Case 12 - Pneumonia Flashcards
What is the CURB-65 scoring system?
Assessment of severity of CAP C - Confusion U - Urea >7 R - Respiratory rate >30 B - BP <90/60 65 - Age >65
0-1 (low severity), 2 (moderate severity), 3-5 (high severity)
How is pneumocystis jiroveci pneumonia treated?
Oral Co-trimoxazole
What are the most common viral causes of community acquired pneumonia (CAP)?
Streptococcus pneumoniae (gram positive) Haemophilus Influenzae (gram negative) Mycoplasma pneumonia
What are the most common causes of hospital acquired pneumonia (HAP)?
Gram negative enterobacteria (e.coli, klebsiella, enterobacter) Staphylococcus aureus (gram positive) Pseudomonas (gram negative)
How is hospital acquired pneumonia defined?
Infection following 48 hours after hospital admission
Which type of bacteria is associated with community acquired pneumonia in patients with alcohol excess?
Klebsiella pneumonia
What is the clinical effectiveness of the influenza vaccine?
Overall efficacy is between 60-82%, being lower in elderly subjects
What are the main symptoms of pneumonia?
Fever Rigours Malaise Dyspnoea (difficulty breathing) Cough - can be with purulent sputum or haemoptysis Plueretic chest pain
What are the main signs of pneumonia?
Pyrexia Cyanosis Confusion Tachypnoea Tachycardia Dull percussion Bronchial breathing (higher pitched)
Which patients with respiratory infection should be referred to hospital for treatment?
Patients with suspected pneumonia
E.g, with high fever/low blood pressure/high respiratory rate/ confusion
How are mild, moderate and severe CAP treated?
Mild: oral amoxicillin or clarithromycin (5 day course)
Moderate: oral amoxicillin + clarithromycin (7-10 day course)
Severe: IV co amoxiclav and oral clarithromycin
Also remember IV fluids and VTE prophylaxis
Where might the CURB65 not be useful?
Younger patients - unable to score >65, also they are likely to compensate so wouldn’t score as severe
Chronic renal patients - who have a higher baseline urea value
What are the major complications of pneumonia?
Pleural effusion (complicates 50% of cases)
Empyema (collection of pus in pleural cavity)
Lung abscess (rare)
Respiratory failure
Septicaemia
What is PipTaz (Tazocin) and when is it used
Piperacillin-Tazobactam is a broad spectrum antibiotic
Used to cover a broad spectrum of bacteria in clinical deterioration
Why should you avoid using broad spectrum antibiotics once you know what the infective cause is sensitive to?
To decrease the risk of developing resistance
In which bacterial infections are muscle and joint pain more common?
Legionella
Mycoplasma
What blood tests would you take in suspected pneumonia and why?
FBC - check for WCC, neutrophils and platelets
U&E - looking at urea especially
LFTs - can be deranged in reduction of liver perfusion in sepsis
CRP - look for inflammation
Lactate - look for signs of sepsis
What should be taken from any patient presenting with fever?
Blood cultures to help diagnose the infection
Taking the blood culture at the time of fever helps to increase the likelihood of ‘catching’ the bacteria in the blood stream
What tests should be done in suspected pneumonia?
Blood tests: FBC, U&E, LFTs, CRP, lactate Blood culture Sputum culture Urinary antigen test Chest X ray ABGs
What additional test should be offered to patients presenting with pneumonia who are under the age of 60 and why?
HIV test
This is common presentation of HIV in an undiagnosed individual
What is meant by typical and atypical pneumonia
Typical organisms can be cultured in the lab - treated with beta lactams
Atypical organisms are intracellular organisms that cannot be cultured used standard methods - atypical organisms need to be treated with antibiotics that get into intracellular spaces (macrolides)
What is the most common type of pneumonia causing agent which is seen in immunocomprimised patients
Pneumocystis jirovecii
What is ventilator acquired pneumonia?
A type of HAP occurring in patients on mechanical ventilation. Mortality rate can reach 50% or higher
What are the risk factors for developing HAP?
ICU stay, mechanical ventilation
Prolonged hospital stay
Severe underlying illness, multiple co-morbities
Underlying respiratory disease e.g, COPD, asthma
Abdominal surgery, vomiting/aspiration
