Pneumococcal pneumonia

Question 1

what are the clinical features of pneumococcal pneumonia ??

Answer 1

• acute onset with prominent respiratory symptoms
• often preceded by flu like symptoms
• cough with rust coloured sputum
• high fevers and pleuritic chest pain is common

Question 2

for who is bacteraemia more common?

Answer 2

females, excess alcohol, dry cough and COPD, diabetics and HIV infection

Question 3

what investigations should be done?

Answer 3

CXR, blood tests and specific diagnostic

Question 4

what would a CXR maybe show?

Answer 4

consolidation with air bronchograms, effusions and collapse due to retention of secretions can all be seen

This is the most often cause of confluent consolidation involving A COMPLETE LOBE

Question 5

what indications of pneumococcal pneumonia would be seen in blood tests?

Answer 5

white cell count in >15 x10^9/L (90% polymorphonuclear leukocytosis)
inflammatory markers significantly elevated
ESR> 100 mm/hour
CRP> 100 mg/L

Question 6

what specific diagnostic tests would be done

Answer 6

• counter- immunoelectrophoresis of sputum (CIE), urine and serum is more sensitive that sputum or blood cultures
• urinary antigen test detects C-polysaccharide
• pneumococcal PCR - low sensitivity and inferior to blood cultures

Question 7

how is pneumococcal treated?

Answer 7

bacteria are sensitive to amoxicillic, doxycyclina and co-trimoxazole