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Pneumoni1 - often thought to point to “atypicals”...

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Pneumonia 2.1. TB TB should be considered in patients with a risk of exposure to TB and an apical pulmonary infiltrate 2.2. Pneumocystis carinii Pneumocystis carinii should be considered in patients with a risk of HIV and a diffuse pulmonary infiltrate (resembling pulmonary edema). 3. Diagnosis The clinical features of pneumonia are usually cough, fever, and sometimes the production of sputum (especially in bacterial pneumonias, in which sputum tends to be “purulent”) and pleuritic chest pain. However, somewhat similar symptoms may be caused by bronchitis: a chest x-ray can distinguish between bronchitis and pneumonia. The causative agent can be diagnosed in only about 50% of community-acquired pneumonias, even with sophisticated studies including serology and special cultures. Clinical clues such as lack of sputum, absence of consolidation, and a poor response to beta-lactam antibiotics, are
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Unformatted text preview: often thought to point to “atypicals” rather than the pneumococcus but prospective studies have not supported this notion. The value of sputum gram-stain (looking for PMNs – to suggest bacterial pneumonia and for characteristic microorganisms) and culture are controversial. Only about 1/3 of patients produce useful sputum and organisms colonizing the mouth but not present in the lung (including the pneumococcus) can confound the interpretation. Blood cultures are also of controversial value because they are positive in only about 10% of patients and usually reveal the pneumococcus (which would be suspected anyway). Nevertheless, these tests are probably useful in sicker patients (fever, elevated WBC) who have not taken antibiotics. Other types of tests that can be useful are shown on the slide titled Additional Test for Cause....
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