Pneumonia

Definition

  • “Pneumonia”: defined as a an alveolar filling process on an imaging study (chest x-ray or chest CT)

Etiology

Infection

Viral

Bacterial (see also Community-Acquired Pneumonia, [[Community-Acquired Pneumonia]] and Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia, [[Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia]])

Fungal

  • Blastomycosis (see Blastomycosis, [[Blastomycosis]])
    • Etiology: Blastomyces
  • Candida/Bronchopulmonary Candidiasis (see Candida, [[Candida]])
    • Etiology: Candida
  • Chronic Pulmonary Aspergillosis (see Chronic Pulmonary Aspergillosis, [[Chronic Pulmonary Aspergillosis]])
    • Etiology: Aspergillus
  • Coccidioidomycosis (see Coccidioidomycosis, [[Coccidioidomycosis]])
    • Etiology: Coccidioides Immitis
  • Cryptococcosis (see Cryptococcosis, [[Cryptococcosis]])
    • Etiology: Cryptococcus
  • Histoplasmosis (see Histoplasmosis, [[Histoplasmosis]])
    • Etiology: Histoplasma
  • Invasive Pulmonary Aspergillosis (see Invasive Aspergillosis, [[Invasive Aspergillosis]])
    • Etiology: Aspergillus
  • Mucoid Impaction (see Mucoid Impaction, [[Mucoid Impaction]])
  • Mucormycosis (see Mucormycosis, [[Mucormycosis]])
    • Etiology: Mucor
  • Pneumocystis Jirovecii (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]])
  • Scedosporiosis (see Scedosporiosis, [[Scedosporiosis]])
    • Etiology: Scedosporium

Parasitic

Aspiration

  • Aspiration Pneumonia (see Aspiration Pneumonia, [[Aspiration Pneumonia]])
  • Barium Aspiration (see Barium, [[Barium]])
  • Gastrograffin Aspiration (see Gastrograffin, [[Gastrograffin]])
  • Near Drowning (see Near Drowning, [[Near Drowning]])
  • Hydrocarbon Aspiration Pneumonitis (see Hydrocarbons, [[Hydrocarbons]])
  • Talcum Powder Aspiration (see Talc, [[Talc]])

Neoplasm

Connective Tissue Disease

Lung Transplant-Associated (see Lung Transplant, [[Lung Transplant]])

Trauma (see Trauma, [[Trauma]])

Mechanical Pulmonary Edema (see Mechanical Pulmonary Edema, [[Mechanical Pulmonary Edema]])

  • Upper Airway Obstruction (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
  • Overdistention Pulmonary Edema
  • Post-Pneumonectomy Pulmonary Edema
  • Re-Expansion Pulmonary Edema

Hemodynamic Disturbance

Hematologic Disorder

Neurogenic Pulmonary Edema (see Neurogenic Pulmonary Edema, [[Neurogenic Pulmonary Edema]])

Pulmonary Infiltrates with Eosinophilia (see Pulmonary Infiltrates with Eosinophilia, [[Pulmonary Infiltrates with Eosinophilia]])

