Bacterial Pneumonia Flashcards

1
Q

CAP and requirements of diagnosis

A

Community Acquired Pneumonia

Evidence of lower respiratory tract infection (LRTI), e.g.

  • Cough
  • Sputum
  • Breathlessness
  • Chest pain

AND

CXR evidence of pneumonia

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2
Q

What is the likely diagnosis of this patient

A

Pneumonia

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3
Q

Risk factors of CSP

A

Males
Elderly
Alcoholics
Chronic Disease

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4
Q

Aetiology of CAP

A

Conventional bacteria [most common]
‘Atypical’ bacteria
Viruses

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5
Q

Conventional vs Non-conventional bacteria

A

Conventional bacteria have cell walls and thus can be treated with antibacterials that target cell walls; non-conventional bacteria do not have cell walls

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6
Q

Examples of bacteria that cause pneumonia

A

Streptococcus pneumococcus
H. influenzae
Mycoplasma pneumoniae (atypical bacteria)

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7
Q

Streptococcus pneumococcus

A

Most common cause of CAP in those without COPD
Capsular polysaccharide is the major virulence factor

Relative resistence to penicillin is becoming common

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8
Q

Haemophilus influenzae

A

The capsulated bacteria is primary cause of CAP in children who have not received Haemophilus vaccination

Non-capsulated H. influenza is an important cause of disease in COPD

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9
Q

Mycoplasma pneumoniae

A

Second most cause of CAP

Causes >30% of CAP in 17-44 year olds; seasonal

Can cause occasional epidemics

Has characteristic extra-pulmonary features (e.g. skin)

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10
Q

Legionella pneumophila

A

Cause of both sporadic and outbreak CAP

Can cause severe disease, especially in immunocompromised patients and smokers

Requires specific high dose fluoroquinolone or macrolide antibiotic treatment

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11
Q

Which serogroup of Legionella pneumophila causes almost all human infection with the disease

A

Serogroup 1

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12
Q

Investigation of CAP (Clue, 4 steps)

A

Confirm diagnosis (CXR)

Assess severity of disease
Define aetiological agent (respiratory sample, blood sample)

Identify complications

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13
Q

Microbiological Investigations of pneumonia

A

Sputum analysis and culture
Immunofluorescence on sputum samples
Blood Cultures
Urinary pneumococcal and legionella antigen

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14
Q

Antimicrobial Chemotherapy

A

Based on:
Assessment of likely pathogen
Severity of illness
Likelihood of drug resistance (local and national); tell the lab about how infection was acquired

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15
Q

CURB65 Score

A

Score for pneumonia severity

Confusion (MMT score 8 or less)
Urea (new elevation >7 mmol/L)
Respiratory rate > 30bpm
BP (Systolic <90, DS <60)
65 or more years old
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16
Q

Low severity CAP

A

CURB 65 0 or 1

Oral antibiotics amoxicillin 500mgs qds for 5 days
OR
Doxycycline 200mgs loading then 100mg od

Only IV if unable to take oral therapy

If severe allergy to penicillin, ciproflaxacin (quinolone) 400mgs bd + (glycopeptide) vancomycin

These patients should be manageable in community unless frail

JESUS CHRIST DO NOT MEMORISE THIS!!! JUST BE VAGUELY AWARE

17
Q

Where is the pneumonia in this patient

A

Right upper lobe

18
Q

Moderate severity CAP

A

CURB 65 2

Amoxicillin 500mgs qds 7 days + clarithromycin 500mgs bd for 7 days
OR
Doxycycline 200mgs loading then 100mg od

IV only if unable to take oral treatement

Normally managed in a hospital environment

JESUS CHRIST DO NOT MEMORISE THIS!!! JUST BE VAGUELY AWARE

19
Q

Severe CAP

A

CURB 65 3

Co-amoxiclav 1.2g tds + amoxacillin 1g tds + clarithromycin 500mgs bd iv for 10 days

If severe allergy to penicillins or MRSA
Levofloxacin 500mgs bd + vancomycin 1g bd

20
Q

Severe CAP (Score >3)

A

Continue treatment of score = 3,

Add levofloxacin 500mgs bd for 14 days

Ensure legionella antigen in urine requested and culture sputum if possible (alert lab)