Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

218 Bacterial Arthritis Bacterial Pneumonia

■Joint-related

➣Contractures

➣Joint erosions & destruction

Prognosis

■Poor prognosis w/ increased mortality & poor joint outcomes in

elderly, RA, those w/ prosthetic joints

■Poor prognosis w/ delayed institution of therapy

Bacterial Pneumonia..................................

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Predisposing factors-smoking, altered mental status (aspiration),

excessive alcohol, older age, immunosuppression, viral upper res-

piratory tract infections, endotracheal and nasogastric tubes (noso-

comial pneumonia)

■Etiology depends on clinical setting:

➣Outpatient: S pneumoniae, H influenzae, C pneumoniae, M

pneumoniae, Legionella

➣Nosocomial: S aureus, Pseudomonas, other Gram-negative

bacilli

➣Aspiration: aerobic and anaerobic “mouth flora”

➣Immunocompromised: any of above plus Pneumocystis carinii

(PCP), fungi (aspergillus, Cryptococcus, coccidioidomycosis),

nocardia

Signs & Symptoms

■Fever, cough, pleuritic chest pain, tachycardia, tachypnea, dyspnea,

rales, evidence of consolidation (dullness, decreased breath sounds,

bronchial breath sounds)

tests

■CXR to confirm infiltrate

■Determine etiology with 2 pretreatment blood cultures and sputum

for Gram stain and culture; thoracentesis for culture if pleural effu-

sion

■Urine antigen for Pneumococcus. Also, Legionella if diagnosis is sus-

pected.