ATS Guidelines on Diagnosis of Community-Acquired Pneumonia (CAP) among Outpatients

A physical examination and diagnosis of CAP

A physical examination, which largely focuses on confirming the characteristic symptoms associated with the lung infection, is one of the most important factors in diagnosing CAP in outpatients. The definite indications of CAP, according to the American Thoracic Society (ATS), include pleuritic chest pains, chills, cough, and the formation of mucopurulent sputum. However, not all instances are confirmed by the prodromal manifestation. A wonderful illustration is the occurrence of CAP among the elderly, who do not exhibit any of the usual symptoms. Instead, the respiratory condition is characterized by a high fever above 40°C and decline in mental and functional abilities. In the event the causative agent is the Legionella bacterium, the CAP is symptomized by vomiting, nausea, muscle pain, diarrhea, and breathing difficulties.

ATS guidelines for diagnosing CAP

According to ATS guidelines, the documentation of history should centralize on establishing signs that are consistent with CAP. The diagnosis should also investigate history with conditions that have been known to compromise immunity such as HIV infection and COPD. Similarly, pathogenic exposure should be established by assessing sex history, occupational risks, as well as contacts with animals. The criticality of pathogenic exposures is informed by the existence of various forms of atypical pneumonia arising from infection with Legionella bacterium, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.

Establishing pneumonia through differential signs

The pneumonia is only established by differential signs such as tachycardia, dullness, and egophony. While the symptoms are highly specific to CAP, their absence does not rule out the presence of the infection. Instead, it should necessitate the need for radiological examination and culture as a confirmatory test for clinically suspected CAP. The review should entail chest radiography, as imaging not only helps in establishing CAP but also determining the degree of severity. The radiographic findings also inform inceptive point-of-care decisions. For instance, parenchymal involvement confirms viral pneumonia while lobar consolidation suggests a bacterial infection. The revelation helps in determining the nature of antimicrobial therapy.

JT's Case Study

Additional Tests

While coarse rhonchi, labored breathing, and tachypnea being presented by JT are specific symptoms of CAP, there is a need for laboratory analysis and radiological imaging. The need for the differential tests is necessitated by other manifestations and claims that JT is seeking clinical attention because his condition is worsening. For instance, while rust-colored mucus is a positive confirmation for pneumococcal bacteria, it is also a manifestation of other diseases of the respiratory system such as pulmonary tuberculosis, pulmonary embolism, and lung cancer (Li, 2015). Chest pain and breathing challenges are also caused by non-respiratory events such as heartburn as well as cardiovascular diseases. An infiltrate on lung imaging would help in establishing the suspected CAP while sputum culture would offer investigative benefits on specific pathogens.

Diagnosis and Results

I expect the CT scan and X-ray to reveal lower and right middle lobe consolidation as well as the presence of air bronchograms. The microscopic examination results of the sputum should show the lancet-shaped cocci Streptococcus pneumoniae.

Medications

The primary line of treatment is empiric therapy. According to the guidelines put forward by ATS, the empiric antibiotic treatment of the disease should be a respiratory fluoroquinolone alone or combination of a β-lactam and a macrolide. The choice is influenced by the effectiveness of the treatments in eradicating both common causes such as Haemophilus influenza and S pneumoniae as well as atypical organisms such as Staphylococcus aureus and Moraxella catarrhalis (Vardakas, Trigkidis, & Falagas, 2017).

References

Li, H. (Ed.). (2015). Radiology of Infectious Diseases. Springer Netherlands.

Vardakas, K. Z., Trigkidis, K. K., & Falagas, M. E. (2017). Fluoroquinolones or macrolides in combination with β-lactams in adult patients hospitalized with community acquired pneumonia: a systematic review and meta-analysis. Clinical Microbiology and Infection, 23(4), 234-241.