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Pneumococcal Pneumonia    

Title               

Ñ    Pneumococcal Pneumonia

Definition

Ñ    Pneumonia caused by Streptococcus pneumoniae

Aetiology

Ñ    Streptococcus pneumoniae

Pathogenesis

Ñ    As for pneumonia

Clinical Features

History

Ñ    Often preceded by an upper respiratory tract infection

E&M

Ñ    Single chill with rigor

Ñ    Fever

Ñ    Malaise

RS

Ñ    Pleuritic chest pain

Ñ    Cough with sputum production:

Purulent

Blood streaked

Rusty

Ñ    Dyspnoea

GIT

Ñ    Abdominal pain:

Lower lobe pneumonia

Ñ    Nausea, vomiting

LMS

Ñ    Myalgia

Examination

E&M

Ñ    Fever

RS

Ñ    Tachypnoea

Ñ    Lobar consolidation

Complications

CVS

Ñ    Septic shock

Ñ    Endocarditis

RS

Ñ    Pleural effusion

Ñ    Empyema

GIT

Ñ    Peritonitis

CNS

Ñ    Meningitis

LMS

Ñ    Septic arthritis

Investigations

Fluids

Haematology

Ñ    Leucocytosis with left shift

Microbiology

Ñ    Culture:

Blood

Sputum

Pleural fluid

Transtracheal aspirate

Imaging

Chest X-ray

Ñ    Pulmonary infiltrate:

Findings may be minimal or undetectable in the first hours

Management

Cure

Drugs

Ñ    Benzylpenicillin

Ñ    Amoxycillin

Ñ    Erythromycin

Ñ    Clarithromycin

Ñ    Cefuroxime

Ñ    Cefotaxime

Ñ    Quinolones

Support

Equipment

Respiratory support:

Ñ    Oxygen

Prevention

Biological agents

Ñ    Pneumococcal vaccine

Prognosis

Ñ    Worse at extremes of age

Ñ    Follow up X-ray for patients > 35 years:

Persistence of infiltration after 6 weeks suggests bronchogenic neoplasm or tuberculosis

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