Pneumonia and Tuberculosis

Infection, precautions, and prevention

Respiratory

CAP

Community-acquired: starts outside hospital or within 48 h of admission.

HAP

Hospital-acquired: starts ≥48 h after admission.

VAP

Ventilator-associated: starts ≥48 h after intubation.

"HCAP" (healthcare-associated pneumonia) was dropped from US guidelines in 2019. Updated

Assessment

Fever, chills, productive cough, pleuritic chest pain, dyspnea, tachypnea.
Crackles; bronchial breath sounds, dullness and ↑ tactile fremitus over consolidation.
Older adults: may present with confusion, falls, no fever.
Chest X-ray; sputum and blood cultures before antibiotics (don't delay antibiotics in sepsis).
CURB-65 severity: Confusion, Urea (BUN >19 mg/dL), RR ≥30, BP <90 systolic or ≤60 diastolic, age ≥65.

Care and prevention

Antibiotics on time; oxygen to target; fluids unless restricted.
HOB ≥30°; turn, cough, deep breathe; incentive spirometer; early mobility.
Aspiration precautions: swallow screen, sit at 90° to eat, chin tuck, oral care.
Vaccines: pneumococcal (PCV20 or PCV21, or PCV15 + PPSV23) for all adults ≥50 and younger adults with risk conditions; yearly influenza; COVID-19; RSV for older or high-risk adults. Updated

Tuberculosis (TB)

S&S: cough >3 weeks, hemoptysis, night sweats, weight loss, low-grade afternoon fever, fatigue.
Screening: TST (skin test) or IGRA blood test. Positive = infection, not proof of active disease. TST read in 48–72 h; ≥5, ≥10 or ≥15 mm is positive depending on risk group.
Active disease: chest X-ray + 3 sputum samples for AFB smear, NAAT and culture (at least one early morning). Culture confirms.

Airborne precautions: negative-pressure room, fit-tested N95; patient wears a surgical mask when outside the room.
Standard treatment: RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) for 2 months, then rifampin + isoniazid for 4 months (6 months total). A 4-month regimen is an option for some.
Directly observed therapy (DOT) improves adherence.
Usually non-infectious after ~2 weeks of effective treatment, clinical improvement, and negative sputum smears (per policy).

Memory hook: TB drugs (details in Pharmacology) Rifampin turns body fluids Red-orange and weakens birth control · Isoniazid causes neuropathy: give vitamin B6 · Pyrazinamide raises uric acid · Ethambutol affects the Eyes. All except ethambutol can harm the liver.