LRTI Flashcards
What are the different types of pneumonia?
- CAP
- HAP
- VAP
- Aspiration
- Immunocompromised
- Viral
What are risk factors for pneumonia?
- Age
- COPD
- Smoking
- Alcoholism
- Season
How is pneumonia diagnosed?
- Clinical history + physical examination
- Blood for culture, gram stain, PCR
- Nose/throat swab for viral
- WCC
- Radiology: CXR
What are risk factors of HAP?
- General anasthesia
- Surgery
- Immunosuppression
- Decreased conciousness
- VAP
What bacteria cause HAP/VAP?
GNB:
- E.coli
- Klebsiella
- Enterobacter
- Pseudomonas
Staph. aureus (MRSA)
Legionella pneumophilia
What viruses cause HAP/VAP?
- SARS-CoV-2
- Influenza
- RSV
What bacteria cause CAP?
- Strep pneumoniae (60%)
- Mycoplasma pneumoniae (10-20%)
- H. influenzae
- Legionella pneumophilia
- S. aureus
- GNB
What does S. pneumoniae cause?
- CAP
- Sinusitis + otitis media
- Meningitis + BSI
What diagnostic test is done for S.pneumoniae?
- Sputum culture
- Blood culture
- Urinary antigen
What is seen on a culture for S. pneumoniae?
- Gram positive diplococci
- alpha-haemolytic
- Catalase negative
- Susceptible to optochin
What is the treatment for CAP?
S. pneumoniae
- Benzylpenicillin IV → Amoxicillin oral
- Ceftriaxone IV if penicillin-resistant
What is the diagnosis and treatment for H. influenzae?
- GNB
- Fastidious
- Require factor X and V
- chocolate agar
Treatment: co-amoxiclav
What are the organisms that cause atypical pneumoniae?
- Mycoplasma
- Legionella
- Chlamydia
- Coxiella
look at slides for detail on each
What antibiotic is given for atypical pneumoniae?
- Not susceptible to B-lactams
- Macrolides, tetracyclines, fluoroquinolones
What antibiotic is given for mycoplasma pneumoniae?
- Clarithromycin
- Doxycycline
What antibiotic is given for legionella?
- Clarithromycin (macrolide)
- Levofloxacin (fluoroquinolone)
What antibiotic is given for chlamydia?
- Clarithromycin
- Doxycycline
What is a common feature of Staph aureus and Klebsiella pneumoniae?
- Abscess formation
- both associated with severe CAP
What are viral causes of CAP?
- SARS-CoV-2
- Influenza A&B
- RSB
- Varicella, measles, CMV as part of systemic infection
What is CURB-65?
- Assesment score used asses CAP
- C: Confusion
- U: Urea >7mmol/L
- R: Respiratory rate >30/min
- B: BP, Systolic <90 and diastolic <60
- 65: Age > 65 years
What treatment is given for CAP according to CURB-65?
- 0-1, Mild: oral amoxicillin/clarithromycin/doxycycline
- 2, Moderate: IV axomicillin + oral clarithromycin
- 3-5, Severe: IV co-amoxiclav + oral clarithromycin
What antibiotic is given for VAP?
- piperacillin-tazobactam IV
- covers gram positive and negative, and pseudomonas
What causes aspiration pneumonia?
- Loss of gag reflex
- Organisms: Strep, S. aureus, E.coli and other GNB
What are oppurtinistic pathogens in immunocompromised pneumonia?
- Fungi: P. jiroveci, aspergillus
- Viruses: HSV, CMV
- Mycobacteria: NTM
What is lung abscess?
- Destruction of lung parenchyma to produce cavitation
What bacteria cause lung abscess?
- Polymicrobial: peptostreptococcus
- Monomicrobial: S. aureus, K. pneumoniae, Strep pyogenes
What is bronchiectasis?
- chronic bronchial dilation
What organisms cause bronchiectasis?
- H. influenzae
- S. pneumoniae
- S. aureus
- P. aeruginosa
Why do Cystic Fibrosis patients get infection?
- Defects on microbial clearance (excess mucous production)
- Altered salt content in airway surface liquid: kills neutrophils
- P.aeruginosa receptors
- Decreased NO
- Hyper inflammatory airway
What do we do urinary antigen tests for?
- Legionella
- Pneumococcal antigens
What antibiotics are used to treat coxiella burnetti?
- Doxycycline (+ rifampicin if chronic)
What specimen do we take for VAP?
- Broncho-alveolar lavage (BAL)
if no sputum, done during bronchoscopy
What antibiotics are given for pseudomonas aeruginosa?
- Piperacillin-tazobactam
