Community Acquired Pneumonia Flashcards
List the most common bacteria which cause:
a) Typical pneumonia (3)
b) Atypical pneumonia (4)
TYPICAL PNEUMONIA:
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catharralis
ATYPICAL PNEUMONIA: Mycoplasma pneumoniae Legionella pneumoniae Chlamydophila pneumoniae Chlamydophila psittaci
List 5 risk factors for Strep. pneumoniae infection.
Alcohol abuse Smoking Immunosuppression COPD Influenza
What is the most common cause of pneumonia?
Strep. pneumoniae (80%)
List the signs (4) and symptoms (4) of typical pneumonia.
SYMPTOMS: Abrupt onset Cough Fever Pleuritic chest pain
SIGNS: Dull percussion Coarse crepitations Increased vocal resonance Consolidation on CXR
How is strep. pneumoniae treated?
Amoxicillin
List 2 risk factors for H. influenzae infection.
Older age
Underlying lung disease
Describe the 2 types of H. influenzae.
Which one is more common?
What conditions do they cause?
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
How is H. influenzae treated?
Amoxicillin
List signs (4) and symptoms (3) of an atypical pneumonia caused by M. pneumoniae.
SYMPTOMS:
General malaise
Headache
Fever
SIGNS: Dull percussion Coarse crepitations Increased vocal resonance Consolidation on CXR
List 5 complications of M. pneumoniae infection.
Haemolysis Guillain-Barre syndrome Erythema multiforme Cardiac problems Arthritis
How is M. pneumoniae diagnosed?
Serology
PCR of sputum/throat swab
Which 3 antibiotics are used to treat M. pneumoniae?
Macrolides
Tetracyclines
Quinolones
Why can you NOT use penicillin to treat:
a) M. pneumonia
b) Legionella?
M. pneumonia - no cell wall, therefore no beta lactam activity
Legionella - intracellular, therefore no beta lactam activity
List signs (4) and symptoms (3) of an atypical pneumonia caused by legionella.
SYMPTOMS:
General malaise
Flu-like symptoms
Myalgia
SIGNS: Dull percussion Coarse crepitations Increased vocal resonance Consolidation on CXR
How is legionella diagnosed?
Blood cultures
Serology
Urinary antigen test
List 3 antibiotics which can be used to treat legionella.
Macrolides
Quinolones
Tetracyclines (possibly less effective)
Which 3 features are used to identify severe pneumonia?
CURB65 score
Multilobar consolidation on CXR
Hypoxia on room air
List the measurement of a CURB65 score.
C: confusion U: urea above 7 R: resp rate above 30 B: BP systolic <90; diastolic <60 65: above 65yo
List the 4 features used to measure SIRS (systemic inflammatory response syndrome).
Temperature: <36 or above 38
HR: above 90
Resp rate: above 20
WCC: <4 or above 12
List 4 investigations you would do for pneumonia.
What are the 5 types of microbiological tests you would do?
Bloods (e.g. FBC, U&Es, ABGs, O2 sats)
CXR
ECG
Microbiology
Microbiology:
- Blood cultures
- Sputum cultures
- Throat swab
- Bronchoalveolar lavage
- Urinary legionella antigens
Describe the clinical significance of the CURB65 score. (3)
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
How would you manage CAP?
ABCDs
Antibiotics
What is the empirical antibiotic treatment for non-severe CAP with CURB65 score 0-1?
Oral amoxicillin, OR
Oral doxycycline, OR
Oral clarithromycin
For 7 days
What is the empirical antibiotic treatment for non-severe CAP with CURB65 score 2?
Oral amoxicillin, PLUS
Oral doxycycline OR oral clarithromycin
For 7 days