Lower respiratory infections Flashcards

1
Q
  • symptoms might be extremely variable
  • no one finding will allow you to definitely diagnose pneumonia
  • might be particularly difficult in the elderly
  • sx: cough, fever, chills, pleuritic chest pain, wheezing, sputum prodcution, abdominal symptoms, tachycardia, tachypnea, SOB, DOE
A

Community acquired pneumonia

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2
Q

what are some historical elements of pneumonia that you should keep in mind?

A
  • change in hydration status wiht complaints of orthostatis
  • nausea, vomiting, vomiting triggered by coughing
  • signs of pulmonary involvement (bacteremia-skin, arthritis, etc)
  • aspiration potential
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3
Q

organisms include

  • Streptococcus pneumonia
  • haemophilus influenzae
  • staphylococcus aureus
  • gram negative bacteria

CXR: may be signs of pulmonary consolidation (dullness, increased fremitus, egophony, bronchial breath sounds and rales

Common presentation: chils, tachypnea, pleurtic chest pain, fever, consolidations, rigors

A

Typical pneumonia

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4
Q

Organism Include

  • mycoplasma pneumoniae
  • legionella species
  • chlamydophila pneumoniae
  • respiratory viruses (covid-19, influenza, adenovirus, RSV)

The common presentation might be a range of respiratory signs that are non-specific (non-productive cough, fever, dyspnea)

intrinsically resistant to all B-lactam agents

A

Atypical Pneumonia

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5
Q

What is some of the differences between typical and a typical pneumonia?

A
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6
Q

what are some clinical manifestations that are thought to be more common with legionella atypical pneumonia infection?

A
  • diarrhea
  • temperature > 39 degrees celcius
  • neurologic change (confusion, etc)
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7
Q

what are other types of pneumonias?

A
  • Viral pneumonias (influenza, respiratory synctial virus, adenovirus, parainfluenza virus, covid-19)
  • fungal pneumonias
  • pneumonitis (inflammation of lungs caused by chemicals, food, liquids, or foreign objects)- can lead to infectious pneumonia
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8
Q

Initial site of treatment for pneumonia states

A
  • The PSI has been validated for predicting mortality, guidelines discuss using the PSI recommendations to assist identifying pts with CAP who may be candidates for outpaitent tx
  • PSI not a good substitute for good clincial judgement
  • first asess preexisting conditions that may compromise the safety of outpatient care
  • outpatient tx is recommended for risk classes I, II, III
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9
Q

evaluation of pneumonia uses?

A
  • History and physical exam
  • chest X-ray (typical- lobar consolidation; atypical- interstitial infiltrates; virus- interstitial infiltrates)

Cannot accurately differentiate typical from atypical based on CXR alone

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10
Q
  • Diagnosis of pneumonia if there is a new infiltrate when the clincial and microbiologic features are supportive
  • recommended for all adults
  • if not infiltrate found, dx of pneumonia questionable
  • False negatives- too early, dehydration, neutropenia
A

Chest X-ray

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11
Q

When should you evaluate blood cultures?

make sure to get two cultures before antiobiotics

A
  • advised in patients with severe community acquired pneumonia, chronic liver disease or neutropenia secondary to pneumonia, asplenia or complement deficiencies
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12
Q

what empirical antibiotic treatment of CAP should be used in patients with no comorbidities?

A

for previously healthy patients with No use of antimicrobial within the previous 3 months

  • Use Amoxicillin 1 G PO TID X 7 DAYS
  • or doxyclycline
  • or a macrolide Azithromycin 250mg tablets 2 PO tabs today and 1 tab PO daily x 4 days)

know bolded

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13
Q

Empirical antibiotic treatment of CAP in a patient with comorbidities?

A

In the presence of comorbidities such as chronic heart, lung, liver or renal disease; DM; alcoholism, cancer, asplenia; immunocompromising conditons or drugs causing immunocompression; or use of antimicrobials within the previous 3 months

  • respiratory fluroquinolone (strong rec)- levofloxacin, moxifloxacin…
  • or B-lactam plus macrolide
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14
Q

empirical antibiotic treatment for pneumonia? (INPATIENT) non-ICU

A

USE:

  • a respiratory fluoroquinolone
  • or B-lactam plus a macrolide
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15
Q

what is the guideline for the duration of antibiotic therapy for patients with CAP?

A

patients with CAP should be treated for a minimum of 5 days, should be afrebrile for 48-72h and should have no more than 1 CAP-associated sign of clincial instability

  • a longer duration of therapy may be needed if initial was not active against the identified pathogen or etc
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16
Q

what is considered clincal stability?

A
  • temperature < 37.8
  • heart rate < 100bpm
  • respiratory rate < 24
  • systolic > 90mmHg
  • aterial oxygen > 90%
  • ability to maintain oral intake
  • normal mental status
17
Q

how do you calculate the pneumonia mortality criteria?

Don’t need to know specific calc- just generality

A

CURB-65

  • confusion
  • uremia > 7mmol/1
  • respiratory rate > 30/min
  • blood pressure: SBP < 90mmHG

OR

  • DBP < 60mmHg
  • 65 years or older

Presence of each item contributes 1 point to the score

18
Q

What is the microorganism?

  • Single rigor or chills and rust colored sputum
  • lobar pneumonia
  • aka pneumococcal pneumonia
  • pts typically affected: anyone, post splenectomy
  • TX: Amoxicillin 1G TID
A

Strep Pneumoniae

19
Q

What is the microorganism?

  • hyponatremia
  • vomitting and diarrhea
  • relative bradycardia, confusion, LFT changes
  • pts typically affected: exposure to “humid” environments (A/C units or stagnant water)
  • tx: Fluoroquinolone or Azithromycin
A

legionella pneumoniae

20
Q

What is the microorganism?

  • Bilateral nodular infiltrates, empyema, or pulmonary abscess formation
  • pts typically effected: IV drug use, post-influenza
  • tx: Beta lactam +macrolide
A

staph aureus

21
Q

What is the microorganism?

  • bullous myringitis, cold agglutination +
  • cobweb infiltrates,
  • low grade fever and cough
  • pts typically effected: Young adults, college students
A

mycoplasma pneumoniae

22
Q

What is the microorganism?

  • Productive cough
  • green sputum
  • pts typically effected: COPD, Post splenectomy, decreased immunities
  • tx: Amoxicillin 1g TID
A

Haemophilis influenza

23
Q

What is the microorganism?

  • Current jelly sputum
  • bulging fissure sign, lung necrosis possible if not treated appropriately
  • Pts typically effected: Alcoholics, chronic illnesses and aspiration
  • tx: 3rd or 4th cephalosporin or quinolone
A

Klebsiella pneumoniae

24
Q

What is the microorganism?

  • green sputum with abscess formation
  • pts typically effected: ventilator pts and CF pts
  • tx: fluroquinolone
A

pseduomonas aeruginosa

25
Q

What is the microorganism?

  • Foul smelling sputum
  • periodontal infection
  • pts typically effected: aspiration and neonates
  • tx: beta lactam +beta lactamase inhibitor or clindamycin
A

anaerobic pneumonia