Community acquired pneumonia Flashcards
pathological changes of pneumonia ?
edema and proteinaceous exudate
1-2 days
red hepatisation - where abc and neutrophils get in
3-4
grey hepatisation - red blood cells have been broken down and neutrophils are predominant with fibrin
fibrosuppuration
5-7
resolution - mainly for pneumococcal infection
8 to 4 weeks
etiology of community acquired penumonia ?
LESS THAN 48 HOURS OF HOSPITAL ADMISSION
typical :s pneumonia (lobar and bronchopneumonia )
h influenza (bronchopenumonia)
sometimes -
s areus (bronchopneumonia)
klebseilla (bronchopneumonia)
========
atypicall - MOSTLY INTERSTITIAL PNEUMONIA
mycoplasma pneumonia ,
chalmidophylia pneumonia
legionella (lobar)
viruses - adenovirus , RSV
risk factors for community acquired pneumonia
old age
alcoholism - strep pneumonia
COPD and smoking - hemophillus
legionella
chlamydophilia pneumonia
asthma
clinical features ?
high fever and chills
malaise
typical productive cough - mucoid , purulent or blood tingled
atypical - non productive cough
tachypnea
dyspnea
pleuritic chest pain - if pleura is involved
physical examinations ?
crackles and decreased bronchial breathing
enhanced tactile fremitus
dullness on percussion
auscultation of atypical - unremarkable
diagnosis of community acquired pneumonia ?
chest x ray
lobar - opacity of one or more pulmonary lobes
bronchopneumonia - patchy infiltrates scattered through out the lungs
atypical - reticular opacities
cbc - crp , ESR, leukocytosis
serum prolactonin
blood culture - mainly for s pneumonia
sputum culture and gram staining
pneumococcal urinary antigen
legionella pneumophilisa irunary antigen
chest CT
management of treatmnet ?
criteria for hospitalisation
CURB65
confusion serum urea >7mmol/l respiratory rate > 30/min BP <90mmhg systolic age >65
0 - treated as outpatient
2 or more - hospitalisation
3 or more - ICU care
what is the empiric antibiotic therapy for community acquired pneumonia - OUTPATIENT ?
previously healthy patients without comorbidities or risk factors for resistant pathogens
mono therapy of amoxicillin
doxycycline
==============
patients with comorbiidties or risk factors for resistant pathogen
combination therapy
amoxicillin +clavulanate
or
cefuroxime
PLUS
macrolide - azithromycin
clarithromycin
mono therapy
fluroquinilones :levofloxacin
usually 5 days
treatmnet for INPATINET
non ICU
ampicillin sublactum + macrolide / doxycycline
mono therapy - fluroquinilone - moxifloxacin
=======
ICU
ampicillin sublactum + macrolide/ doxycycline ./ fluroquinilone
====
for pseudomonas auriginosa risk
pi[eracillin tazobactum + macrolide / doxycycline / fluroquinilones
======
risk for mesa
vancomycin and linezolid
duration of therapy 5-7 days
complications of nosocomial pneumonia ?
lung abcess , pleural effusion , metastatic infection
