I. Definition
Community-acquired pneumonia is an inflammation of the infected lung parenchyma that develops outside the hospital, including pneumonia that develops within an average incubation period after hospital admission due to pathogenic infection with a defined incubation period.
II. Diagnosis
(A) Clinical diagnosis based on
1. Newly developed cough and sputum, or aggravation of existing respiratory disease symptoms with purulent sputum; with or without chest pain.
2, fever.
3.Signs of solid lung and/or wet woven grass.
4, WBC>10×109/L or 25/low magnification field, or the ratio of the two <1:2, 5). Inoculate with qualified specimens in both blood agar plates and chocolate plates with selective media or other media if necessary. The standard 4-zone delineation method was used to inoculate for semi-quantitative culture. Smear oil microscopy to see the typical form of Streptococcus pneumoniae or Haemophilus influenzae has diagnostic value.
2, test results (usually bacteria, atypical pathogens) diagnostic significance of the judgment
(1) Determination
① blood or pleural fluid culture to pathogenic bacteria.
② specimens cultured to pathogenic bacteria concentration by fiberoptic bronchoscopy or artificial airway suction.
(③) respiratory specimens cultured to Mycoplasma pneumoniae or serum antibody titers in a 4-fold increase.
(iv) Serum Mycoplasma pneumoniae at a 4-fold or greater increase in antibody titers to the protozoa.
(5) Serum Legionella pneumophila direct fluorescent antibody positive and 4-fold increase in antibody titer.
(2) Significant
(1) Qualified sputum specimens with moderate or more growth of dominant bacteria (≥+++).
(ii) Qualified sputum specimens with a small amount of growth but consistent with Xu film microscopy results (Streptococcus pneumoniae, Haemophilus influenzae, and Catamorax).
③ repeated cultures of the same bacteria within 3 days of admission.
(iv) Increased serum Chlamydia pneumoniae antibody titer ≥ 1:32.
(⑤ Serum Legionella pneumophila test tube agglutination test antibody titer elevated once up to 1:320 or indirect fluorescence test ≥ 1:256 or 4-fold increase up to 1:128.
(3) No significance
(i) Sputum culture with bacteria of the normal flora of the upper respiratory tract (e.g. Streptococcus straw green, Staphylococcus epidermidis, non-pathogenic Neisseria, diphtheria-like bacilli).
② Sputum culture for a small amount of multiple pathogenic bacteria (65 years old).
2. Presence of underlying disease or associated factors
① chronic obstructive pulmonary disease.
② diabetes mellitus.
③ chronic cardiac and renal insufficiency.
④Inhalation or aspiration-prone factors.
⑤ history of hospitalization for CAP within the last 1 year.
(6) Altered mental status.
(vii) post-splenectomy status.
⑧ Chronic alcoholism or malnutrition.
3.Abnormal physical signs
① respiratory rate > 30 times/min.
②Pulse ≥ 120 times/min.
③ Blood pressure.