Pulmonology
Community-Acquired Pneumonia
지역사회폐렴
Acute alveolar infection acquired in the community
- How common
- Common; inpatient mortality 5–10%
- Typical age
- Severe at extremes of age
What is it?
Pathogens reach alveoli; neutrophils and exudate fill alveoli forming consolidation.
Commonly affected: Lobar or bronchopneumonia pattern
How it develops
- Pathogen entryS. pneumoniae, Mycoplasma, virus
- Alveolar invasionOverwhelms alveolar macrophages
- Neutrophil/exudateAlveolar consolidation forms
- Impaired gas exchangeV/Q mismatch → hypoxemia
Symptoms
- Fever/chillsAcute high fever
- Productive coughPurulent/rust-colored sputum
- Pleuritic chest painWorse with deep breath
- Dyspnea/tachypneaRR ≥30/min
- Consolidation signsCrackles, bronchial breath sounds
How it is examined
- CURB-65 scoreConfusion, BUN, RR, BP, age >65
- Sputum/blood cultureObtain prior to antibiotics
- PSI scoreGuides admission/ICU decisions
Imaging
Lobar or patchy consolidation; air bronchograms.
- Lobar consolidation
- Air bronchograms
- Pleural effusion
Chest CT for complications (abscess/necrosis).
- Lung abscess
- Necrotizing pneumonia
Non-surgical care
- Empiric outpatient antibioticAmoxicillin or doxycycline/azithromycin
- Empiric inpatient antibioticCeftriaxone + azithromycin (typical+atypical)
- Severe/ICU regimenCeftriaxone + azithromycin OR respiratory FQ
- Supportive careO2, fluids, antipyretics, cough mgmt
- Vaccination (prevention)Pneumococcal (PCV13/PPSV23) + influenza
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Lung abscess drainage, complicated effusion
Procedures that may be discussed
- Chest tube placement
- VATS decortication
- Percutaneous abscess drainage
Outlook
Outpatient mortality <1%; ICU mortality 30–50%.