Community-acquired pneumonia (CAP) is a common medical problem accounting for about 4 million visits to physicians and 600,000 adult hospitalizations per year. 9 Pneumonia is the sixth leading cause of death and is particularly lethal among very young children and older adults, in whom the disease is more common. Whereas older studies of pneumonia pointed to pneumococcus as the most common cause of pneumonia, there is an increasing frequency of atypical or opportunistic infections.1011 Unfortunately, although the classic presentation of pneumococcal pneumonia is generally apparent, atypical infections, infections in compromised hosts, and infections in extremes of age may present with more subtle findings.12 older patients often present with a change in mental status and often do not manifest respiratory symptoms. Pneumonia may occur through a variety of routes of infection. Pathogenic organisms may be inhaled or aspirated directly into the lungs. Alternatively, some bacteria, such as Staphylococcus aureus or pneumococcus, may develop as a result of hematogenous seeding. With this in mind, patients most at risk for pneumonia are those with a predisposition to aspiration, impaired mucociliary clearance, or risk of bacteremia ( T§bie,,,5,9:1).

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