The manuscript reviews the recent literature describing the occurrence, risk factors, recognition and treatment of sepsis, respiratory failure, and multiple organ dysfunction in patients with community-acquired pneumonia (CAP).
CAP may present with varying degrees of disease severity ranging from an almost asymptomatic infection to a fulminant systemic disease with both respiratory failure and multiple organ dysfunction. Severe sepsis occurs early in the course of the infection in more than 30% of cases. It may involve several organ systems and is associated with the severity and mortality of CAP. A number of factors exist, which may promote the transition of CAP from a local to a systemic disease, particularly immunosuppression and poorly controlled inflammatory responses, which promote extrapulmonary dissemination of the causative pathogens. Although CAP may be associated with complications involving most organ systems, much recent research has focused attention on cardiac complications, particularly those associated with pneumococcal infections. Biomarkers as a strategy for discriminating between invasive and noninvasive CAP have been comprehensively studied. A number of treatment strategies using antibiotics and various adjunctive therapies have been studied in severe CAP.
Recent research highlights the fact that CAP is frequently a systemic illness.
aCharlotte Maxeke Johannesburg Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
bDepartment of Immunology, Faculty of Health Sciences, and Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa
Correspondence to Charles Feldman, MB BCh, DSc, PhD, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, 2193, Johannesburg, South Africa. Tel: +27 11 488 3840; fax: +27 11 488 4675; e-mail: Charles.Feldman@wits.ac.za