Community Acquired Pneumonia Flashcards
What is the incidence of CAP?
3rd Leading cause of death worldwide
What are the major risk factors for pneumonia?
- Smoking – damages epithelium, inhibits cilliary function
- Low BMI – very low antibody levels as failure to synthesise proteins
- Chronic illnesses (heart failure, diabetes, chronic liver disease, untreated HIV)
- Respiratory diseases (COPD, asthma)
- Influenza and other respiratory tract infections – primary flu pneumonia, more likely secondary bacterial infection (e.g. staph aureus)
What are risk factors for aspiration pneumonia?
- Epilepsy (LOC)
- Stroke
- Chronic neurological diseases e.g MS
- Alcohol abuse (aspiration of vomit, etc)
What drug treatments increase the risk of pneumonia?
- Inhaled corticosteroids
- Oral steroids (immunosuppression)
- Proton pump inhibitors
What drug treatments decrease the risk of pneumonia?
- Influenza vaccination
- Pneumococcal vaccination
- Statins
- ACE-I in Asian patients
What is the aetiology of pneumonia?
- Bacteria
- Viruses
- Fungi
- Eosinophilic pneumonia
- Autoimmunity
What is eosinophilic pneumonia?
Alveoli become filled with eosinophils and neutrophils - it is NOT an infection
What are symptoms of pneumonia?
- Malaise, Anorexia, sweating, rigors, myalgia, arthralgia and headache
- Breathlessness
- Cough and sputum (often green)
- Haemoptysis (rusty coloured in pneumococcal pneumonia)
- Pleuritic chest pain
- Confusion (esp Legionella pneumonia)
Why is pneumonia usually lobar?
Doesn’t normally cross fissures
What are signs of pneumonia on examination?
- Dull to percussion
- Bronchial breathing
- Crackles
- Pleural rub
What investigations would be carried out for pneumonia?
- Bloods (WCC, CRP)
- Sputum and blood cultures
- Atypical serology (Mycoplasma IgM, Legionella urinary antigen, respiratory viruses, chlamydia serology)
What is CURB65 score used for?
To predict mortality of pneumonia on admission
Explain CURB65
C - confusion U - urea >7mmol/l R - resp rate >30 breaths/min B - blood pressure <90mmHg systolic or <60mmHg diastolic 65 - Over 65
For each letter, score 1 point
What do the different CURB65 scores mean?
- 0-1: outpatient treatment
- 2: short inpatient stay
- 3: Admit
- 4: consider for HDU/ITU
Why is ciprofloxacin not given as a treatment for pneumonia?
Strep.pneumoniae is resistant
What are complications of pneumonia?
- Parapneumonic effusion
- Empyema
- Lung abscess/cavitation
- Metastatic infection/abscesses
- ARDS/Multiorgan failure
- Death
What pneumonias can lead to lung abscesses?
- Staphylococcus
- Klebsiella
- Anaerobes
What is the treatment for lung abscesses caused by pneumonia?
- Flucloxacillin
- Augmentin
- Metronidazole
- Drainage
What pneumonias can lead to empyema?
- Strep.Milleri
- Strep.pneumoniae
- Klebsiella
- Anaerobes
What is the treatment for empyema?
- Gentamicin
- Metronidazole
- Amoxicillin
- Drainage
What pneumonia is likely to be present in a Glaswegian alcoholic?
- Aspiration pneumonia
* Klebsiella (weakened immune system so more likely to get unusual things)
What pneumonia is likely to be present in an IV drug user?
Staph aureus
What pneumonia is likely to be present in a sex worker?
Strep pneumoniae
What pneumonia is likely to be present in a pigeon farmer?
Chlamydia psittaci
