Lecture 9 LRTI (Pneumonia) Flashcards
What are clinical Signs of Infection
- inflammation
- Redness
- Heat
- Pus
Systemic Signs; fever, Increased HR, Increased RR, Increased WBC
What are the characteristics of a fever
fever most common & most non-specific feature of infection
❑ > 37.5 (oral / armpit) (99.5 oF)
❑ > 38oC (tympanic / rectal) (100.2oF)
- Very young and Elderly may not respond with a fever
- HR is increased by 10-15BPm for each 1* increase
What are potential results of an untreated fever
❑ enhanced leukocyte migration
❑ augmented lymphocyte function
❑ reduced microbial replication
❑ improved survival
White blood count ranges and meanings
WBC increased (leukocytes) in most bacterial or fungal infections
Normal ; 4-11
> 11; suspect of infection
> 15-17; very sick
Sepsis- either very low or very high -50
What’s the risk involved with Pneumonia
• Those > 65 years of age at greatest risk
• >50% of cases and 90% of mortality in these patients
• Mortality is <1% in outpatients but 14% in those hospitalized
• A viral infection precedes pneumonia in up to 50% of
cases
What is community acquired Pneumonia (CAP)
- defined as an acute infection of the pulmonary
Blood culture and sensitivity test
Should be performed in ill febrile pt’s
Should be taken from two different peripheral sites at least a few minutes to an hour apart from one one another
Sputum C&S
Usually performed in LRSTI
❑ Specimen quality can be assessed by considering
the relative proportions of the components seen
under the microscope
❑ PMNs
❑ Epithelial cells
What are the systemic signs of infection?
Fever, increased heart rate (HR), increased respiratory rate (RR), and increased white blood cell count (WBC).
What is the normal range for white blood cell count (WBC)?
4.0-11.0 x 10^9/L (4,000-11,000/mm^3).
What is a common cause of fever besides infection?
Drug fevers, transfusion reactions, lymphoma, or post-myocardial infarction (MI).
What is the most common bacterial pathogen causing community-acquired pneumonia (CAP)?
Streptococcus pneumoniae.
What are the risk factors for resistant S. pneumoniae?
Antibacterial use in the past 3 months, age >65, exposure to children from daycare, alcoholism, and immunosuppression.
What is the typical presentation of Mycoplasma pneumoniae infection?
Gradual onset of fever, headache, malaise, followed by a persistent hacking cough, often with non-pulmonary symptoms like nausea, vomiting, and skin rashes.
What is the role of procalcitonin (PCT) in diagnosing bacterial infections?
PCT is a biomarker used to predict the likelihood of bacterial infection and can guide antibacterial therapy, especially in respiratory infections and sepsis.
What are the 2016 IDSA/ATS guidelines for procalcitonin use in HAP/VAP?
Procalcitonin levels plus clinical criteria should be used to guide discontinuation of antibiotic therapy in HAP/VAP (weak recommendation, low-quality evidence).
What are the clinical signs of pneumonia?
Fever >37.8°C, hypothermia, rigors, sweats, new cough with sputum, chest discomfort, dyspnea, and abnormal breath sounds (rales, rhonchi).
What are the risk factors for poor outcomes in pneumonia?
Respiratory rate >30, systolic BP <90, acute renal dysfunction, malnourishment, functional impairment, and leukopenia <4 x 10^9/L.
What is the CURB-65 score used for?
It is a risk assessment tool for community-acquired pneumonia (CAP) to determine the need for hospitalization based on confusion, uremia, respiratory rate, blood pressure, and age >65.
What is the first-line empiric treatment for outpatient CAP with no comorbidities?
Amoxicillin 1 g PO TID or doxycycline 200 mg PO once, then 100 mg PO BID.
What is the empiric treatment for severe CAP requiring ICU admission?
Ceftriaxone 1-2 g IV daily plus azithromycin 500 mg IV/PO daily. If MRSA is suspected, add vancomycin or linezolid.
What are the criteria for clinical stability in pneumonia patients?
Temperature ≤37.8°C, heart rate ≤100 bpm, respiratory rate ≤24 breaths/min, systolic BP ≥90 mmHg, O2 saturation ≥90%, ability to maintain oral intake, and normal mental status.
What are the common pathogens in nursing home-acquired pneumonia (NHAP)?
S. pneumoniae, H. influenzae, S. aureus, Enterobacterales, and C. pneumoniae.
What is the empiric treatment for late-onset hospital-acquired pneumonia (HAP)?
Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg PO/IV daily, plus gentamicin if P. aeruginosa is suspected.
What are the prevention strategies for ventilator-associated pneumonia (VAP)?
Elevate the head of the bed 30-45°, mouth care, remove NG/ET tubes ASAP, continuous sub-glottic suctioning, and hand hygiene.
What are the common pathogens in aspiration pneumonia with risk factors for gut anaerobes?
