Community acquired pneumonia Flashcards
Define typical pneumonia
CAP
Acquired outside of hospital/healthcare facilities
Define atypical pneumonia
Milder symptoms with gradual onset
Resistance to beta-lactams
Extrapulmonary symptoms
Name causative bacterial organisms of typical pneumonia
S. pneumo (most common)
H. influenza
S. aureus
GNB (klebs)
Anaerobes
Pseudo
Name causative viral organisms of typical pneumonia
Influenza
RSV
Rhinovirus
Adenovirus
Parainfluenza virus
Metapneumovirus
Coronavirus
Name common causative organism of typical pneumonia in HIV patients
PJP
Name strong risk factors for typical pneumonia
Age>65y
Residence in healthcare setting
COPD
Smoker
Alcohol
Poor oral hygiene
PPIs
Contact with children
Name weak risk factors for typical pneumonia
DM
CKD
Opioid use
What are risk factors for hospitalisation in pneumonia?
HIV
Increasing age
Underlying lung disease
What are risk factors for mortality in pneumonia?
HIV
Increasing age
Mechanical ventilation
Supplemental oxygen
What is the clinical presentation of pneumonia?
SOB, chest pain, cough, tachypnea, mucopurulent sputum with at least 1 systemic feature
Which manifestation of pneumonia is most common in the elderly?
Confusion
What is the differential diagnosis for pneumonia
PE
Pneumothorax
Cardiac failure
What is the workup of typical pneumonia?
CXR
Laboratory (CRP, PCT, FBC, urea)
Micro (sputum MCS, urine legionella and pneumococcal, PCR)
Which micro test is being phased out of typical pneumonia work up?
Blood culture
Which scores are used to determine outpatient vs hospitalised pneumonia care?
CURB65
Pneumonia Severity Index (PSI)
What are the parameters of CURB65
Confusion
Urea>7
RR>30
BP <90
Age>65y
What is the gold standard for PJP diagnosis?
Immunofluroscent staining
Which biomarkers can be done to assist with PJP diagnosis?
BDG
LDH
What is the empiric choice of antibiotics in CAP in low risk patients?
Outpatient - amoxil
Inpatient (non-severe) - ampi
Inpatient (severe) - augmentin or 3rd gen plus macrolide
What is the empiric choice of antibiotics in CAP in high risk patients?
Outpatient - augmentin or 2nd gen
Inpatient (non-severe) - augmentin or 3rd gen
Inpatient (severe) - augmentin or 3rd gen plus macrolide
What is empiric TB therapy?
Rarely required - only in severely ill patient with biliary pattern on CXR with suspected TB
What is empiric PJP therapy?
Bactrim
Systemic corticosteroids
What is the empiric therapy for influenza?
Oseltamivir 75mg bd
What are features of clinical stability to switch from IV to oral in CAP?
Haemodynamic stability
Respiratory stability
No fever
No delirium
Able to take oral
What are causative bacteria of atypical pneumonia?
Mycoplasma pneumo
C. psittaci/pneumonia
Legionella
F. tularensis
Y. pestis
B. anthracis
C. burnetii
What are causative fungi of atypical pneumonia?
Histoplasma
Blastomyces
Coccidioides
Pneumocystis
What are causative viral of atypical pneumonia?
Influenza
Parainfluenza
RSV
Adenovirus
Metapneumovirus
VZV
Measles
EBV
CMV
Hantavirus
Name strong risk factors for atypical pneumonia
Closed communities
Immunosuppression
Hx of exposure
<50y
Name weak risk factors for atypical pneumonia
Smoking
Male
Travel
Immunomodulators
Chronic lung disease
Discuss the clinical features of atypical pneumonia
Constitutional
Persistent, dry cough
Throat involvement
Fever
Non-respiratory
Name common features of legionella pneumonia
Diarrhea
Encephelopathy
Severe infx with multi system involvement
Contaminated artificial water sytems
Name common features of mycoplasma pneumonia
Diarrhea
Abdo pain
Nausea
Headache
Sore throat
Name common features of chlamydia pneumonia
No specific
Name common features of Q fever
Exposure to infected animal sourcesName common features of
Name common features of klebs pneumonia
Alcohol dependency
Discuss investigations for atypical pneumonia
CXR
Lab (FBC, LFT, urea, O2)
Micro (covid PCR, urine and sputum legionella, mycoplasma/chlamydia PCR, coxiella serology, nasopharyngeal viral cultures)
Which pneumonia can have low Hb?
Mycoplasma
Elevated LFTs suggest which pneumonia?
Mycoplasma
Legionella
What is first line treatment for atypical pneumonia?
Macrolide
Doxycycline
If severe, add beta lactam
Name causes of pleural effusions as a complication
Legionella
Mycoplasma
Name causes of rash as a complication
Mycoplasma
Name causes of neurology as a complication
Mycoplasma
Name causes of pericarditis as a complication
Legionella
Mycoplasma
Name causes of atherosclerosis as a complication
Chlamydia pneumonia
What is the treatment if aspiration pneumonia?
Augmentin, clindamycin and flagyl
How much gastric contents must be aspirated to develop aspiration pneumonitis?
> 150ml
When should you give empiric therapy for aspiration pneumonitis
If symptoms >48h post aspiration
What are the current PCV vaccines and the new ones?
Current - PPSV23, PCV13
New - PCV15, PCV10
If you have only taken the PPSV23 vaccine, when can you take the PCV13 vaccine
Wait at least one year after last PPSV23 dose
