Bacterial pneumonia - community acquired pneumonia (CAP) Flashcards
_______ _______ _______ = CAP
- common in ___ ____ and _____
- mortality ~__%
Community acquired pneumonia = CAP
- common in very young and elderly
- mortality ~10%
Pneumonia pathogenesis
- ___ _____ ____ (e.g steroid use, immunocompromised)
- _____ ______ (defences are fine but lots of pathogen)
- increased ________ (bad strain)
Pneumonia pathogenesis
- host defence defect (e.g steroid use, immunocompromised)
- large innoculum (defences are fine but lots of pathogen)
- increased virulence (bad strain)
Community acquired pneumonia
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-
ATYPICAL: - - - -
Community acquired pneumonia
TYPICAL:
- Streptococcus pneumoniae (always always the most common - in old, young, immunocompromised / everyone)
- Haemophilus influenzae
- Moraxella catharralis
ATYPICAL:
- mycoplasma pneumoniae
- legionella pneumoniae
- chlamydophila pneumoniae
- chlamydophila psittaci
Streptococcus pneumoniae / S.pneumoniae
Risk factors:
- ______
- _______ (destroys a lot of innate immunity)
- ___
- ______ (e.g. inhaler users)
- ___________ (e.g. HIV, cancer patients)
Streptococcus pneumoniae / S.pneumoniae
Risk factors:
- alcohol
- smoking (destroys a lot of innate immunity)
- flu
- steroids (inhaler users)
- immunosuppression (HIV, cancer patients)
Streptococcus pneumoniae classic features
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-
Signs:
- _____ percussion
- ____ crackles
- ________ vocal resonance
Streptococcus pneumoniae classic features
Symptoms (abrupt onset):
- cough
- fever
- pleuritic chest pain
Signs:
- dull percussion
- coarse crackles
- increased vocal resonance
Streptococcus pneumoniae treatment
Resistance to amoxicillin (penicillins) by strep pneumoniae is rare in UK
but in other places it is bad - Asia, Greece, north America etc
If someone has an allergy to penicillin then what do you ? .
–> if there is a huge BP drop and throat swells up etc, then thats allergy - fair enough. If they just feel sick or vomit then likely not an allergy.
If true allergy,
then use ______ (_________) and ________ (________)
Streptococcus pneumoniae treatment
Resistance to amoxicillin (penicillins) by strep pneumoniae is rare in UK
but in other places it is bad - Asia, Greece, north America etc
If someone has an allergy to penicillin then ASK WHAT HAPPENS.
–> if there is a huge BP drop and throat swells up etc, then thats allergy - fair enough. If they just feel sick or vomit then likely not an allergy.
If true allergy,
then use macrolide (clarithromycin) and tertacyclines (doxycycline)
Haemophilus influenzae
(typical one)
- older people with underlying lung disease
- haemophilus influenzae type _ (HI_) we get vaccinated against when young as its the main one
- the other types can colonise upper resp tract and give us systemic symptoms
Typical pneumonia, so signs n symptoms are same as strep. p:
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-
-
-
Haemophilus influenzae
(typical one)
- older people with underlying lung disease
- haemophilus influenzae type B (HIB) we get vaccinated against when young as its the main one
- the other types can colonise upper resp tract and give us systemic symptoms
Typical pneumonia, so signs n symptoms are same as strep. p:
Symptoms (abrupt onset):
- cough
- fever
- pleuritic chest pain
Signs:
- dull percussion
- coarse crackles
- increased vocal resonance
Haemphilus influenzae treatment
- amoxicillin has risk of ___ ______
- so use ________
- as well as macrolides (clarithromycin) and tetracyclines (doxycycline)
Haemphilus influenzae treatment
- amoxicillin has risk of beta lactamases
- so use co-amoxiclav
- as well as macrolides (clarithromycin) and tetracyclines (doxycycline)
Mycoplasma pneumoniae (atypical one - i.e. ? explain atypical meaning )
- smallest free living bacteria
- no cell wall
- can’t culture in lab (implications in diagnosis)
- _____ ___ _____ spread
- has non-specific symptoms (flu-like, tired, achy)
- ______ (cold agglutinins disease, autoimmune agaisnt RBCs)
- _________
- e______ m_____(target lesions)
- cardiac
- arthritis
Mycoplasma pneumoniae (atypical one - i.e. whats not expected in pneumonia, only really see its lung related on X-ray)
- smallest free living bacteria
- no cell wall
- can’t culture in lab (implications in diagnosis)
- person to person spread
- has non-specific symptoms (flu-like, tired, achy)
- haemolysis (cold agglutinins disease, autoimmune agaisnt RBCs)
- Guillain-Barre
- erythema multiforme (target lesions)
- cardiac
- arthritis
Mycoplasma pneumoniae
Which of these can and which cannot be used for diagnosis:
- culture
- serology
- PCR (sputum/throat)
- culture not used in m.pneumoniae - no cell wall so can’t grow it well in lab
- Serology - yes, look for antibodies against mycoplasma pneumoniae
- PCR - yes, nucleic acid sequences (lab detects DNA of organism)
Mycoplasma pneumoniae
treatment
No cell wall so:
- ___ _____ don’t work
so use: - - - these 3 work by intracellular action so will be effective
Mycoplasma pneumoniae
treatment
No cell wall so:
- beta lactams don’t work
so use: - macrolides (clarithomycin) - tetracyclines (doxycycline) - quinolones (ciprofloxacin) [quinolones are DNA synth inhibitors] these 3 work by intracellular action so will be effective
Legionella pneumophila
(atypical)
- found in _____ and ____
- they live in amoebae
- humans inhale air/fumes off of ____/___ (could be due to shower steam, jacuzzis) and they infect _______ (closest thing to amoeba)
atypical Symptoms: - - - -
Legionella pneumophila
(atypical)
- found in water and soil
- they live in amoebae
- humans inhale air/fumes off of water/soil (could be due to shower steam, jacuzzis) and they infect macrophages (closest thing to amoeba)
atypical Symptoms:
- fever
- tired
- myalgia (muscle pain)
- some respiratory symptoms but not at forefront
Legionella pneumophila
Diagnosis techniques?
- Culture
- Serology
- urinary antigen test (most commonly used)
Legionella pneumophila
- beta lactams don’t work
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-
Legionella pneumophila
- beta lactams don’t work
need intracellular ones:
- macrolides (clarithromycin)
- tetracyclines (doxycycline)
- quinolones (ciprofloxacin)
Good pics for typical patient with pneumonia and how to assess it in pics folder.
Yeah, check em out. Hope the revision going well.
