Infection

Question 1

How can pneumonia be classified?

Answer 1

• Community acquired pneumonia (CAP), if it develops in the community
• Hospital acquired pneumonia (HAP), if it develops more than 48 hours after hospital admission
• Aspiration pneumonia

Question 2

What are the clinical features of pneumonia?

Answer 2

• Cough
• Sputum (sometimes haemoptysis)
• Pleuritic chest pain
• Fever
• In severe cases, sepsis

Question 3

Which score is used to grade the severity (mortality rate) of pneumonia?

What are the components of this score?

Answer 3

CURB-65 score:

• Confusion
• Urea > 7
• Respiratory rate > 30
• Blood pressure < 90 systolic or 60 diastolic
• Age > 65

Question 4

How is the CURB-65 score interpreted?

Answer 4

Score of:
0-1 = low risk, manage in community
2 =intermediate risk, consider hospital admission
3-5 = high risk, consider intensive care assessment

Question 5

What are the most common ‘typical’ causes of pneumonia?

Answer 5

• Streptococcus pneumoniae

- Haemophilus influenzae

Question 6

Describe the investigation of pneumonia

Answer 6

CURB65 score 0-2:

• CXR
• Bloods (FBC, U&E, CRP)

CURB65 score 3+ should ALSO have:

• Sputum culture
• Blood cultures
• Legionella and pneumococcal urinary antigens

Question 7

Describe the management of CAP

Answer 7

Antibiotics according to local guidelines, e.g.:

• Mild CAP = amoxicillin (5 day course)
• Moderate/severe CAP = amoxicillin AND clarithromycin (7-10 days)

Question 8

Pneumonia associated with target lesions is typically caused by which bacterium? What is the name of these target lesions?

Answer 8

Mycoplasma pneumoniae

Erythema multiforme

Question 9

Which pneumonia-causing bacterium is linked to exposure to animals and their bodily fluids (e.g. farmer)?

Answer 9

Coxiella burnettii (Q fever)

Question 10

Which pneumonia-causing bacterium is caught from infected birds?

Answer 10

Chlamydia psittaci

Question 11

a) What is the most likely causative organism of a pneumonia in an individual with HIV? What kind of organism is this?
b) How is this infection treated?

Answer 11

a) Pneumocystis jiroveci (fungus)

b) Co-trimoxazole (HIV+ patients with a low CD4 count are prescribed this prophylactically)