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INTERNAL MED 3+ conditions > Community Acquired Pneumonia > Flashcards

Community Acquired Pneumonia Flashcards

1
Q

Define CAP

A

Acute infection of the pulmonary parenchyma acquired outside the hospital or healthcare facilities

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2
Q

Epidemiology of CAP

A
  • Very common
  • Most common infectious cause of death
  • 2nd most common cause of hospitalisation
  • Incidence increases with age
  • M > F
    Pneumococcal pneumonia mortality = 5%
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3
Q

Risk factors for CAP

A
  • Older age
  • Chronic comorbidities
  • Viral respiratory tract infections
  • Impaired airway protection
  • Smoking and alcohol overuse
  • Other lifestyle factors
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4
Q

Chronic comorbidities that increase the risk of CAP

A
  • COPD
  • Bronchiectasis
  • Asthma
  • CHD (esp. congestive HF)
  • Stroke
  • Diabetes
  • Malnutrition
  • Immunocompromised
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5
Q

How are viral respiratory tract infections risk factors for CAP

A
  • Lead to viral pneumonia
  • Predispose one to secondary bacterial pneumonia
  • Highest risk - influenza
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6
Q

What do they mean by impaired airway protection being a risk factor for CAP

A
  • Aspiration
  • Lesion
  • Dysmobility
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7
Q

Other lifestyle factors increasing risk of CAP

A
  • Crowded living
  • Low income
  • Environmental toxins
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8
Q

2 most common causes of CAP (micro)

A
  • Pneumococcus (Strep pneumonia)

- Respiratory viruses

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9
Q

What % of CAP cases have no identifiable pathogen

A

62%

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10
Q

Typical bacterial causes of CAP

A
  • Strep pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Staph aureus
  • Group A Strep
  • Aerobic gram negative
  • Microaerophilic bacteria
  • Anaerobes (aspiration)
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11
Q

What does the term “atypical” bacteria mean

A

Intrinsic resistance to beta-lactams and their inability to be visualised on gram stains or cultured using traditional techniques

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12
Q

Atypical bacterial causes of CAP

A
  • Legionella species
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae/psittaci
  • Coxiella burnetti
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13
Q

Respiratory viruses that cause CAP

A
  • Influenza A and B
  • Rhinovirus
  • Parainfluenza
  • Adenovirus
  • Respiratory syncytial
  • Human metapneumovirus
  • Coronaviruses
  • Human bocaviruses
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14
Q

Relative prevalence of CAP causes

A
  • Geography
  • Vaccinations (pneumococcus)
  • Host risk factors
  • Season
  • Pneumonia severity
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15
Q

2 steps leading from pathogen reaching lung alveoli to established infection

A
  • Inoculum size sufficient

- Host immune defences impaired

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16
Q

3 steps from infection to pneumonia

A
  • Replication of pathogen
  • Production of virulence factors
  • Host immune responses
17
Q

Final step from infection to pneumonia

A
  • Inflammation and damage to lung parenchyma
18
Q

Where can CAP also arise from

A
  • Uncontrolled replication of microbes that normally reside in the alveoli - mainly anaerobes and microaerophilic strep
19
Q

What can cause overgrowth of endogenous microbes to be triggered

A
  • Smoking

- Virus

20
Q

Pulmonary signs and symptoms - clinical presentation of CAP

A
  • Cough
  • Dyspnoea
  • Pleuritic chest pain
  • Tachypnoea
  • Increase work breathing
  • Rales/crackles
  • Rhonchi = low pitched rumbling
  • Dull percussion
  • Hypoxemia
21
Q

Systemic signs and symptoms - clinical presentation of CAP

A
  • Fever
  • Chills
  • Fatigue
  • Chest pain
  • Malaise
  • Anorexia
  • Tachycardia
  • Leukocytosis/leukopenia
  • Increased CRP/ESR/procalcitonin
  • Sepsis = hypotension, altered mental state, organ dysfunction
22
Q

Diagnosing CAP

A
  • CXR

- CT (if clinical signs yet negative CXR)

23
Q

What is seen on a pneumonia CXR

A
  • Lobar consolidation
  • Interstitial infiltrates
  • Cavitations
24
Q

2 scales to measure CAP severity

A

PSI (pneumonia severity index) = most accurate

CURB-65

25
Q

Other testing required in CAP diagnosis

A
  • Blood cultures
  • Sputum gram stain and culture
  • Urinary antigen testing for S.pneumoniae
  • Legionella testing (PCR or urinary antigen)
26
Q

Management for CAP - no comorbidities or recent AB use

A
  • Macrolide or doxycycline
  • Macrolides = azithromycin and clarithromycin
  • Macrolides used if rates of resistance are low - first line

Min 5 days use

27
Q

Management for CAP - comorbidities or resistance

A
  • Fluroquinolone (Levofloaxacine or Moxifloxacin)
    OR
  • Combo = beta-lactam and macrolide together

INTERNAL MED 3+ conditions (18 decks)

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