community acquired pneumonia

Question 1

what is pneumonia ?

Answer 1

acute infection of the pulmonary parenchyma that is association with

Question 2

what are the classification for community acquired pneumonia ?

Answer 2

we have streptococcus pneumonia - (severe enterocci, staphylococci aerus- hematogenous dissemination from extra pulmonary sites , intravenous drug users, in bacteria endocardiytis )
hemophilux influenza

for immunosuppressed , bronchiectasis and cystic fibrosis individuals we can have pseuodomonas aeurginosa

atypical pneumonia - such as mycoplasma pneumonia and respiratory syncopal virus and any other virus
legionella
legionella
chlamydia pneumonia

aspiration pneumonia- which has a mixed bacteria l flora between gram negative and gram positive sometimes
more common in alcoholics , drug abusres , patients who have seizures

Question 3

what is the clinical manifestations of CAP and how to differentiatee them

Answer 3

typical pneumonia

symptoms - sudden onset of fever more than 40 degrees 
sputum producing cough 
pleuritic chest pain 
rare to find extra pulmonary findings 
chills 

physical examination - dullness
decreased vocal fremitus
crackles
bronchial breathing sound 
decreased chest expansion 

x ray - there is homogenous ground glass opacities

atypical
gradula onset of fever which is below 40 degrees
dry cough
no pleuritic chest pain
but extra pulmonary findings such as headaches , myalgia and arthralgia
eg - myocplasma pneumonia - erythema multiforme and hemolytic anemia
legionella - deteriote mental status , renal and hepatic abnormalities

physical findings of consolidation rare

x ray - reticular fomration

Question 4

how do you diagnose CAP pneumonia

Answer 4

sputum culture

bronchoscopy directed protected specimen brush
BAL

viral - immunoflurence test og throat swab and urt

mycoplasma pneumonia - compliment fixation test

urinary antigen testing for pneumoccocal pneumonia

blood test - procalcitonin , crp increased

x ray - patchy cosolidation

ct - ground glass opacity and tee in bud appearance

Question 5

how do you put pneumonia patient into groups for treatment

Answer 5

PSI - pneumonia severty index

we put people with pneumonia into severity index after diagnosis
PSI
CURB65
c - confusion
u - blood urea more than 7mol
r - respiratory rate more than 30 beats per minute
b - blood pressure - low blood pressure systolic less than 90 mmhg
65 - above 65 years of age

we also see if they have cormobidities such as COPD , DIABTESTES , CONGESTIVE HEART FAILURE , IMMUNOSUPPRESSED

Question 6

treatment for CAP pneumonia

Answer 6

emperical treatement - amoxicillin and clavulunaic acid
macrolide - azithromycin

s pneumonia
amoxicllin
alternatives macrolides - authromycins

staphylococci
oxacillin
cephalosporin - ceftriaone
resistant - vancomycin

gram negative
cephalosporin 3-4 generation ceftriaxone
and cefepem
quinilones - ciprofloxacin

legionella - erythromycin intravenous

there atypic pneumonia - macrolide - azuthromycin
fluroquinilones - ciprfloxacin

anaerobes - metronidazole
piperacillin

viral pneumonia
amantadine - influenza

Question 7

strep pneumonia is what type of resistance?

Answer 7

highly penicillin resistant

Question 8

what is progressive pneumonia ?

Answer 8

clinical deterioration in terms of requiring Mechanical ventilation and or septic shock after for at least 72 h of treatment

Question 9

what is Non responding pneumonia ?

Answer 9

resistent fever >38 and/or clinical symptoms after at least 72 h of treatment

Question 10

which are the patients at risk for having resistant strains in CAP

Answer 10

smokers
above 65
antibiotic therapy in last 3months
immunocomprimised