Severe Community Acquired Pneumonia (SCAP)

Abstract

Abstract Although there are no large epidemiological studies from India, mortality data on total number of deaths from lower respiratory tract infection are available. Whereas the world wide mortality of CAP in hospitalised patients varies from 14%–50%, the reported mortality in India varies from 3.3% to 40% with higher rates in elderly & in those requiring intensive care unit (ICU) care. Use of clinical scores like CURB-65, & CRB 65 help to stratify risk of severe disease & need for hospitalisation & ICU care. Early initiation of appropriate antibiotic based upon the knowledge of local resistant patterns of existing pathogens is the key for successful treatment. Pneumonia is the seventh leading cause of death in United States. 1 It is estimated that there are 4 million cases of community-acquired pneumonia (CAP)/yr in the United States which result in approximately 10 million physician visits, 1 million hospitalizations, and 45,000 deaths. 2 There are no large studies from India on incidence of CAP 3 ; however, mortality data on total number of deaths are available related to lower respiratory tract infection (LRTI). 4 Number of deaths due to LRTI was 35.1/100,000 population in 2008 compared to 35.8/100,000 population for tuberculosis & deaths related to gastro intestinal infections & parasitic diseases was 194.9/100,000 population. As per the WHO data overall mortality due to LRTI is around 20% in our country. 4 Worldwide mortality of CAP in hospitalised patients is 14% but increases to 20%–50% in those requiring Intensive Care Unit (ICU)care. The reported mortality from CAP in India is similar to that reported elsewhere in the world. In one Indian series of admitted patients with CAP, 8% had hospital mortality & 2.7% had 30 day mortality. 5 In a recent study decrease in mortality in Severe Community-Acquired Pneumococcal Pneumonia was seen with early antibiotic and combined therapeutic intervention. 6 Another study of 72 Indian patients with CAP showed mortality of 35% in elderly & 14% in young Indian patients. 7 Mortality has varied from 3.3% to 11% in several other Indian studies. 8 , 9 Pneumonia is characterized by the presence of fever, altered general well-being, and respiratory symptoms such as cough (90%), expectoration (66%), dyspnoea (66%), pleuritic pain (50%), and haemoptysis (15%).3