Lobar Pneumonia Flashcards
What is pneumonia?
A lower respiratory tract infection associated with fever, and abnormal Chest Xray
What is the commonest bacterial cause of community acquired pneumonia?
1) Streptococcus pneumoniae (—–> rust coloured sputum)
Then:
- haemophilus influenzae
- mycoplasma pneumoniae
remainder:
- staph aureus
- Legionella
- Morexella
- chlamydia
What is hospital acquired pneumonia and what is the most common bacterial cause?
HAP is development of symptoms 48hrs after admission to hospital.
Gram neg -ve enterobacteria staph aureus Pseudomonas Klebsiella Clostridia
what are the symptoms of pneumonia?
- acute cough
- purulent sputum (haemoptysis - rusty brown)
- SOB
- pleuritic chest pain
- fever + rigors
- malaise
- loss of appetite
- abdo pain, diarrhoea, vomiting
- headache
What is the differance between lobar and bronchopneumonia/
Lobar = localised (one or more lobe) Bronchopneumonia = patchy, associated with bronchi / bronchioles
Aspiration is a caused of pneumonia. What are the risk factors / causes of aspiration?
- stroke —> dysphagia
- Myasthenia gravis (muscle weakness)
- decreased consciousness
- oesophageal disease (achalasia, reflux)
- poor dental hygiene increases risk of aspirating dental anaerobes.
What is the cause of pneumonia in compromised patients?
- Step pneumoniae
- Haemophilus influenza
- staph Aureus
- Morexella catarrhalis
Viruses:
CMV
HSV
fungi e.g. cryptococcys, candida, aspergillus
mycobacteria
Who does lobar pneumonia caused by Klebsiella typically affect?
elderly , diabetics , alcoholics
Who does pneumococcal pneumonia typically affect?
healthy adults between 20 and 50 years
What are the signs of pneumonia?
Signs of consolidation :
- dull percussion
- bronchial breathing.
- reduced chest expansion
- increased tactile fremitus / vocal resonance.
- pleural rub
- crackles
- Pyrexia (over 40 degrees)
- cyanosis
- confusion
- tachypnoea
- tachycardia
- hypotension
- rusty sputum
What are the 4 stages in the pathology of lobar pneumonia?
1) Congestion (24hrs of exudate secretion into alveolar space, venous congestion, heavy-oedematous-red lung)
2) Red hepatisation (last for few days, infilatration of inflammatory cells into alveolar space and red cells from blood. fibrinous exudate in pleura red-solid-airless lung)
3) Grey hepatisation
(fibrin, destruction of inflamm cells, grey-brown-solid lung)
4) Resolution at about 8-10 days in untreated cases. reabsorption of exudate digestion of inflammatory debris (preservation of alveolar wall)
What are the risk factors for community acquired pneumonia?
Age (young and old)
Co-morbidities (HIV, DM, CKD,)
Other Resp conditions( CF, bronchiectasis, COPD)
lifestyle (smoking, alcohol, IVDU)
Iatrogenic (immunosuppressants, long term steroids)
What is the pathology behind SOB in pneumonia:?
pus fills alveoli so gas exchange impaired
stevens-johnson syndrome is a rare and potentially life threatening complication of pneumonia - what is it?
- Stevens-Johnson syndrome is a rare but serious disorder that affects the skin, mucous membrane, genitals and eyes.
- begins with flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off.
What are the extrapulmonary features of CAP caused by legionella and mycoplasma?
- myalgia
- arthralgia
- malaise
Mycocarditis and pericarditis are complications of CAP most commonly in …
Mycoplasma pneumonia
Hepatis can a be a feature of ????..pneumonia
Hepatitis can be a feature of legionella pneumonia
How can CAP present in the elderly?
- confusion
- recurrent falls
What condition should be excluded if symptoms of pneumonia are present for several weeks or have failed to respond to Abx?
tuberculosis
What are the Invx for pneumonia?
1) Chest Xray
(consolidation, pleural effusion)
2) Obs : O2 sats, BP, resp rate0
3) ABG if SaO2 < 92%
4) Bloods
- FBC (raised WCC)
- U&E (kidney function)
- LFT
- CRP
- BLOOD CULTURES (sepsis)
5) Sputum culture
6) Pleural effusion aspiration for analysis
7) bronchoscopy if immunocompromised
How is the severity of pneumonia assessed?
CURB- 65
C- Confusion U - urea >7mmol/L R - resp rate > 30/min B - blood pressure < 90systolic or 60 diastolic 65yrs age
**if score 0-1 then home treatment, if 2+ hospital
score of more than 3 indicates a mortality of 15-40%
Describe the use of a chest xray for invx of pneumonia?
CXR shows:
- consolidation
- pleural effusion (blunt costophrenic angle)
- if normal CXR then should be repeated 2-3 days after if CAP suspected.
- repeat CXR after 6 weeks of treatment to rule out bronchial malignancy
What is the blood results of pneumonia caused by strep pneumoniae ?
- raised WCC >15x10^9/L
- raised inflammatory markers (CRP and ESR >100)
What is the blood results of pneumonia caused by mycoplasma?
WCC normal