S. pneumoniae, H. influenzae, S. aureus, Enterobacterales, and anaerobes.
What is the empiric treatment for aspiration pneumonia with risk factors for gut anaerobes?
Amoxicillin/clavulanate or ceftriaxone 1-2 g IV daily plus metronidazole 500 mg IV/PO BID.
What is the most common cause of acute bronchitis?
Viral infections (≥90% of cases).
What is the recommended supportive treatment for acute bronchitis?
Increased humidity, smoking cessation, antitussives, and bronchodilators (if needed).
What is the mortality rate for outpatients with pneumonia?
Less than 1%.
What is the mortality rate for hospitalized patients with pneumonia?
Approximately 14%.
What are the common non-infectious outcomes of pneumonia?
Acute cardiac events (e.g., myocardial infarction, atrial fibrillation) and worsening heart failure.
What is the Pneumonia Severity of Illness (PSI) scoring system used for?
To assess the severity of community-acquired pneumonia (CAP) and guide treatment decisions.
What are the common symptoms of Chlamydia pneumoniae infection?
Mild respiratory symptoms, fever, headache, and gradual onset, with re-infection common in older adults.
What is the typical presentation of Haemophilus influenzae pneumonia?
Bronchopneumonia or acute exacerbation in COPD patients, with cough, fever, and pleuritic chest pain.
What are the common pathogens in early-onset ventilator-associated pneumonia (VAP)?
Enterobacterales, S. pneumoniae, H. influenzae, and S. aureus.
What is the empiric treatment for early-onset VAP?
Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily. If MRSA is suspected, add vancomycin or linezolid.
What is the empiric treatment for late-onset VAP with risk factors for multidrug-resistant pathogens?
Piperacillin/tazobactam 4.5 g IV q6h or meropenem 500 mg IV q6h, plus tobramycin or ciprofloxacin. If MRSA is suspected, add vancomycin or linezolid.
What are the common pathogens in aspiration pneumonia without risk factors for gut anaerobes?
S. pneumoniae, H. influenzae, S. aureus, and Enterobacterales.
What is the empiric treatment for aspiration pneumonia without risk factors for gut anaerobes?
Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily.
What are the common symptoms of viral pneumonia?
Upper respiratory symptoms, patchy pulmonary infiltrates, and normal or minimally elevated white blood cell count.
What is the recommended duration of antibacterial therapy for CAP?
Minimum of 3-5 days and until clinically stable.
What are the common pathogens in hospital-acquired pneumonia (HAP)?
Enterobacterales, P. aeruginosa, S. aureus, and S. pneumoniae.
What is the empiric treatment for mild-moderate hospital-acquired aspiration pneumonia?
Amoxicillin/clavulanate or ceftriaxone 1-2 g IV daily plus metronidazole 500 mg IV/PO BID.
What is the empiric treatment for severe hospital-acquired aspiration pneumonia?
Piperacillin/tazobactam 4.5 g IV q6h or meropenem 500 mg IV q6h.
What are the common symptoms of influenza pneumonia?
Sudden onset of flu-like syndrome, upper respiratory symptoms, and positive diagnostic test for influenza virus.
What is the role of macrolides in pneumonia treatment?
Macrolides have immunomodulatory effects, suppressing inflammatory cytokines and reducing morbidity and mortality in CAP when added to β-lactams.
What are the common symptoms of lobar pneumonia?
Sudden onset of fever, chills, cough, and pleuritic chest pain, often with dense consolidation on chest X-ray.
What is the recommended follow-up for pneumonia patients?
Follow-up chest X-ray at 6 weeks for patients with extensive/necrotizing pneumonia, smoking history, alcoholism, or weight loss.
What are the common symptoms of Mycoplasma pneumoniae infection?
Gradual onset of fever, headache, malaise, and persistent hacking cough, often with non-pulmonary symptoms like nausea and skin rashes.
What is the recommended treatment for acute bronchitis?
Supportive care, including increased humidity, smoking cessation, antitussives, and bronchodilators if needed. Antibiotics are not recommended.
What is the recommended treatment for Haemophilus influenzae pneumonia?
Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily.
What are the common symptoms of Streptococcus pneumoniae pneumonia?
Sudden onset of fever, chills, cough, and pleuritic chest pain, often with lobar consolidation on chest X-ray.
What is the recommended treatment for Mycoplasma pneumoniae pneumonia?
Azithromycin 500 mg PO daily or doxycycline 100 mg PO BID.
What are the common symptoms of Chlamydia pneumoniae pneumonia?
Mild respiratory symptoms, fever, headache, and gradual onset, with re-infection common in older adults.
What is the recommended treatment for Chlamydia pneumoniae pneumonia?
Azithromycin 500 mg PO daily or doxycycline 100 mg PO BID.
What are the common symptoms of Haemophilus influenzae pneumonia?
Bronchopneumonia or acute exacerbation in COPD patients, with cough, fever, and pleuritic chest pain.
