Medicus, Vol. 14 No. 1_ARI, 2005.
Review article
Pneumonias: Pathogens and Diagnostics
Ilija Kuzman
Abstract
Pneumonia is the most serious
respiratory infl ammatory disease. It is caused by various
microorganisms and affects all age groups and chronic
and immunocompromised patients. Therefore, it has many
symptoms, clinical forms and degrees of severity. The
incidence and severity of pneumonia are higher in the
elderly, where it is not rarely fatal. Pneumonia causes
more deaths than any other infective disease. More than
90% of all deaths caused by pneumonia are recorded in the
elderly.
The main etiological agents responsible for pneumonia in
the general population include: Streptococcus pneumoniae,
Mycoplasma pneumoniae, Chlamydophila pneumoniae,
Legionella pneumophila, Haemophilus infl uenzae, and
respiratory viruses. In our population, they also include
Chlamydophila psittaci (psittacosis) and Coxiella burnetii
(Q fever). The clinical division into bacterial and atypical
pneumonias, which is basically the etiological division,
is very important since the classifi cation of pneumonia
determines further treatment. This is supported by our
long-time experience. There is a signifi cant difference in
the prevalence of certain pathogens between children and
adults. Hospital pneumonias are frequently reported and
they are often very severe and not rarely fatal diseases
mainly caused by resistant gram-negative enterobacteria
and S. aureus. Pneumonias in immunocompromised patients
belong to a special group. In addition to common pathogens,
they are often caused by opportunistic (conditionally
pathogen) microogranisms.
Despite continuous progress, diagnosis and treatment of
pneumonia are accompanied with a number of controversies.
Nowadays, the PORT score (Fine et al.) is mainly used
to assess the severity of the disease and the need for
hospitalisation, i.e. the method of treatment. However,
the etiological diagnosis of pneumonia is very demanding,
complex and complicated so is rarely made prior to the
beginning of treatment. Diagnostics should be logical and
rational, include simple procedures followed by those more
complicated. Therefore, the treatment of most pneumonias
starts, and will probably continue to start, before the
identifi cation of pathogens.
Keywords
pneumonia; community acquired; hospital acquired; pathogens; diagnostic methods
Hrčak ID:
18820
URI
Publication date:
26.1.2005.
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