Lecture 24: Fever and cough - pneumonia

Question 1

where does pneumonia infection start vs bronchitis vs URTI

Answer 1

terminal bronchials pneumonia
conduction bronchioles bronchitis
anything above is URTI

Question 2

most common cause of pneumonia?

Answer 2

• Streptococcus pneumoniae (most common)
• haemophilllus influenza (5-10%)
• Staph aureus (severe cases)
• COPY

Question 3

distinguish bronchitis from pneumonia?

Answer 3

clinical features:
-pneumonia affected lung breath decreased (kids)
-respiratory distress 
-listening to lungs - dullness 
pneumonia is worse

Question 4

Pneumonia in elderly

Answer 4

• increased RR
• 50% fever
• Problems outside lung e.g delirium (systemic illness)

Question 5

How do you develop pneumonia?

Answer 5

-Bacteria Aspiration from upper airway, usually happens when asleep

Question 6

Risk factors for pneumonia?

Answer 6

• <2 , >65
• Chronic lung disease
• Smoking
• Immune dysfunction

Question 7

Treatment of pneumonia

Answer 7

• depends on how sick
• Not overly sick: no tests just give generalised antibiotics
• really sick: do tests, give ABs, alter based on tests

Question 8

Pneumococcal virulence features

Answer 8

• Capsule: prevents phagocytosis and complement
• Pneumococcal surface protein A binds to epithelial cells and prevents C3b binding (opsonisation)
• PspC prevents no complement activation
• Choline binding protein binds to Ig receptor on epithelial cell, allowing transport into
• Pneumolysin: lyses neutrophils and epithelial cells
• pilli contribute to colonisation and cytokine (TNF a) production

Question 9

Investigations and management of pneumonia

kidney function?

Answer 9

• CXR first line, if negative no antibiotics
• Sputum culture: yield dependent on sample
• Nasopharyngeal swab: if admitted- viral PCR, if positive stop antibiotics
• if admitted, yield low
• Urine ICT- if admitted moderate yield for Strep pneumoniae, lower for legionella
• serology
• CT chest/bronchoscopy

Question 10

Macrolides

Answer 10

Ribosome targets
Are broad spectrum
Limited activity against gram -ve bacteria
Active against streptococci, staphylococci and other pneumonia causes (used in skin infection when allergic to penicillin)
Treatment of chlamydia

e.g erythromycin, azithromycin and clarithromycin

Question 11

Adverse effects of macrolides

Answer 11

GIT upset, erythromycin agonist of motilin receptor
Sudden death
drug interactions