Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009

Abstract

Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.Keywords: Pneumonia; Diagnosis; Epidemiology; Practice guideline; Primary prevention. ResumoA pneumonia adquirida na comunidade mantém-se como a doença infecciosa aguda de maior impacto médico-social quanto à morbidade e a custos relacionados ao tratamento. Os grupos etários mais suscetíveis de complicações graves situam-se entre os extremos de idade, fato que tem justificado a adoção de medidas de prevenção dirigidas a esses estratos populacionais. Apesar do avanço no conhecimento no campo da etiologia e da fisiopatologia, assim como no aperfeiçoamento dos métodos propedêuticos e terapêuticos, inúmeros pontos merecem ainda investigação adicional. Isto se deve à diversidade clínica, social, demográfica e estrutural, que são tópicos que não podem ser previstos em sua totalidade. Dessa forma, a publicação de diretrizes visa agrupar de maneira sistematizada o conhecimento atualizado e propor sua aplicação racional na prática médica. Não se trata, portanto, de uma regra rígida a ser seguida, mas, antes, de uma ferramenta para ser utilizada de forma crítica, tendo em vista a variabilidade da resposta biológica e do ser humano, no seu contexto individual e social. Esta diretriz constitui o resultado de uma discussão ampla entre os membros do Conselho Científico e da Comissão de Infecções Respiratórias da Sociedade Brasileira de Pneumologia e Tisiol...

Patients hospitalized for community-acquired pneumonia present reduced functional performance

“…It generates high costs and is the leading cause of death from infectious diseases [1][2][3][4][5] . CAP's mortality rate has been the main focus of previous studies.…”

“…Inclusion criteria were: CAP as a cause of hospitalization, length of stay of less than 48 hours, over 18 years of age, hemodynamically stable, and an ability to walk and handle objects unassisted. CAP was diagnosed according to the Brazilian guidelines 5 (newly acquired respiratory symptoms, cough, sputum production, dyspnea, fever, tachypnea, auscultatory findings of abnormal breath sounds and crackles and presence of new lung infiltrate in a chest radiograph). Patients with other pulmonary diseases (chronic obstructive pulmonary disease-COPD, asthma, bronchiectasis or cystic fibrosis) and orthopedic or neurological conditions were excluded.…”

“…The clinical findings are cough, sputum production, chest pain, tachypnea, and fever. Other systemic manifestations, such as generalized myalgia, anorexia, nausea, vomiting, diarrhea, and sensory abnormalities, may also be observed 1,5 . The combination of respiratory and systemic symptoms contributes to malaise and severe prostration.…”

Fatores de risco associados ao prognóstico de adultos internados com pneumonia adquirida na comunidade

“…Pneumonia Adquirida na Comunidade (PAC) é aquela que acomete o paciente fora do ambiente hospitalar ou que surge nas primeiras 48 horas da admissão 1 . Cerca de 80% dos casos de PAC podem ser tratados em ambulatório, porém os pacientes internados apresentam taxas de mortalidade entre 12% e 25% 1,2 .…”

Predicting Mycobacterium tuberculosis in patients with community-acquired pneumonia

“…In fact, guidelines for managing CAP in several countries recognise M. tuberculosis as a potential pathogen [4][5][6][7][8].…”