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19 views

Cap 4

Uploaded by

vkrvbjphk2
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as KEY, PDF, TXT or read online on Scribd
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Community acquired pneumonia

Balaji C
Etiological diagnosis M3 unit
INVESTIGATIONS

Sputum examination by Gram’s stain and culture


Blood cultures
Urinary antigen tests
Polymerase chain reaction
Biomarkers
Gram’s stain and culture of sputum
Ensure an acceptable specimen.
Acceptable specimen- sputum sample must have > 25 neutrophils and <
10 squamous epithelial cells per low-power field.
Elderly patients - may not be able to produce appropriate sputum
sample.
The sputum Gram’s stain and culture are recommended only for
hospitalized CAP patients , particularly those with risks of MRSA.
Gram stain of sputum showing Gram Gram negative rods
positive diplococci characteristic of characteristic of Klebsiella
Streptococcus pneumoniae. pneumoniae
Blood cultures
Only 5-14% of cultures from hospitalized CAP patients are positive.
In viral and atypical pneumonias, TLC is often <5000/mm3.
Neutrophilic leukocytosis suggests bacterial pneumonia.
Because of the low yield and lack of significance, blood cultures are not
considered for all hospitalized CAP patients.
Streptococcus pneumoniae colonies with a surrounding green zone of
alpha-hemolysis on a SBA ( Sheep blood agar) plate
Urinary antigen tests
Two commercially available tests detect pneumococcal and Legionella
antigen in urine.
The sensitivity and specificity of these test are >70% and >90%
respectively.
The Legionella pneumophila test detects only serogroup 1 , which
accounts for most community acquired cases of Legionnaires’s disease.
Both test can detect antigen even after the initiation of appropriate
therapy.
Urinary antigen kits
Polymerase chain reaction
One technique that has significantly improved the rapid sputum diagnosis
of pneumococcal pneumonia is Real-time Quantitative Polymerase Chain
Reaction (RQ-PCR).
PCR of nasopharyngeal swabs has become the standard for diagnosis of
respiratory viral infections.
It can also detect the nucleic acids of Legionella species and
Mycobacteria.
Not cost effective.
Polymerase chain reaction
Biomarkers
Acute phase reactants

C- reactive protein Procalcitonin

Both CRP and PCT are less sensitive for detecting bacterial pathogens.
Used in conjunction with findings from the history, physical examination,
radiography and laboratory tests.
Finally helps in appropriate management of seriously ill CAP patients.
Diagnostic testing recommended for hospitalized patients
with CAP

Chest radiograph
Sputum Gram stain and culture
Blood cultures
Routine hematology and biochemistry
Rapid urine antigen testing
Thoracentesis for pleural effusion
Bibliography
HARRISON’S PRINCIPLES OF INTERNAL MEDICINE.

DAVIDSON’S PRINCIPLE AND PRACTICE OF MEDICINE.

TEXTBOOK OF PULMONARY & CRITICAL CARE MEDICINE- SK JINDAL


Thank you

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