Eosinophilic Pulmonary Syndromes of Known Etiology

Parasitic Infection
  • General Comments: parasite-associated eosinophilic pneumonias represent the most common etiologies of pulmonary infiltrates with eosinophilia worldwide
  • Capillaria Aerophila (see Capillariasis, [[Capillariasis]])
    • Epidemiology: rare etiology of eosinophilic pulmonary infiltrates
  • Clonorchis Sinensis (see Clonorchiasis, [[Clonorchiasis]])
    • Epidemiology: rare etiology of eosinophilic pulmonary infiltrates
  • Dirofilariasis (see Dirofilariasis, [[Dirofilariasis]])
    • Clinical: eosinophilic pulmonary infiltrates
  • Echinococcosis (see Echinococcosis, [[Echinococcosis]])
  • Paragonimiasis (see Paragonimiasis, [[Paragonimiasis]])
    • Epidemiology: rare etiology of eosinophilic pulmonary infiltrates
  • Schistosomiasis (see Schistosomiasis, [[Schistosomiasis]]): the manifestations of schistosomiasis in the lung vary dependent on the stage of disease
    • Early Acute Schistosomiasis: transient, multiple small pulmonary nodules with peripheral eosinophilia
    • Chronic Schistosomiasis: embolization of ova in small arteries of the lung results in granuloma formation, occlusion and remodeling of pulmonary arteries, and further pulmonary hypertension mediared by portopulmonary hypertension
    • Post-Treatment of Schistosomiasis: eosinophilic pneumonitis (lung shift, verminous pneumonia, reactionary Loffler-like pneumonitis) due to antigen release following treatment
  • Simple Pulmonary Eosinophilia (Loffler Syndrome) (see Simple Pulmonary Eosinophilia, [[Simple Pulmonary Eosinophilia]])
    • Ascaris Lumbricoides (or Ascaris Suum): most common etiology of simple pulmonary eosinophilia (Loffler syndrome)
    • Necator Americanus
    • Ancylostoma Duodenale
    • Ancylostoma Brazliense or Canium
    • Entamoeba Histolytica
    • Fasciola Hepatica
    • Schistosomiasis (see Schistosomiasis, [[Schistosomiasis]]): the manifestations of schistosomiasis in the lung vary dependent on the stage of disease
      • Early Acute Schistosomiasis: transient, multiple small pulmonary nodules with peripheral eosinophilia
      • Chronic Schistosomiasis: embolization of ova in small arteries of the lung results in granuloma formation, occlusion and remodeling of pulmonary arteries, and further pulmonary hypertension mediared by portopulmonary hypertension
      • Post-Treatment of Schistosomiasis: eosinophilic pneumonitis (lung shift, verminous pneumonia, reactionary Loffler-like pneumonitis) due to antigen release following treatment
    • Strongyloides Stercoralis: simple pulmonary eosinophilia (Loffler syndrome) may occur when larvae migrate through the lungs after acute infection
  • Strongyloides Stercoralis Hyperinfection Syndrome (see Strongyloides Stercoralis, [[Strongyloides Stercoralis]])
    • Epidemiology: occurs in 20% of patients hospitalized with strongyloidiasis and coexisting chronic lung disease (COPD, asthma)
    • Diagnosis: rhabditiform larvae may be recovered via bronchoalveolar lavage, bronchial wash, or sputum sample
    • Clinical: cough/wheezing/dyspnea with bilateral patchy infiltrates and variable degree of eosinophilia
  • Trichinosis (see Trichinosis, [[Trichinosis]])
    • Epidemiology: rare etiology of eosinophilic pulmonary infiltrates
  • Tropical Pulmonary Eosinophilia (Occult Filariasis) (see Tropical Pulmonary Eosinophilia, [[Tropical Pulmonary Eosinophilia]])
    • Wuchereria Bancrofti
    • Brugia Malayi
    • Brugia Timori
  • Visceral Larva Migrans (see Visceral Larva Migrans, [[Visceral Larva Migrans]])
    • Toxocara Canis
Other Infection
  • Aspergillus Niger (see Aspergillus, [[Aspergillus]])
    • Epidemiology: case reports of eosinophilic pneumonia
  • Bipolaris Australiensis
    • Epidemiology: case reports of eosinophilic pneumonia
  • Bipolaris Spicera
    • Epidemiology: case reports of eosinophilic pneumonia
  • Brucellosis (see Brucellosis, [[Brucellosis]])
    • Epidemiology: case reports of eosinophilic pneumonia [Eosinophilia and pneumonitis in chronic brucellosis: a report of two cases. Ann Intern Med. 1942;16:995-1001]
  • Coccidioidomycosis (see Coccidioidomycosis, [[Coccidioidomycosis]])
    • Clinical: pronounced peripheral eosinophilia may be an early indicator of dissemination
  • Cryptococcosis (see Cryptococcosis, [[Cryptococcosis]])
    • Epidemiology: case reports of eosinophilic pneumonia (South Med J, 1995) [MEDLINE]
  • Histoplasmosis (see Histoplasmosis, [[Histoplasmosis]])
  • Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
  • Influenza Virus (see Influenza Virus, [[Influenza Virus]])
    • Epidemiology: may produce eosinophilic pneumonia in some cases
  • Mycobacterium Simiae (see Mycobacterium Simiae, [[Mycobacterium Simiae]])
    • Epidemiology: case reports of eosinophilic pneumonia (NEJM, 1989) [MEDLINE]
  • Pneumocystis Jirovecii (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]])
    • Epidemiology: BAL eosinophilia has been reported in HIV-associated cases
  • Respiratory Syncytial Virus (RSV) (see Respiratory Syncytial Virus, [[Respiratory Syncytial Virus]])
    • Epidemiology: may produce eosinophilic pneumonia in some cases
  • Tuberculosis (see Tuberculosis, [[Tuberculosis]])
    • Epidemiology: may produce eosinophilic pneumonia in some cases
Allergic Bronchopulmonary Aspergillosis and Related Syndromes
Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])
  • More Than 80 Drugs/Toxins Have Been Reported to Cause Drug-Induced Pulmonary Eosinophilia
Other
  • Breast Radiation-Associated Eosinophilic Pneumonia (see Radiation Therapy, [[Radiation Therapy]])
    • Clinical: chronic eosinophilic pneumonia
  • Eosinophilia-Myalgia Syndrome (see Eosinophilia-Myalgia Syndrome, [[Eosinophilia-Myalgia Syndrome]])
    • Physiology: due to contaminated L-tryptophan (see L-Tryptophan, [[L-Tryptophan]])
  • Toxic Rapeseed Oil Syndrome (see Contaminated Rapeseed Oil, [[Contaminated Rapeseed Oil]])
    • Physiology: due to contaminated rapeseed oil

