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7. Microbiology II > Community Acquired Pneumonia > Flashcards

Community Acquired Pneumonia Flashcards

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1
Q

List the most common bacteria which cause:

a) Typical pneumonia (3)
b) Atypical pneumonia (4)

A

TYPICAL PNEUMONIA:
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catharralis

ATYPICAL PNEUMONIA:
Mycoplasma pneumoniae
Legionella pneumoniae
Chlamydophila pneumoniae
Chlamydophila psittaci
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2
Q

List 5 risk factors for Strep. pneumoniae infection.

A 
Alcohol abuse
Smoking
Immunosuppression
COPD
Influenza
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3
Q

What is the most common cause of pneumonia?

A

Strep. pneumoniae (80%)

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4
Q

List the signs (4) and symptoms (4) of typical pneumonia.

A 
SYMPTOMS:
Abrupt onset
Cough
Fever
Pleuritic chest pain
SIGNS:
Dull percussion
Coarse crepitations
Increased vocal resonance
Consolidation on CXR
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5
Q

How is strep. pneumoniae treated?

A

Amoxicillin

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6
Q

List 2 risk factors for H. influenzae infection.

A

Older age

Underlying lung disease

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7
Q

Describe the 2 types of H. influenzae.

Which one is more common?

What conditions do they cause?

A

TYPE B

  • Rare: largely eradicated by vaccine
  • Causes:
    1. Epiglottitis
    2. Stridor
    3. Acute respiratory distress

NON-TYPEABLE

  • Common
  • Causes:
    1. Otitis media
    2. Conjunctivitis
    3. Headache
    4. Meningitis
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8
Q

How is H. influenzae treated?

A

Amoxicillin

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9
Q

List signs (4) and symptoms (3) of an atypical pneumonia caused by M. pneumoniae.

A

SYMPTOMS:
General malaise
Headache
Fever

SIGNS:
Dull percussion
Coarse crepitations
Increased vocal resonance
Consolidation on CXR
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10
Q

List 5 complications of M. pneumoniae infection.

A 
Haemolysis
Guillain-Barre syndrome
Erythema multiforme
Cardiac problems
Arthritis
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11
Q

How is M. pneumoniae diagnosed?

A

Serology

PCR of sputum/throat swab

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12
Q

Which 3 antibiotics are used to treat M. pneumoniae?

A

Macrolides
Tetracyclines
Quinolones

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13
Q

Why can you NOT use penicillin to treat:

a) M. pneumonia
b) Legionella?

A

M. pneumonia - no cell wall, therefore no beta lactam activity

Legionella - intracellular, therefore no beta lactam activity

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14
Q

List signs (4) and symptoms (3) of an atypical pneumonia caused by legionella.

A

SYMPTOMS:
General malaise
Flu-like symptoms
Myalgia

SIGNS:
Dull percussion
Coarse crepitations
Increased vocal resonance
Consolidation on CXR
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15
Q

How is legionella diagnosed?

A

Blood cultures
Serology
Urinary antigen test

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16
Q

List 3 antibiotics which can be used to treat legionella.

A

Macrolides
Quinolones
Tetracyclines (possibly less effective)

17
Q

Which 3 features are used to identify severe pneumonia?

A

CURB65 score
Multilobar consolidation on CXR
Hypoxia on room air

18
Q

List the measurement of a CURB65 score.

A 
C: confusion
U: urea above 7
R: resp rate above 30
B: BP systolic <90; diastolic <60
65: above 65yo
19
Q

List the 4 features used to measure SIRS (systemic inflammatory response syndrome).

A

Temperature: <36 or above 38
HR: above 90
Resp rate: above 20
WCC: <4 or above 12

20
Q

List 4 investigations you would do for pneumonia.

What are the 5 types of microbiological tests you would do?

A

Bloods (e.g. FBC, U&Es, ABGs, O2 sats)
CXR
ECG
Microbiology

Microbiology:

  • Blood cultures
  • Sputum cultures
  • Throat swab
  • Bronchoalveolar lavage
  • Urinary legionella antigens
21
Q

Describe the clinical significance of the CURB65 score. (3)

A

0-1 points - oral antibiotics and outpatient treatment

2 points - may need admission; dual antibiotic therapy

3+ points - severe CAP; needs hospital admission and IV antibiotics

22
Q

How would you manage CAP?

A

ABCDs

Antibiotics

23
Q

What is the empirical antibiotic treatment for non-severe CAP with CURB65 score 0-1?

A

Oral amoxicillin, OR
Oral doxycycline, OR
Oral clarithromycin

For 7 days

24
Q

What is the empirical antibiotic treatment for non-severe CAP with CURB65 score 2?

A

Oral amoxicillin, PLUS
Oral doxycycline OR oral clarithromycin

For 7 days

25
Q

What is the empirical antibiotic treatment for severe CAP with CURB65 score 3+?

What if they had a penicillin allergy?

A

IV clarithromycin, PLUS
IV amoxicillin OR IV co-amoxiclav

In penicillin allergy: IV levofloxacin

For 7-10 days (up to 14 if atypical organisms suspected/bacteraemia present)

7. Microbiology II (12 decks)

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