Lower respiratory tract infections incl pneumonias Flashcards
What is Pneumonia?
Infection causing inflammation of the lung tissue and sputum filling the airways and alveoli
How does Pneumonia appear on a chest x-ray?
Consolidation.
How is pneumonia classified?
- Community acquired
- Hospital acquired (> 48h after hospital admission)
- Aspiration pneumonia
How does pneumonia present?
- Shortness of breath
- Fever
- Productive cough
- Haemoptysis
- Pleuritic chest pain
- Delirium
- Sepsis
What is pleuritic chest pain?
Sharp chest pain worse on inspiration
List 3 characteristic signs of pneumonia?
- Bronchial breath sounds
- Focal coarse crackles
- Dullness to percussion
What scoring system assesses severity of pneumonia?
Explain
CURB-65
- Confusion
- Urea > 7
- RR ≥ 30
- BP < 90 systolic or ≤ 60 diastolic.
- Age ≥ 65
Interpret the various scores of CRUB-65
- 0/1: Consider treatment at home
- ≥ 2: Consider hospital admission
- ≥ 3: Consider intensive care assessment
List the 4 most common bacteria causing CAP
- Streptococcus pneumoniae
- Haemophilus Influenzae
- Klebsiella pneumoniae
- Moraxella cattarhalis
List the 4 most common bacteria causing HAP
- Staphylococcus Aureus
- Pseudomonas
- MRSA
- Gram negative enteric bacteria
List 3 risk factors for Psuedomonas.
- Bronchiectasis
- COPD exacerbations leading to frequent steroid or Abx use
- HCAP
List 4 risk factors for CAP
- Altered Mental Status
- Smoking
- Alcohol
- Malnutrition
- Immunosuppression
- Underlying lung disease
- Age ≥65 years
- Specific exposure
What is Atypical pneumonia?
Caused by an organism that cannot be cultured normally or detected with gram stain
Does NOT respond to penicillins
List the 5 atypical pneumonia
(“Legions of psittaci MCQs”)
- Legionella pneumophila (Legionnaires’ disease)
- Chlamydia psittaci
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Coxiella burnetii (Q fever”)
How is Legionella pneumophila typically contracted?
Infected water supplies or air conditioning units
What does Legionella typically cause?
SIADH causing hyponatremia
(typical exam patient has recently had a cheap hotel holiday and presents with hyponatraemia)
How is Legionella and pneumococcal diagnosed?
Urinary antigens
How is Legionnaires disease treated?
macrolides/quinolones +/- rifampicin
How is Chlamydia pneumoniae and Chlamydia psittaci diagnosed?
Serology
How is Chlamydia psittaci contracted?
Contact with infected birds (bird poop)
Example of a Fungal Pneumonia?
In which group of patients does this most commonly affect?
Pneumocystis jiroveci (PCP)
Occurs in patients that are immunocompromised (ie. HIV )
How does Pneumocystis jiroveci present?
- Dry cough without sputum
- Shortness of breath on exertion
- Night sweats
How is PCP treated?
Co-trimoxazole (trimethoprim/sulfamethoxazole)
List 4 investigations for pneumonia
- Chest xray
- FBC
- U&Es
- CRP
- Sputum cultures
- Blood cultures
Compare the treatment course of mild, moderate and severe CAP
Mild: 5 day course of oral antibiotics (amoxicillin or macrolide)
Moderate- severe: 7-10 day course of dual antibiotics (amoxicillin and macrolide)
List 4 complications of pneumonia
- Sepsis
- Pleural effusion
- Empyema
- Lung abscess
- Death
What does the pneumococcal vaccine protect against?
Streptococcus pneumoniae
To whom is the pneumococcal vaccine offered?
- 3 injections at 2, 4 and 12-13 months
- ≥ 65 years
- At-risk groups ie. chronic heart, liver or renal conditions.
In which 2 groups of people is Klebsiella most common?
Diabetics and alcoholics