Eosinophilic Pulmonary Syndromes of Unknown Etiology

Other Pulmonary Disorders with Possible Associated Pulmonary Eosinophilia

  • Asthma (see Asthma, [[Asthma]])
  • Eosinophilic Bronchitis (see Eosinophilic Bronchitis, [[Eosinophilic Bronchitis]])
    • Clinical: chronic cough with sputum eosinophilia (about 40%)
      • Normal Lung Function with Absence of Bronchial Hyperreactivity: although it may evolve over time into either fixed airflow obstruction without asthma or into true asthma
      • Absence of Eosinophilic Pneumonia
  • Gastric Cancer with Tumor-Related Production of GM-CSF and IL-5 (see Gastric Cancer, [[Gastric Cancer]])
    • Epidemiology: case report
  • Hodgkin’s Disease (see Hodgkins Disease, [[Hodgkins Disease]])
    • Epidemiology: xxxx
  • Idiopathic Interstitial Pneumonias
    • Desquamative Interstitial Pneumonia (DIP): mild BAL eosinophilia may occur in some cases
    • Non-Specific Interstitial Pneumonia (NSIP): mild BAL eosinophilia may occur in some cases
  • Idiopathic Pulmonary Fibrosis (IPF) (see Idiopathic Pulmonary Fibrosis, [[Idiopathic Pulmonary Fibrosis]]): mild BAL eosinophilia may occur in some cases
  • Langerhans Cell Histiocytosis (LCH) (see Langerhans Cell Histiocytosis, [[Langerhans Cell Histiocytosis]])
    • Diagnosis: pulmonary pathologic lesions are nodules (with bronchiolocentric stellate shape) with Langerhans cells and variable numbers of eosinophils, plasma cells, and lymphocytes
      • Eosinophils are Usually Present in the Initial, Active Stage of the Disease: they contribute to the eosinophilic granuloma
      • Eosinophils are Numerous in 25% of Cases: usually located at the periphery of the lesions
      • Eosinophils are Rare or Absent at the Chronic Stage of the Disease
  • Lung Transplant (see Lung Transplant, [[Lung Transplant]])
    • Acute Lung Transplant Rejection (Acute Cellular Lung Transplant Rejection) (see Acute Lung Transplant Rejection, [[Acute Lung Transplant Rejection]]): peripheral eosinophilia may occur with/without pulmonary infiltrates (as acute rejection may be detected by surveillance bronchoscopy with transbronchial biopsy prior to the development of pulmonary infiltrates)
  • Organizing Pneumonia (see Cryptogenic Organizing Pneumonia, [[Cryptogenic Organizing Pneumonia]])
    • Diagnosis: mild BAL eosinophilia may occur in some cases (usually <20%)
  • Sarcoidosis (see Sarcoidosis, [[Sarcoidosis]])
    • Diagnosis: peripheral eosinophilia (and tissue eosinophilia) may be present, but are usually mild

Cryptogenic Organizing Pneumonia (COP)

Hypersensitivity Pneumonitis (HP)

Diffuse Alveolar Hemorrhage (DAH)

