community acquired pneumonia Flashcards by Rawan El gamal

what is pneumonia ?

an acute infection characterized by clinical signs of consolidation along with radiological signs of consolidation

How well did you know this?

Not at all

Perfectly

what are the different types of pneumonia ?

CAP - acquired in community
HAP - in hospital ( more than 48 hours of admission)
VAP - on mechanical ventilation for more than 48 hours on ventilator

How well did you know this?

Not at all

Perfectly

what are the different routes of transmission associated with pneumonia ?

inhalation
aspiration
colonization
blood spread
associated with viruses and atypical bacteria

How well did you know this?

Not at all

Perfectly

what are the causes of having an unprotected airway and what are thee associated organisms ?

cerebrovascular stroke
alcohol
hypnotics
which can all cause aspiration, associated with oral flora which is anaerobic bacteria

How well did you know this?

Not at all

Perfectly

what are the reasons behind colonization in pneumonia and what are the associated organisms ?

pre-existing lung disease :
bronchieactsis
chronic bronchitis
cystic fibrosis
variable organisms

How well did you know this?

Not at all

Perfectly

what are the causes of bacteremia what are the associated organisms ?

IV drug addiction
intravenous cannula
heamodialysis
staph aureus, gram negative bacteria

How well did you know this?

Not at all

Perfectly

what are the stages of pneumonia ?

congestion
red hepatization
grey hepatization
resolution

How well did you know this?

Not at all

Perfectly

what does incomplete resolution in pneumonia result in ?

permanent scaring

How well did you know this?

Not at all

Perfectly

how long do the stages pf pneumonia take ?

7-10 days

How well did you know this?

Not at all

Perfectly

what is the clinical picture of atypical pneumonia ?

extra-thoracic affection
otitis, pharyngitis
haemolytic anemia
GI symptoms
confusion
hyponatraemia

How well did you know this?

Not at all

Perfectly

in terms of pathology what is different about atypical pneumonia ?

formation of hyaline tissue

superimposed infection

How well did you know this?

Not at all

Perfectly

what are the microorganisms causing atypical pneumonia ?

legionella pneumonia
mycoplasma pneumonia
chalmydia pneumoniae

How well did you know this?

Not at all

Perfectly

what routine investigations would be performed on a patient suspecting pneumonia ?

chest x-ray 
CT Chest 
CBC
ABG 
BUN ( renal function) divide urea by 2

How well did you know this?

Not at all

Perfectly

what would the findings be on auscultation ?

reduced breathing sounds
bronchial breathing
crackles

How well did you know this?

Not at all

Perfectly

what are the radiological findings with atypical pneumonia vs bacterial pneumonia ?

ground glass opacities in atypical pneumonia
consolidations in bacterial pneumonia

How well did you know this?

Not at all

Perfectly

what is required to make a diagnosis of severe pneumonia ?

IDS/ATS criteria

1 major or 3 minor

How well did you know this?

Not at all

Perfectly

what are the major criteria for pneumonia ?

septic shock with need for vasopressors
respiratory failure in need of mechanical ventilation

- respiratory failure requiring mechanical ventilation

How well did you know this?

Not at all

Perfectly

what are the minor criteria ?

respiratory rate less than 30
hypotension corrected by IV fluids 
hypothermia 
confusion 
leukopenia 
thrombocytopenia 
uremia 
PaO2/FiO2 ratio is less than 250 
multi lobar infiltrates

How well did you know this?

Not at all

Perfectly

what are the specific tests for a case of pneumonia ?

1- sputum gram stain
2- sputum culture and sensitivity
3- blood culture and sensitivity
4- urinary antigen for legionella and pneumococcal bacteria
molecular test (PCR)
5- procalcitonin levels

How well did you know this?

Not at all

Perfectly

what are the specific situations where it is required to make those special tests ?

patients managed inn the hospital AND have severe pneumonia according to the IDSA/ATS criteria
or
have risk factors for specific/resistant bacteria

- patients who have risk factors for specific/resistant bacteria

How well did you know this?

