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Week 6 - Clinical Microbiology & Infections 1 > Community Acquired Pneumonia > Flashcards

Community Acquired Pneumonia Flashcards

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1
Q

Define pneumonia [1]

A

Inflammation of the lung caused by bacterial infection, in which the alveoli become filled with inflammatory cells and the lung becomes consolidated

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2
Q

What are the 3 pathological causes of pneumonia? [3]

A
  1. Defect in the host defence mechanisms
    • Immunosuppressed patients
    • Smokers - destroy their tissue macrophages
  2. Large innoculum
    • i.e. inhaling a significantly large amount of pathogens which overwhelms the immune system leading to pneumonia
  3. Increased virulence
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3
Q

What are the 3 typical microbiological causes of pneumonia? [3]

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catharralis
    • (more in people with COPD/defects in lung architecture)
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4
Q

What are the atypical microbiological causes of pneumonia? [4]

A
  1. Mycoplasma pneumoniae
  2. Legionella pneumoniae
  3. Chlamydophila pneumoniae
  4. Chlamydophila psittaci
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5
Q

What kind of bacteria is streptococcus pneumoniae? [2]

A

gram positive coccus

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6
Q

What are the risk factors for streptococcus pneumoniae? [5]

A
  1. Alcohol
  2. Smoking
  3. Chronic lung disease (asthma/COPD)
  4. Flu virus
  5. Immunosuppression (e.g. people with HIV)
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7
Q

What are the symptoms of streptococcus pneumoniae? [4]

A
  • Abrupt onset of:
    1. Cough
    2. Fever
    3. Pleuritic chest pain
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8
Q

What are the signs of streptococcus pneumoniae? [4]

A
  • Typical signs of consolidation:
    1. Dull percussion
    2. Coarse crepitations
    3. Increased vocal resonance
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9
Q

What are the treatment options for streptococcus pneumoniae? [3]

A

Amoxicillin (penicillin)

  • If patient has allergy to penicillin, use:
    • Macrolides (clarithromycin)
    • Tetracyclines (doxycycline)
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10
Q

What kind of bacteria is haemophilus influenzae? [2]

A

gram negative rod

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11
Q

Who tends to get haemophilus influenzae pneumonia? [2]

A
  1. Older people
  2. Patients with underlying lung disease (COPD/pulmonary fibrosis/cystic fibrosis)
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12
Q

What are the complications of non-typeable haemophilus influenzae which normally colonise the upper respiratory tract? [5]

A
  1. Otitis media
  2. Conjunctivitis
  3. Sinusitis
  4. Meningitis (occasionally)
  5. Pneumonia
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13
Q

What are the symptoms of haemophilus influenzae pneumonia? [4]

A
  • Abrupt onset of:
    1. Cough
    2. Fever
    3. Pleuritic chest pain
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14
Q

What are the signs of haemophilus influenzae pneumonia? [4]

A
  • Typical signs of consolidation:
    1. Dull percussion
    2. Coarse crepitations
    3. Increased vocal resonance
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15
Q

What are the treatment options for haemophilus influenzae pneumonia? [5]

A
  • Treatment → oral Amoxicillin
  • However risk of beta lactamase (so use…)
    1. Co-amoxiclav
    2. Macrolides (clarithromycin)
    3. Tetracyclines (doxycycline)
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16
Q

Describe the features of the mycolplasma pneumoniae bacterium [3]

A
  1. Smallest free living bacterium
  2. Lack of cell wall
  3. Very difficult to grow → tend not to culture it (use other ways to identify it)
17
Q

How is mycolplasma pneumoniae typically spread? [3]

A
  • Spread from person to person
    • Sneezing
    • Coughing
18
Q

What are the typical presenting symptoms of mycolplasma pneumoniae? [6]

A
  • Non-specific clinical presentation = flu-like illness
    1. Headache
    2. Fever
    3. Myalgia
    4. Arthralgia
    5. Cough (not a prominent symptom)
19
Q

What are the typical signs elicited on examination in a patient with mycolplasma pneumoniae? [4]

A
  • Typical signs of consolidation
    1. Dull percussion
    2. Coarse crepitations
    3. Increased vocal resonance
20
Q

What are the manifestations that mycolplasma pneumoniae can cause beyond the lungs? [5]

A
  1. Haemolysis → produce cold agglutinins
  2. Guillain-Barre
  3. Erythema multiforme → rashes
  4. Cardiac → endocarditis
  5. Reactive Arthritis
21
Q

What is the typical investigation used to diagnose mycolplasma pneumoniae? [3]

A

PCR (sputum/throat swab)

22
Q

What are the treatment options for mycolplasma pneumoniae? [3]

A
  • Use intracellular agents:
    1. Macrolides (clarithromycin)
      • bind to ribosomes and inhibit protein metabolism
    2. Tetracyclines (doxycycline)
      • bind to ribosomes (different class) and inhibit protein metabolism
    3. Quinolones (ciprofloxacin)
      • inhibit ability to store DNA
23
Q

What is the typical investigation used to diagnose Legionella Pneumophila pneumonia? [1]

A

urinary antigen test

24
Q

What are the treatment options for Legionella Pneumophila pneumonia? [3]

A
  • Use intracellular agents:
    1. Macrolides (clarithromycin)
    2. Tetracyclines (doxycycline)
    3. Quinolones (ciprofloxacin)
25
Q

What things do you want to gather during a history of a patient with suspected pneumonia? [12]

hints:

  1. symptoms [7]
  2. past medical history [2]
  3. epidemiology [3]
A
  1. symptoms
    • cough
    • sputum
    • fever
    • chest pain
    • insidious
    • abrupt onset
    • non-respiratory symptoms
  2. past medical history
    • immunosuppression
    • underlying lung disease
  3. epidemiology
    • recent travels
    • ill contacts
    • water exposure
26
Q

What is sepsis defined as under the qSOFA score? [4]

A
  1. systolic BP < 100mmHg
  2. respiratory rate > 22 breaths/min
  3. altered mental status
  4. a score of 2 or more = sepsis
27
Q

What is the CURB65 score? [5]

A
  1. C = confusion
  2. U = urea >7
  3. R = respiratory rate ≥ 30
  4. B = BP, diastolic <60 or systolic <90
  5. 65 = age over 65yrs
28
Q

What is classified as severe pneumonia? [2]

A
  1. multilobar consolidation on CXR and/or hypoxia on room air
  2. CURB65 score <2
29
Q

What investigations should be ordered for a patient with suspected pneumonia? [10]

hints:

  1. blood tests? [4]
  2. microbiology? [4]
  3. other investigations? [2]
A
  • blood tests
    1. FBC
    2. U&Es
    3. ABGs (arterial blood gas)
    4. oxygen saturation
  • microbiology
    1. blood culture
    2. sputum sample
    3. throat swab
    4. urine legionella swab
  • other investigations
    • chest x-ray
    • ECG

Week 6 - Clinical Microbiology & Infections 1 (13 decks)

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