Respiratory Infections

Intracranial epidural and subdural abscesses are rare. They usually result from spread of infection from a nidus of osteomyelitis after neurosurgery from an infected sinus (in particular the frontal sinus), or less commonly, from an infected middle ear or mastoid.

The Pneumonia Patient Outcome Research Team developed useful criteria called the pneumonia severity index for assessing pneumonia severity; however, that index proved to be complex and difficult to use. A simpler index called the CURB-65 (confusion, urea nitrogen, respiratory rate, blood pressure, age 65 years or older) has been shown to have sensitivity and specificity nearly equal to that of the pneumonia severity index. Both indexes can be used to guide decisions on admission to a hospital ward or intensive care unit. As shown in Figure 4.5, patients with a score of 0 or 1 can be treated as outpatients; those with a score of 2 or more warrant hospitalization.

Great overlap occurs among the clinical manifestations of the pathogens associated with acute community-acquired pneumonia. However, constellations of symptoms, signs, and laboratory findings serve to narrow the possibilities. By developing an ability to focus on a few pathogens or to identify a specific pathogen, clinicians can better predict the clinical course of pneumonia and can narrow antibiotic coverage. Pathogenic strains of S. pneumoniae have a thick capsule that prevents PMN binding and that blocks phagocytosis.

The goals of treatment include reduction in signs and symptoms, eradication of infection, and prevention of complications. Avoidance of unnecessary antibiotic use is another goal in view of S. pneumonia. dClindamycin is only recommended in cases of documented S. pneumoniae. It is not effective against H. influenzae or M. catarrhalis.

Bronchitis, bronchiolitis, pneumonia clinical presentation and treatment.

Pneumonia is the most common infectious cause of death in the United States. It occurs in persons of all ages, although the clinical manifestations are most severe in the very young, the elderly, and the chronically ill. The course of anaerobic pneumonia is typically indolent with cough, low-grade fever, and weight loss, although an acute presentation may occur. Putrid sputum, when present, is highly suggestive of the diagnosis.

Incidence/Prevalence in USA: Common in winter. Almost all persons infected one or more times during lifetime. Outpatient for mild cases; inpatient for severe disease or for those with underlying disorders.