Not at all

Perfectly

what is the target sample to test with intubated patients ?

endotracheal aspirate

what are the risk factors for acquiring specific/resistant bacteria ?

recent hospitalisation and receipt of recent IV antibiotics inn the last 90 days
previous isolation of pseudomans aeruginosa or MRSA
presence of comorbidities

when would it be necessary to carry out a urinary antigen test ?

legionella outbreak/recent travel
or
severe pneumonia

when would a PCR resting of influenza be required ?

in influenza outbreaks or in pandemics like COVID-19

what may help in the differentiation between bacterial or viral pneumonia ?

procalcitonin | a high level of procalcitonin may be an indication of bacterial infection

how do we decide the site of care for a pneumonia patient ?

CURB-65 score

what does the CURb-65 score measure ?

``` confusion BUN level ( below 20 ) Respiratory rate ( below 30 ) low blood pressure (90/60) and an age of 65 years old ```

what scores indicate what location with the CURB-65 ?

0-1 at home outpatient 2 - ward 3-5 then the ICU

what is the treatment for a patient who scored 0-1 on the CURB-65 ?

depends on comorbidities and no risk of MRSA no comorbidities :amoxycillin OR doxycilline OR macrolide with comorbidities : we give a combination therapy of amoxicillin/clauvanate + macrolide OR fluoroquinolone ( mono therapy)

if the patient is an inpatient ( score of 2 in the CURB-65), what treatments are required ?

``` IF NON SEVERE: give a combination of b lactam and macrolide OR fluoroquinolone IF SEVERE : give a combination of b lactam and macrolide OR B lactam and fluoroquinolone ```

what must the patient take if there is a risk of acquiring resistant/MRSA/p.aeruginosa ?

Anti-MRSA or | Anti-P.aeruginosa

what are examples of macrolides ?

azithromycin | clarithomycin

what are examples of fluroquinolones ?

levofloxacin | moxifloxacin

what are the antibiotics effective against MRSA?

vancomycin | linezolid

what is aspiration pneumonia caused by ?

anaerobic bacteria

when do you add anti-anerobic antibiotics in aspiration pneumonia ?

only when the patient develops complications including lung abscess or empyema ( clindamycin)

when should corticosteroids be used ?

only in CAP patients who are in septic shock that are not responsive to resuscitation and vasopressor support

when do you follow up on the patient when managing pneumonia ?

after 3 days - 72 hours

when do we diagnose non-responding pneumonia ?

if there is deterioration or no clinical improvement in antibiotic therapy that has lasted 5-7 days

what are the causes of non responsive pneumonia ?

doctor related organism related patient related

what can be done to prevent pneumonia ?

vaccination against influenza | vaccination against pneumococcal polysacchride vaccine

what are the types of influenza vaccine ?

inactivated influenza vaccine recombinant influenza vaccine live attenuated influenza vaccine

when is the live attenuated vaccine contraindicated ?

pregnant women immunosuppression adults older than 65 history of allergic reaction

in order to make a diagnosis of severe pneumonia using the IDSA/ATS criteria how many of each do wee need ?

1 major or 3 minor

what is the treatment for P.areguinosa ?

levofloxacin or meropenem

what is the presentation of legionella pneumonia ?

associated with legionnaires disease look for hyponatraemia and deranged LFTs

how is legionella pneumonia spread ?

through aerosolized water particles - bad air conditioning

what is the synonym for klebsiella pneumonia ?

friedlanderrs pneumonia

which type of patients are at a higher risk of developing klebsiella ?

diabetics and alcoholics

what is seen on chest x ray of a patient with klebsiella ?

fissure bulging sign ( due to massive enlargement of the right upper lobe )

what is distinctive about the appearance off the sputum of klebeisella ?

red currant sputum