Complications of pneumonia

Question 1

what may be the general complications of pneumonia ?

Answer 1

• respiratory failure
• hypotension
• sepsis
• jaundice

Question 2

what could the local complications of pneumonia be ?

Answer 2

• atrial fibrillation
• pleural effusion
• empyema
• lung abscess
• pericarditis and myocarditis

Question 3

what type of respiratory failure is it and why?

Answer 3

type 1 -
Type I respiratory failure occurs because of damage to lung tissue. This lung damage prevents adequate oxygenation of the blood (hypoxaemia); however, the remaining normal lung is still sufficient to excrete the carbon dioxide being produced by tissue metabolism.

Question 4

what is the treatment for respiratory failure?

Answer 4

high flow oxygen - 60%
- transfer the patient to ICU is hypoxia does not improve with O2 therapy or PaCO2 rises to above 6 kilopascals
take care with COPD

Question 5

why may patients be hypotensive?

Answer 5

ma be due to a combination of dehydration and vasodilation due to sepsis.

Question 6

what is the treatment for hypotension?

Answer 6

If systolic BP is 90mmHg. If systolic BP remains

Question 7

what is the treatment for atrial fibrillation?

Answer 7

is quite common, particularly in the elderly. It usually resolves
with treatment of the pneumonia. -blocker or digoxin may be required to
slow the ventricular response rate in the short term.

Question 8

how does pleural effusion develop from pneumonia

Answer 8

PE is fluid in the pleural space.

It results from inflammation of the pleura by adjacent pneumonia, causing fluid. If the fluid accumulates faster than it is reabsorbed a PE develops

Question 9

what is the treatment for PE?

Answer 9

If this is small it may be of no consequence.
If it becomes large and symptomatic, or infected (empyema), drainage is
required

Question 10

how common is PE?

Answer 10

effusions commonly occur with pneumonia and complicate around one-third to a half of all CAP cases

the majority of these are simple exudative effusions but empyema may also develop.

Question 11

what is an empyema?

Answer 11

pus in the pleural space.

Question 12

what are the indications of empyema?

Answer 12

• ongoing fever

- rising or persistently high inflammatory markers, despite appropriate antibiotic treatment

Question 13

what are the clinical features of empyema?

Answer 13

CXR indicates pleural effusion

The aspirated pleural fluid is typically yellow and turbid with a pH

Question 14

what should be done if there is a PE?

Answer 14

• thoracocentesis should be performed to make a diagnosis
• using ultrasound, fluid should be aspirated and sent for a gram-stain, culture, fluid, protein, glucose and LDH
• lights’s criteria should be use to assess whether the effusion is transudative or exudative

Question 15

what should be done if an empyema develops ?

Answer 15

• fluid should be urgently drained
• the duration of antibiotic administration will usually need to be extended
• thoracic surgery if severe

Question 16

what is a lung abscess ?

Answer 16

a cavitating area of localised, suppurative infection within the lung

it often comes under the same differential diagnosis as cancer and TB

• it can come from smoking too

Question 17

what causes lung abscess?

Answer 17

• inadequately treated pneumonia
• aspiration
• bronchial obstruction (tumour, foreign body)
• pulmonary infarction
• septic emboli (septicaemia, right heart endocarditis, IV drug use)
• subphrenic or hepatic abscess

Question 18

what are the clinical features of lung abscess?

Answer 18

• persisting or worsening pneumonia
• large quantities of sputum - which is often foul smelling
• usually have a swinging fever, malaise and weight loss

Question 19

what may be found on examination of lung abscess ?

Answer 19

clubbing ay occur in chronic suppuration

• patients may have normocytic anaemia and/or raised inflammatory markers
• may have crepitations

Question 20

what tests are done for lung abscess?

Answer 20

blood tests : FBC for anaemia and neutrophilia, ESR, CRP, blood cultures

sputum microscopy, culture and cytology

CXR, CT

need to do a bronchoscopy

Question 21

what would be observed in a lung abscess CXR?

Answer 21

walled cavity, often with a fluid level

Question 22

why is a CT done for lung abscess?

Answer 22

to exclude obstruction, and bronchoscopy to obtain diagnostic specimens

Question 23

what is the treatment for lung abscess?

Answer 23

• should be guided by available culture or clinical judgement
• continue antibiotics until healed (4-6 weeks)
• may need surgical drainage

Question 24

how does septicaemia arise?

Answer 24

may occur as a result of bacterial spread from the lung parenchyma
into the bloodstream.

Question 25

what may septicaemia cause?

Answer 25

may cause metastatic infection, e.g. infective endocarditis, meningitis

Question 26

what is septicaemia treated with?

Answer 26

IV antibiotics according to sensitivities

Question 27

how is jaundice a complication of pneumonia ?

Answer 27

this is usually cholestatic and may be due to sepsis or secondary to antibiotic therapy