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Acquired Pneumonia

Case report:

A 27 year old patient comes into practice and complains of fever to 39.5 C, which began two days ago with chills. Furthermore, there is a significant cough with mucopurulent expectoration and significantly increasing pain symptoms, especially when taking deep breaths in the left dorsal thorax area. It started the disease five days ago with the typical symptoms of a viral infection of the upper airways, which was run with headache and body aches, severe fatigue, sore throat and cough also. The physical examination of normal weight, not smoking patients results in a respiratory rate of 24 / minute, a percussion shortening posteriorly over the left lower lobe associated with fine-bubble earring near rales. A pleural rub is not clearly detectable.

Diagnosis and Etiology:

The history and the constellation of findings suggest in this patient indicate a acute pneumonia caused the left lower lobe. A chest radiograph confirmed this suspicion finding in the blood leukocytosis of 18,000 / ul with marked left shift (10 bar polynuclear granulocytes) is detected; CRP is increased with 45 mg / l. The acute onset with chills, the X-ray findings and the laboratory findings indicate the manifestation of a "typical" pneumonia. On a sputum examination is waived, as is expected with such a constellation of a pneumococcal infection.

Therapy:

In patients with acute community-acquired pneumonia without other risk factors and / or abroad, must be considered in this age of a pneumococcal infection or pneumonia by atypical pathogens such as Mycoplasma or Chlamydia. The findings described in a 27-year-old patient indicate a pneumococcal infection, which in Germany still quite with penicillin V (ISOCILLIN etc.) can be treated at a dose of 4-8 million. E. daily, alternatively, three times a day 750 -1000 mg amoxicillin (Clamoxyl others) are given. Other alternatives are macrolide antibiotics Azithromycin (ZITHROMAX), clarithromycin (Klacid etc.) or newer fluoroquinolones like levofloxacin (Tavanic) or moxifloxacin (Avelox). The therapy with macrolides or newer fluoroquinolones has compared to therapy with -lactam antibiotics advantage that also atypical pathogens (eg mycoplasma) are detected. Also orally administrable cephalosporin derivatives wieCefuroximaxetil (ELOBACT et al), cefixime (CEPHORAL) and loracarbef (LORAFEM) could be administered. Furthermore, the patient bed rest, plenty of fluids and paracetamol against pleuritic (div. Trademark) or acetylsalicylic acid (div. Trademark) is prescribed. The treatment is about three to five days continued at this pneumonia about defervescence addition.

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