Louis Pasteur first isolated pneumococcus in 1881, and the association between pneumococcus and lobar pneumonia was discovered in 1883.1 In the pre-antibiotic era, treatment options were limited, and mortality from pneumonia was high.2
In the early to mid-1900s, the development of antipneumococcal serum therapy and the antibiotics sulfapyridine and penicillin allowed for effective treatment of bacterial pneumonia. The first pneumococcal vaccine was approved in the United States in 1977, and the first conjugate pneumococcal vaccine was licensed in 2000. With these advances, pneumonia and influenza ranked as the ninth leading cause of death in 2019 (14.9 deaths per 100,000 people), far behind heart disease (163.5 deaths per 100,000 people) and cancer (149.1 deaths per 100,000 people).3 The treatment of pneumonia continues to evolve as bacterial pathogens develop resistance to antibiotics, as patients are treated with more medications that change their response to infections and increase their risk of more unusual infections, and as new medications are developed.
Throughout most of my career, like many office-based family physicians, I have encountered pneumonia occasionally. Although I sometimes lost a patient to a respiratory infection, I generally regarded pneumonia as a treatable condition—far less concerning for my patients than the diabetes, hypertension, and heart disease I managed daily. Then, in March 2020, the world changed.
The COVID-19 pandemic transformed the way we practiced medicine and lived our lives. Most of us experienced profound loss—patients, colleagues, friends, and family. No physician who endured this pandemic will ever underestimate the devastating impact of acute respiratory diseases on our patients, our practices, or the world.
This monograph reviews the diagnosis and management of pulmonary infections in adults, focusing on bacterial infections. Section One focuses on community-acquired pneumonia. Sections Two and Three examine the approach to pneumonia that develops in hospitalized patients and those with immunocompromise. Section Four reviews the evaluation and treatment of lung abscesses and pleural effusions. When you complete this monograph, you will have the information you need to confidently diagnose and treat lung infections in your adult patients.
Ryan D. Kauffman, MD, FAAFP, CCFP, Associate Medical Editor
Family Physician
Erie Shores Family Health Team, Leamington, Ontario, Canada
