LOBAR PNEUMONIA Flashcards
What is pneumonia?
Acute inflammation with an intense infiltration of neutrophils in and around the terminal bronchioles. The affected bronchopulmonary segment or the entire lobe may be consolidated by the resulting inflammation and oedema.
What is CAP?
Pre-hospital or within 1st 24hrs
What is HAP?
More than 24hrs post-admission
What is the mortality rate?
21% in hospital
What age group is most affected?
Elderly. Only 30% are <65 years
What are the most common organisms?
S. pneumoniae, S. aureus, Mycoplasma pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae and respiratory viruses. Mixed pathogens occur up to 25% of the time.
Most common Aetiology of CAP?
may be primary or secondary to underlying disease
o Streptococcus pneumoniae is commonest cause
o Then H influenzae, Mycoplasma pneumonia
o Staph A, Legionella speciies, Moraxella catarrhalis and Chlamydia = rest of bacteria
o Gram -ve and anaerobes are rare
o Viruses only 15%
Aetiology of HAP?
o Acquired >48hrs after hospital admission
o Most commonly due to G -ve bacteria or Staph A
o Anaerobes
o Also Pseudomonas, Klebsiella, Bacteriodes, Clostridia
Aetiology of aspiration pneumonia?
o Usually due to vomit
o Occurs in those with stroke, myasthenia, bulbar palsies, decreased consciousness (drunk), oesophageal disease (achalasia, reflux), poor dental hygiene
o Staph pneumoniae and anaerobes
Aetiology in the immunocompromised patient
o Strep pneumoniae, H influenza, Staph A, M catarrhalis, M pneumoniae, G -ve bacilli, Pneumoncystic jiroveci (used to be named P carinii)
o Fungi
o Viruses
2 other aetiology’s of
- Radiotherapy
* Allergic mechanisms
What risk factors?
Age - elderly and very young
Lifestlye: smoking and alcohol
Prev. Viral infections: influenza or parainfluenza
Resp disease: asthma, COPD, malignancy, bronchiectasis, cystic fibrosis
Immunosuppresion: AIDS, cytotoxic therapy.
IV drug abuse (staph. Aureus infection)
Hospitalisation
Underlying comorbidities: DM, CV disease etc.
What symptoms?
Cough, purelent sputum (rust-coloured or blood-stained), breathlessness, fever, malaise.
Elderly: malaise, faitugie, anorexia and myalgia.
Young children: unspecific or abdominal pain
Cough, purulent sputum, fever, rigors, malaise, anorexia, dyspnoea. Heamoptysis, pleuritic pain
What signs?
Tachypneoa, bronchial breathing, crepitatoins, pleural rub, dullness with percussion.
Pyrexial, cyanosis
Confusion
Tachypnoea, tachycardia
Hypotension
Resp exam:
Reduced expansion. Dull to percussion. Increased tactile vocal fremitus. Bronchial breathing. Pleural rub. Bibasal crackles if pleural effusion
What is CURB-65?
- Confusion
- Urea >7mmol
- Resp rate 30/min+
- Systolic pressure below 90, or diastolic below 60
- Age > 65yrs