or more atypical pathogens, or an atypical pathogen and a bacterial pathogen are rare.5 Cunha B.A. Legionnaires' disease Infect Dis Pract 1994 ; 18 : 72
Haga clic aquí para ir a la sección de Referencias, 11 Cunha B.A., Ortega A.M. Atypical pneumonias Postgrad Med 1996 ; 99 : 123-132
Haga clic aquí para ir a la sección de Referencias, 23 Heath C.H., Grove D.I., Looke D.F. Delay in appropriate therapy of Legionella pneumonia associated with increased mortality Eur J Clin Microbiol Infect Dis 1996 ; 5 : 286-290 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 35 Lieberman D., Porath A., Schlaeffer F. , y al. Legionella species community-acquired pneumonia: A review of 56 hospitalized adult patients Chest 1996 ; 109 : 1243-1249 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 40 Plouffe J.F., Herbert M.T., File T.M. , y al. Ofloxacin versus standard therapy in treatment of community-acquired pneumonia requiring hospitalization Antimicrob Agents Chemother 1996 ; 40 : 1175-1179
Haga clic aquí para ir a la sección de Referencias, 45 van Riemsdijk, van Overbeeke I.C., van den Berg B. Severe legionnaire's disease requiring intensive care treatment Neth J Med 1996 ; 49 : 185-188
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All typical and atypical pathogens causing CAP may present clinically with varying severity, depending on the pathogen, host defense status, underlying lung disease, associated systemic illnesses, and the size of the infecting inoculum.17 Fine M.J., Orloff J.J., Arisumi D. , y al. Prognosis of patients hospitalized with community-acquired pneumonia Am J Med 1990 ; 88 : 5
Haga clic aquí para ir a la sección de Referencias, 18 Fine M.J., Hanusa B.H., Lave J.R. , y al. Comparison of medis groups admission severity groups and a pneumonia-specific severity index for patients hospitalized with community-acquired pneumonia J Gen Intern Med 1995 ; 10 : 359-368 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 19 Fine M.J., Smith M.A., Carson C.A. , y al. Prognosis and outcomes of patients with community-acquired pneumonia JAMA 1996 ; 274 : 134-141
Haga clic aquí para ir a la sección de Referencias, 20 Fine M.J., Hough L.J., Medsger A.R. , y al. The hospital admission decision for patients with community-acquired pneumonia Arch Intern Med 1997 ; 157 : 36-44
Haga clic aquí para ir a la sección de Referencias, 38 Marrie T.J., Durant H., Yates L. Community-acquired pneumonia requiring hospitalization: Five year prospective Rev Infect Dis 1989 ; 11 : 586-599 [cross-ref]
Haga clic aquí para ir a la sección de Referencias Although each of these pathogens can cause death under certain circumstances, fulminant disease is more frequently associated with some of these organisms, all other factors being equal.15 Farr B.M., Sloman A.J., Fisch M.J. Predicting death in patients hospitalized for community-acquired pneumonia Ann Intern Med 1991 ; 115 : 428-436
Haga clic aquí para ir a la sección de Referencias, 34 Leroy O., Santré C., Beuscart C. , y al. A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit Intensive Care Med 1995 ; 21 : 24-31 [cross-ref]
Haga clic aquí para ir a la sección de Referencias Acute fulminating CAP is more associated with pneumococci than with H. influenzae, for example.46 Wallace R.J., Musher D.M., Martin R.R. Hemophilus influenzae pneumonia in adults Am J Med 1978 ; 64 : 87-93
Haga clic aquí para ir a la sección de Referencias Except when it occurs in patients with a severe underlying cardiac, pulmonary, or systemic illness, M. catarrhalis pneumonia is rarely severe.47 Wallace R.J., Musher D.M. In honor of Dr. Sarah Branham. A star is born: The realization of Branhamella catarrhalis as a respiratory pathogen Chest 1986 ; 90 : 447-450 [cross-ref]
Haga clic aquí para ir a la sección de Referencias Group A streptococcal pneumonia, S. aureus pneumonia, and Klebsiella pneumonia usually result in clinically severe pneu-monias.29 Jong G.M., Hsiue T.R., Chen C.R. , y al. Rapidly fatal outcome of bacteremic Klebsiella pneumonia in alcoholics Chest 1995 ; 107 : 214-217 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 30 Karalus N.C., Cursons R.T., Leng R.A. , y al. Community-acquired pneumonia: Etiology and prognostic index evaluation Thorax 1991 ; 46 : 413-418 [cross-ref]
Haga clic aquí para ir a la sección de Referencias Among the atypical pathogens, Legionella is most likely to present as a severe CAP, but M. pneumoniae pneumonia in compromised hosts may be a life-threatening illness.23 Heath C.H., Grove D.I., Looke D.F. Delay in appropriate therapy of Legionella pneumonia associated with increased mortality Eur J Clin Microbiol Infect Dis 1996 ; 5 : 286-290 [cross-ref]
Haga clic aquí para ir a la sección de Referencias, 45 van Riemsdijk, van Overbeeke I.C., van den Berg B. Severe legionnaire's disease requiring intensive care treatment Neth J Med 1996 ; 49 : 185-188
Haga clic aquí para ir a la sección de Referencias Usually, C. pneumoniae is a relatively mild and benign illness. Psittacosis, Q fever, and tularemia are serious problems, but usually do not present as acute fulminating CAPs (Table 1).35 Lieberman D., Porath A., Schlaeffer F. , y al. Legionella species community-acquired pneumonia: A review of 56 hospitalized adult patients Chest 1996 ; 109 : 1243-1249 [cross-ref]
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W. B. Saunders Company. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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