Drug

Toxin

Other


References

General

  • Preferences for home vs hospital care among low-risk patients with community-acquired pneumonia. Arch Intern Med 1996; 156:1565–71 [MEDLINE]
  • A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan 23;336(4):243-50 [MEDLINE]
  • The cost of treating community-acquired pneumonia. Clin Ther. 1998 Jul-Aug;20(4):820-37 [MEDLINE]
  • Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: anal- ysis of the MEDENOX Study. Arch Intern Med 2004; 164:963–8 [MEDLINE]
  • Validation of predictive rules and indices of severity for community acquired pneumonia. Thorax 2004; 59:421–7 [MEDLINE]
  • Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax 2004;59:960-965 [MEDLINE]
  • Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72 [MEDLINE]
  • CDC EPIC Study. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015 Jul 30;373(5):415-27. doi: 10.1056/NEJMoa1500245. Epub 2015 Jul 14 [MEDLINE]
  • Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. 2016 Sep 1;63(5):e61-e111. doi: 10.1093/cid/ciw353. Epub 2016 Jul 14 [MEDLINE]

Prevention

  • Facilitating influenza and pneumococcal vaccination through standing orders programs. JAMA 2003; 289:1238 [MEDLINE]

General Treatment

  • The cost of treating community-acquired pneumonia. Clin Ther 1998; 20: 820–37 [MEDLINE]

Antibiotics

  • Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Respir Crit Care Med. 1999;160(2):608-613 [MEDLINE]
  • PneumA Trial. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19):2588-2598 [MEDLINE]
  • Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004; 164:637–44 [MEDLINE]
  • De-escalation in lower respiratory tract infections. Curr Opin Pulm Med. 2006;12(5):364-368 [MEDLINE]
  • De-escalation therapy in ventilator-associated pneumonia. Curr Opin Crit Care. 2006;12(5):452-457 [MEDLINE]
  • Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest 2006; 129:1210–1218 [MEDLINE]
  • Antibiotic stewardship: overcoming implementation barriers. Curr Opin Infect Dis. 2011;24(4): 357-362 [MEDLINE]
  • Antimicrobial stewardship programs: mandatory for all ICUs. Crit Care. 2012;16:179. doi:10.1186/cc11853 [MEDLINE]
  • Impact of regular collaboration between infectious diseases and critical care practitioners on antimicrobial utilization and patient outcome. Crit Care Med. 2013;41:2099–2107. doi: 10.1097/CCM.0b013e31828e9863 [MEDLINE]
  • Efficacy of single-dose antibiotic against early-onset pneumonia in comatose patients who are ventilated. Chest. 2013 May;143(5):1219-25. doi: 10.1378/chest.12-1361 [MEDLINE]
  • Antibiotic stewardship in hospital-acquired pneumonia. Chest. 2013;143:1195–1196. doi:10.1378/chest.12-2729 [MEDLINE]
  • Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. JAMA. 2014 Jun 4;311(21):2199-208. doi: 10.1001/jama.2014.4304 [MEDLINE]
  • What can be expected from antimicrobial de-escalation in the critically ill? Intensive Care Med 2014; 40:92–5 [MEDLINE]
  • CAP-START Trial. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015 Apr 2;372(14):1312-23. doi: 10.1056/NEJMoa1406330 [MEDLINE]
  • A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit. Clin Infect Dis. 2016 Apr 15;62(8):1009-17. doi: 10.1093/cid/civ1199. Epub 2015 Dec 23 [MEDLINE]
  • Duration of Antibiotic Treatment in Community-Acquired Pneumonia
    A Multicenter Randomized Clinical Trial. JAMA Intern Med. 2016 Jul 25. doi: 10.1001/jamainternmed.2016.3633 [MEDLINE]

Corticosteroids

  • Adjuvant steroid therapy in community-acquired pneumonia: a systematic review and meta-analysis. J Hosp Med. 2013 Feb;8(2):68-75 [MEDLINE]

Respiratory Support

  • Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med. 1999 Nov;160(5 Pt 1):1585-91 [MEDLINE]
  • Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success. Thorax. 1995 Jul;50(7):755-7 [MEDLINE]
  • Predictors of failure of noninvasive ventilation in patients with severe community-acquired pneumonia. J Crit Care. 2010 Sep;25(3):540.e9-14. doi: 10.1016/j.jcrc.2010.02.012 [MEDLINE]
  • The role of noninvasive positive pressure ventilation in community-acquired pneumonia. J Crit Care. 2015 Feb;30(1):49-54. doi: 10.1016/j.jcrc.2014.09.021. Epub 2014 Oct 2 [MEDLINE]

Prognosis

  • Readmission following hospitalization for pneumonia: the impact of pneumonia type and its implication for hospitals. Clin Infect Dis. 2013 Aug;57(3):362-7 [MEDLINE]
    • Editorial commentary: “excess readmissions” for pneumonia: a dilemma with a penalty. Clin Infect Dis. 2013 Aug;57(3):368-9 [MEDLINE]