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Internal Medicine MD2 Lectures > 3+ Pneumonia > Flashcards

3+ Pneumonia Flashcards

1
Q

What is CAP?

A

Infection of the lung parenchyma not acquired in a hospital setting

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2
Q

Is it more normal that not to find more than one pathogen is implicated in CAP?

A

Yes

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3
Q

What are the typical bacterial causes of CAP?

A

S.pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Klebsiella pneumoniae
Enteric/oral anaerobes
S.aureus

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4
Q

What are the atypical bacterial causes of CAP?

A

Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumophila
Coxiella burnetti

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5
Q

What are some viral causes of CAP?

A

SARS-COV2
Influenza
Parainfluenza
RSV
Metapneumovirus

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6
Q

What are some fungal causes of CAP?

A

Cryptococcus neoformans
Aspergillus spp.
Pneumocystis jirovecii

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7
Q

Who is most likely to get a fungal CAP?

A

Immunocompromised patients

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8
Q

What are some unusual bugs to be aware of if people have travelled?

A

Acinetobacter in tropics
Meliodosis in tropics
Histoplasmosis in central america and southern USA
TB

Chlamydia psittaci
Coxiella brunetti
Leptospirosis

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9
Q

What are some risk factors for CAP?

A

Chronic lung disease (COPD, asthma)
Chronic heart failure
Smoking
Diabetes
Chronic kidney or liver disease
Recent viral infection
Contact with young children
Alcoholism (aspiration)
Institutiionalisation
Age >70

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10
Q

What are some risk factors for gram-negatives?

A

Dementia
CVD
Alcoholism

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11
Q

What are some risk factors for MRSA?

A

Being an indigenous australian
Alcoholism
prison
Men who sleep with men

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12
Q

What is the pathogenesis of pneumonia?

A

Microbes access the lower respiratory tract:
- Aspiration
- Inhalation of droplets
- Haematogenous spread

Proliferate within the alveoli (not cleared by MAC and surfactant)

When microbes overwhelm the immune system –> inflammatory response –> white cell migration (pus), leaky membranes (fluid filled alveoli) –> reduced oxygenation

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13
Q

What is the histological appearance of alveoli in pneumonia?

A
  • Congested capillaries in alveolar septa
  • Inflammatory cells in RBC fill alveolar spaces
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14
Q

What is the typical history of pneumonia?

A

Sudden onset
- Fever
- Chills/rigors
- Dyspnoea
- Cough: productive or unproductive, can have haemoptysis
- Pleuritic chest pain
- Exercise intolerance
- Fatigue

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15
Q

What is the atypical history of pneumonia?

A
  • Low grade fever
  • Non-productive dry cough
  • Dyspnoea

Extra-pulmonary features:
- Myalgia
- Arthralgia
- Headache
- GI: diarrhoea, vomiting (influenza)

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16
Q

What signs may be evident on examination of a patient with pneumonia?

A

Tachycardia
Hypotensive
Febrile
Low O2 sats
Resp distress: tachypnoea, dyspnoea, nasal flaring, accessory muscle use
Decreased air entry
Crackles, bronchial breath sounds
Dullness to percussion

17
Q

What Ix do you do for pneumonia?

A

Bedside:
- ECG if chest pain
- Spirometry to rule out obstructive disease

Labs:
- FBC
- CRP
- UEC, LFTs, BSL
- ABG if CO2 retainer (COPD, smoker)

Imaging:
- CXR: show consolidation
- Only do CT if CXR inconclusive or recurrent infections

Micro:
- Blood culture + sputum MCS if sick, failed antibiotics, risk factors fo antibiotic resistant pathogens
- Serological testing if concerned for atypical pneumonia
- Sputum PCR if pneumocystis risk
- Legionella urinary antigen

18
Q

What are some severity scales you can use?

A

CURB-65

Pneumonia Severity Index (PSI)

19
Q

What is CURB-65?

A

Confused
Urea elevated
RR elevated
BP low
Age >65

20
Q

What is the DDx for pneumonia?

A

CHF
COPD exacerbation
Asthma exacerbation
PE
Pneumothorax
Acute bronchitis

21
Q

What is the overall management of CAP as inpatient?

A
  • O2 if hypoxic
  • Fluids if needed
  • Electrolytes if disturbance
  • Analgesia
  • Bronchodilators if asthma
  • VTE thromboprophylaxis
  • Antibiotics
22
Q

What antibiotics are first line for CAP?

A

If suspect S.pneumoniae: amoxicillin or ceftriaxone

If suspect legionella, mycoplasma or chlamydia (atypical): macrolide like azithromycin

Summary:
- Beta lactam: amoxicillin or ceftriaxone
OR
- Macrolide: azithromycin

23
Q

When do you give oral ABx vs IV ABx for CAP?

A

Oral is fine for mild

Moderate CAP requires hospital admission and often will be an IV penicillin and oral doxy or macrolide

24
Q

What are some complications of pneumonia?

A

Acute MI (increased risk with pneumonia)
Increased mortality
Respiratory failure
Abscess
Complicated effusion

25
Q

What does consolidation from CAP look like on CXR?

A

Opacification

26
Q

How is hospital acquired pneumonia treated and what are the causes?

A

Usually gram negatives and more resistant bacteria

MRSA- Tazocin

E.coli, proteus, klebsiella: ceftrixaone

27
Q

What type of pneumonia are the immunocompromised most likely to get?

A

Fungi (pneumocystis, aspergillus)

Varies based on low neutrophils or low lymphocytes

Internal Medicine MD2 Lectures (14 decks)

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