LRTI and Pneumonia

Question 1

Symptoms of pneumonia
- Typical respiratory
- Non-respiratory

Answer 1

Typical respiratory symptoms
1. Fever
2. Cough
3. Sputum production irrespective of colour
4. Dyspnoea

Non-respiratory symptoms
1. Fatigue
2. Malaise
3. Night sweats
4. Delirium

Question 2

Causes of community acquired pneumonia
- Common
- Uncommon

Answer 2

Common
1. Streptococcus pneumonia
2. Legionella sp
3. Mycoplasma pneumoniae
4. Chlamydial pneumoniae
5. Various circulating viruses

Uncommon
1. Staphylococcus aureus
2. Pseudomonas aeruginosa
3. Klebsiella pneumoniae
4. Francisella tularensis
5. E. coli
6. Moraxella catarrhalis
7. Mixed anaerobic infections
(Contrary to traditional teachings, these bacterias no longer present uniquely in HAP, they are increasing community acquired)

Question 3

Diagnosis of pneumonia is based on __ and __

Answer 3

1. Clinical features
2. Radiographic imaging of lung

Question 4

Radiological findings:
Bacterial etiology more commonly __
Viral etiology more commonly __
(Not always the case)

Answer 4

Bacteria
- Lobar consolidation
- Cavitation
- Large pleural effusions or empyema

Virus
- Patchy ground glass opacities
- Airspace consolidation
- Poorly defined small nodules

Question 5

CURB-65

Answer 5

Confusion
Urea > 7mmol/L
RR > 30
BP < 90/60
65 years old

Score 2 or more - hospitalisation
Score 3 or more - severe pneumonia

Question 6

When should we consider blood and sputum culture for pneumonia?

Answer 6

1. Admission to ICU
2. Cavitary infiltrates
3. Leukopenia
4. Alcohol abuse - klebsiella pneumoniae
5. Advanced liver disease
6. Asplenia
7. Positive pneumococcal or legionella urine antigen
8. Pleural effusion
9. Failed outpatient antibiotics therapy
10. Structural or obstructive lung disease

Question 7

Atypical pneumonias consist of (3)

Patients usually present with __ followed by __

Answer 7

1. Mycoplasma pneumoniae
2. Legionella sp
3. Chlamydial pneumoniae

Mild URTI -> pneumonia

Question 8

Mycoplasma pneumoniae is more prevalent in individuals who are __ such as military bases, boarding schools, nursing homes and colleges

They account for ____ of cases, with increased incidence in __ and __ (seasons)

They present as __ with __ most common, and __, progresses into __.
1/3 patients may have __

Radiographic findings are more extensive than physical examination with ______

It is also associated with: (3)

Answer 8

Institutionalised

10-30% of cases, late summer and early fall

ARI symptoms, sore throat most common
Constitutional symptoms
Progresses into LRTI/pneumonia
1/3 has ear findings - bullous myringitis

Radio: lower lobe unilateral or bilateral patchy infiltrates in 1 or more segments in bronchial or peribronchial distribution

Associated with:
1. Hyponatraemia
2. Autoimmune haemolytic anaemia
3. Target skin lesions

Question 9

Chlamydia pneumoniae often seen with __.
Symptoms of __ and __ progressing into __
Cough begins __ to __ after initial manifestation

Extrapulmonary infections (3)

Answer 9

Other pathogens

Sore throat and ARI -> pneumonia

Days to weeks

Extrapulmonary infections:
1. Otitis media
2. Sinusitis
3. Pericarditis, myocarditis, endocarditis

Question 10

Legionella is often acquired from __
Risk factors of legionella infection (5)

Presents as milder disease of __, __ and __
Rapidly progresses to __ and __

Extrapulmonary associations: (9)

Answer 10

Water sources

Risk factors
1. Smoking
2. Immunosuppression
3. Chronic lung disease
4. Alcoholism
5. Exposure to hot tubs

Mild disease - malaise, non-productive cough, myalgia
Rapid progression to pneumonia, high fever

Extrapulmonary associations
1. Relative bradycardia **classic
2. Diarrhoea
3. Rash
4. Hyponatraemia
5. Hypophosphataemia
6. Elevated liver enzymes
7. Elevated creatinine
8. Myocarditis, pericarditis