Lecture 60 - Dx and Tx of PNA Flashcards
Define PNA:
• “an abnormal inflammatory condition of the parenchyma of the lung ”
What are the classifications of PNA?
CAP: Typical vs Atypical
Nosocomial: HAP, VAP, HCAP
Aspiration
Opportunisitic (Immunocompromised host)
PNA in general (CAP typical?) — symptoms?
Signs?
Symptoms
§ Cough – productive vs non productive, +/- hemoptysis
§ Chest pain – pleuritic vs non-descript
§ Dyspnea - SOB –
§ Constitutional – malaise, fever, weight loss, night sweats, anorexia
Signs:
Tachypnea, tachycardia, hypoxemia, crackles
consolidation (dullness to percussion, egophony)
Differentiate signs and symptoms of PNA vs Acute Bronchitis
PNA - cough, fever, ABN VITALS, Tachypnea, crackles, consodlidaiton
Opacities CXR
Acute Bronchtiis –
cough (+/- fever),
Normal vitals
Rhonchi, wheezes, crackles
Normal CXR
Imaging – CXR findings of
- lobar PNA
- Atypical PNA
- Aspiration PNA
Lobar – consolidation to 1 or more lobes
Atypical – NO CONSOLIDATION; increased marking of the interstitium; diffusely
Aspiration – consolidation of dependent lobes (RLL, RML)
Are PFTs used for the dx of PNA?
how is the clinical Dx of PNA made?
No – not very useful
Clinical dx is made on CXR
what are some predisposing risk factors for PNA?
How can bacteria reach the lungs?
redisposing factors:
• Loss or suppression of cough reflex; injury or defect to mucociliary, impairment of the phagocytic process, pulmonary congestion; accumulation of secretions
Bacteria can enter the lungs via inspiration, aspiration, hematogenous
what are some predisposing risk factors for a nosocomial PNA?
host factors, prior antibotics, invasive devices, medications altering gastric pH
what are some common pathogens that cause typical CAP ?
S. Pneumonia (majority) S. Aureus -- IVDU, foreign body, Klebsiella H flu Catarrhalis
what are some bacterial causes for atypical pneumonia?
Mycoplasma pneumonia
Legionella
Chlamydia
What viruses are known to cause atypical PNA
CMV
RSV
Influenza
Parainfluenza
Causes of Nosocomial PNA:
early onset vs late onset
Early Onset: S. Pneumo, MSSA, H flu, anaerobes
Late Onset – Pseudomonas, klebsiella, serratia, enterobacter, MRSA
Who needs to be cultured to purse a definitive etiology?
Severe CAP, failure of out patient threapy, nosocomial, pt has structureal disease, liver disease, alcohol abuse, asplenia
Causes of aspiration PNA?
CXR?
Anaerobes (Bacteroides, fusobacter)
CXR – dependent lobar opacities
Fungal PNA –
causes-
endemic vs opportunisits
Inhalation or hematogenous spread
endemic: histo, blasto, cocci
Opportunistic – candida, aspergillus, cryptococcus,