Community Acquired Pneumonia - no specific types Flashcards
Describe pneumonia
Inflammation of the lung parenchyma
In pneumonia, the airspaces fill with ___, leading to localised ___ and therefore ___
In pneumonia, the airspaces fill with EXUDATE, leading to localised OEDEMA and therefore CONSOLIDATION
What are the 3 ways in which pneumonia can be classified?
Clinical setting
Causative organism
Morphology
What 2 things must a patient NOT have to be diagnosed with CAP?
Immunosuppression or malignancy
What 2 ages is CAP particularly apperent in?
The extremes of life
<16 and >65 y/o
What gender are 2x more likely to get CAP?
Men
State the 5 major risk factors for CAP
Age Co-morbidities Resp conditions Smoking Immunosuppression
What kind of comorbidities increase the risk of CAP?
HIV, Liver disease, diabetes, heart failure, malnutrition, low BMI
What are the 4 main resp conditions that can increase the risk of CAP?
COPD
Asthma
CF
Obstruction
What 3 lifestyle components increase the risk of CAP?
Smoking
Alcohol
IV drugs
What 3 medications are known to increase the risk of CAP?
ICS
Oral steroids
PPIs
What 2 things is the presentation of CAP dependant on?
The causative organisms
Age/health of the patient
Why does a patient become breathless in CAP?
The pus and debris impairs gas exchange
What are the 3 clinical examination findings in CAP that are due to consolidation?
Coarse crackles
Dull to percussion
Bronchial breathing
What does a swinging fever indicate?
Empyema
Why does pleuritic pain occur in CAP?
Pleural inflammation
What can sometimes be heard early in CAP?
Pleural rub
What population gets very generalised/non-specific symptoms in CAP?
Elderly
What is a common skin manifestation of CAP and why does it occur?
Herpes lablialis
Reactivation of the virus due to the altered immune system
What 2 conditions should always be considered when a patient has a possible pneumonia?
TB
Lung cancer
What is the severity assessment of CAP?
CURB 65
What are the components of the CURB 65 score?
C - new onset confusion U - urea >7 mmol/L R - RR >30/min B - BP (systolic <90, diastolic <60) 65 - >65 y/o
What are the 3 tiers of treatment based on the CURB65 score?
O-1 = outpatient treatment
2 - admission
3+ = ICU required
What are the 2 antibiotics used in the treatment of mild, outpatient CAP?
Amoxicillin
Clarithromycin if penicillin allergic
What should be done if a CAP outpatient patient fails to improve within 48 hrs?
CXR
What should be measured in bloods taken from a CAP patient? (5)
FBC U&Es Biochemistry Serology LFTs
What 2 cultures should be taken in a CAP patient?
Sputum
Blood
Ideally, when should blood cultures be taken in CAP?
In all patients with moderate-severe, before antibiotics
treatment should not be delayed to do this
What test should be offered to all CAP patients?
HIV
What are the 6 other severity markers in CAP?
Multi-lobar involvement PaO2 <8 kPa Low albumin <35 g/l WCC <4 or >30 Positive blood culture Fever <35 or >40
What are the 3 times at which a CXR should be performed in pneumonia?
on admission
2-3 days post-admission
6 weeks post admission
Why is a CXR done 6 weeks after a pneumonia?
To look for underlying malignancy
What are the 5 general principles of pneumonia management?
Oxygen Fluids Antibiotics Thromboprophylaxis (if admitted for >12 hrs) Analgesia
If a patient has a CURB score of 0-2, what antibiotic treatment should they get?
Amoxicillin for 5 days
If a 0-2 CURB patient is penicillin allergic, what are the 2 options for antibiotics?
Doxycycline or clarithromycin
If a patient has a CURB score of 3-5, what antibiotics should they be on?
Co-amoxiclav IV
+
Doxycyline oral
What should be given to pencillin allergic 3-5 CURB patients?
IV levofloxacin
If a CAP patient is in ICU/HDU, what 2 antibiotics should they be on?
Co-amoxiclav IV
+
Clarithromycin IV
What should all ICU/HDU patients be stepped down to? (antibiotics)
Doxycyline
What are the 2 components of thromboprophylaxis?
Subcutaneous, low molecular weight heparin
Compression stockings
Why should CAP patients be given analgesia?
For the pleuritic pain - reduces
What are the 2 general complications of CAP?
Resp failure/ARDS
Sepsis - multi-organ failure
What are the 4 resp complications of CAP?
Pleural effusion
Empyema
Lung abscesses
Organising pneumonia
What kind of therapy is needed in hospital acquired pneumonia?
Extensive gram negative cover
What kind of therapy is needed in aspiration pneumonia?
Anaerobic cover
What 4 groups of people should be offered both the flu jab and the pneumococcal vaccination?
Over 65 y/o
Chronic chest/cardio conditions
Diabetes
Immunocompromised
Define lobar pneumonia
Confluent consolidation involving a complete lung lobe
What organism normally causes lobar pneumonia?
Strep. pneumoniae
What are the 2 rarer organisms that can cause lobar pneumonia?
Legionella
Klebsiella
In what 2 ways is a lobar pneumonia a classic picture of acute inflammation?
Exudation of fibrin-rich fluid
Neutrophil and macrophage inflitration
Describe bronchopneumonia
Starting in the airways and spreading to the adjacent alveolar lung
What context is bronchopneumonia normally seen in?
With underlying/pre-existing conditions
