Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- tosse com aumento da produção de escarro
- febre ou calafrios
- dispneia
- dor pleurítica
- achados anormais da ausculta
Risk factors
- idade >65 anos
- residência em um ambiente de cuidados médicos
- doença pulmonar obstrutiva crônica (DPOC)
- exposição à fumaça de cigarro
- abuso de álcool
- higiene bucal ineficiente
- uso de medicamentos antiácidos, corticosteroides inalatórios, antipsicóticos e medicamentos antidiabéticos
- contato com crianças
- Infecção pelo vírus da imunodeficiência humana (HIV)
- diabetes mellitus
- doença renal crônica
- doença hepática crônica
- uso de opioides
Diagnostic investigations
1st investigations to order
- radiografia torácica
- Hemograma completo
- eletrólitos séricos, ureia
- testes da função hepática
- glicose sanguínea
- gasometria arterial/oximetria
- hemocultura
- cultura de escarro
Investigations to consider
- ultrassonografia do pulmão no local de atendimento
- tomografia computadorizada (TC) do tórax
- teste de antígeno urinário para Legionella e pneumococo
- proteína C-reativa sérica
- procalcitonina sérica
- toracocentese e cultura do líquido pleural
- broncoscopia
- testes de vírus respiratórios
- técnicas microbiológicas moleculares
Treatment algorithm
Contributors
Authors
Catia Cilloniz, MD, PhD, FERS
Applied Research in Respiratory Diseases
Hospital Clinic of Barcelona
CIBERES
IDIBAPS
Associate Professor
University of Barcelona
Barcelona
Spain
Раскрытие информации
CC is an author of a number of references cited in this topic.
Antoni Torres, MD, PhD
Professor of Medicine
Director
Pulmonary Intensive Care Unit
Respiratory Institute
Hospital Clinic of Barcelona
Barcelona
Spain
Раскрытие информации
AT is an author of a number of references cited in this topic.
Выражение благодарностей
Dr Catia Cilloniz and Professor Antoni Torres would like to gratefully acknowledge Dr M. Nawal Lutfiyya, Dr Linda Chang, and Dr Robert Bales, previous contributors to this topic.
Раскрытие информации
MNL is an author of a reference cited in this topic. LC and RB declare that they have no competing interests.
Рецензенты
Barbara Jones, MD, MSc
Assistant Professor
Division of Pulmonary and Critical Care Medicine
University of Utah
Salt Lake City
UT
Раскрытие информации
BJ declares that she has no competing interests.
Denise Nassisi, MD
Associate Professor
Departments of Emergency Medicine and Medicine
Icahn School of Medicine at Mount Sinai
New York
NY
Раскрытие информации
DN declares that she has no competing interests.
Grant Waterer, MBBS, PhD, MBA, FRACP, FCCP
Professor of Medicine
Royal Perth Hospital
Perth
Australia
Раскрытие информации
GW declares that he has no competing interests.
Jeremy Brown, MBBS, FRCP, PhD
Professor of Respiratory Infection/Honorary Consultant
University College London
London
UK
Disclosures
JB was a member of the NICE pneumonia guidelines committee.
Nathan Dean, MD
Professor (clinical) of Medicine
Section Chief Pulmonary Critical Care Medicine
University of Utah
Intermountain Medical Center
Murray
UT
Disclosures
ND declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-67.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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