2-Underlying poor host status: smoker, alcoholism, COPD, bronchiectasis, HIV/AIDS, Cystic fibrosis, chronic steroid use, diabetics, asplenia
2- Infectious etiologies: wrong target or resistant bugs
Review all differential again of HCAP, unknown HIV infection/AIDS, endemic fungal infections, aspiration, Tuberculosis and MAC, resistant bacterias such as Pseudomonas and MRSA
- Consider PCP and nocardia: need specific therapy: Bactrim
- Consider Coccidioidomycosis, Hantavirus in the southwest
- Consider Histoplasmosis in the Midwest
- Consider Blastomycosis in the southeast
- Consider Pseudomonas in bronchiectasis and COPD
- Consider MRSA in hemodialysis patients(HCAP) and during the influenza period.
- Consider Anthrax, plague, tularemia in possible terrorism
- Consider Aeprgillosis, zygomycosis, cryptococcosis in chronically immunodeficient
- Consider CMV in Bone Marrow transplant
3-Complications :
- Empyema: need for drainage
- lung abscess: need for long term therapy and possibly surgical intervention
- metastatic infections.
