Community Acquired Pneumonia

Also Know As CAP

Community-acquired pneumonia

Community acquired pneumonia (CAP) is a lung infection which is a major concern worldwide as it is a leading cause of morbidity and death. CAP must have been obtained from other locale other than hospital or health care setting which makes it different from nosocomial pneumonia and hospital-acquired pneumonia. ^{[1] [2]}

Causes

Majority of cases are caused by bacteria called S. pneumoniae, H. influenzae, and M. catarrhalis with S. pneumonia being the most common. Viruses and fungi also cause CAP. People who have increased chances of getting CAP include those who have chronic lung diseases, immune system problems, serious medical conditions i.e. heart disease, recent surgeries and long term lung diseases like Chronic Obstructive Pulmonary Disease or COPD.  Smokers also are more prone to have CAP. ^[3]

Signs and Symptoms

The most common symptoms are productive or nonproductive cough, chest pain and fast or labored breathing. Mild or high fever with chills is also a frequent finding. The patient can have cold, clammy skin, headache, appetite loss and may complain of fatigue. Older people may develop confusion. Certain bacteria types like legionella may cause symptoms that relate to the gastrointestinal system such as abdominal pain. ^{[1] [3]}

Diagnosis

After obtaining the medical history, the physician conducts a physical examination which includes listening to breathe sounds. CAP often produces abnormal breathe sounds such as crackles. When the physician suspects CAP, a chest x-ray is frequently requested. Other tests include complete blood count, arterial blood gases, sputum, blood and pleural fluid culture and thoracentesis. ^[3]

Treatment

A patient can be treated on an outpatient basis. The physician may prescribe a single drug or a drug combination. Among the single drugs are doxycycline and respiratory quinolones. Patients are advised to drink plenty of water and to abstain from alcoholic drinks. When the case is classified as moderate to severe, hospitalization is recommended wherein the patient is given fluids and antibiotics thru the veins. When there is a need, oxygen is also given. Most patients improve in a span of 2 weeks. Elderly patients and those with more severe CAP may take a longer time of recovery.

References:

1.      http://emedicine.medscape.com/article/234240-overview

2.      http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease/community-acquired-pneumonia/

3.      http://www.nlm.nih.gov/medlineplus/ency/article/000145.htm

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Megavitamin Therapy (Multivitamin, Vitamin Supplements) [1, 2, 3, 4, 5, 6, 7]:

Please Note that while supplements are effective in correcting deficiencies in the body, their long-term usage is not helpful in preventing diseases like cancer and heart disease. To prevent these illnesses one should eat the natural foods which these vitamins and minerals come from. Replacing natural sources with artificial supplements actually increases the risk of heart disease, cancer, and other diseases. Supplements should be taken only as a balanced multivitamin supplement that contains no more than 100% of the recommended daily allowance. It would be most helpful in people with restricted food intakes, pregnant women and women of childbearing age.

Recommendation: Weakly against (There is no evidence that Megavitamin therapy can prevent or treat pneumonia. In fact, long term therapy can lead to increased risk)

Grade of Evidence: Moderate quality of evidence

Osteopathy [8, 9, 10]:

Recommendation: Weakly in favor (There is some evidence to support claims that osteopathy may be able to help treat pneumonia. More studies are needed)

Grade of Evidence: Low quality of evidence

Zinc [11, 12, 13, 14, 15]:

Recommendation: No recommendation (Current studies have yielded mixed results on the level of efficacy of zinc as a treatment for pneumonia. More studies are needed)

Grade of Evidence: Low quality of evidence

Vitamin C [16, 17]:

Recommendation: No recommendation (There is insufficient evidence to support claims that vitamin c may be able to help treat colorectal cancer. More studies are needed)

Grade of Evidence: Very low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/orthomolecular-medicine

3. http://archpedi.ama-assn.org/cgi/reprint/163/2/192.pdf

4. http://www.quackwatch.org/01QuackeryRelatedTopics/ortho.html

5. http://pediatrics.aappublications.org/cgi/content/abstract/72/5/707

6. http://www.ama-assn.org/ama/no-index/about-ama/13638.shtml

7. http://www.ncbi.nlm.nih.gov/pubmed/17327526

8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845139/

9. http://www.ncbi.nlm.nih.gov/pubmed/18806080

10. http://jaoa.org/article.aspx?articleid=2093709

11. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323679/

12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276784/

13. http://www.healthnet.org.np/ebook/imci/cough/bhuttaza.pdf

14. http://www.researchgate.net/profile/W_Abdullah_Brooks/publication/7594531_Effect_of_weekly_zinc_supplements_on_incidence_of_pneumonia_and_diarrhoea_in_children_younger_than_2_years_in_an_urban_low-income_population_in_Bangladesh_randomised_controlled_trial/links/54336f3a0cf20c6211be4bb7.pdf

15. http://www.ijponline.net/content/38/1/36

16. http://www.ncbi.nlm.nih.gov/pubmed/23925826

17. http://www.atsjournals.org/doi/full/10.1164/ajrccm.184.5.621a#.Vd2unvmqpBc

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