Pneumonia Flashcards
what is pneumonia
infection of the lung tissue
causes inflammation of the lung tissue and sputum in the airways and alvoli
classification of pneumonia
- CAP (community acquired pneumonia)
- HAP (hospital acquired pneumonia) *develops 48 hours after admission to hospital
- aspiration pneumonia (after inhaling foreign material e.g. food)
how does pneumonia present?
Shortness of breath
Cough productive of sputum
Fever
Haemoptysis (coughing up blood)
Pleuritic chest pain (sharp chest pain worse on inspiration)
Delirium (acute confusion associated with infection)
Sepsis
signs of pnuemonia
Derranged vital signs (sepsis) Tachypnoea (raised respiratory rate) Tachycardia (raised heart rate) Hypoxia (low oxygen) Hypotension (shock) Fever Confusion
O/E pnuemoina
Bronchial breath sounds. These are harsh breath sounds equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway.
Focal coarse crackles. These are air passing through sputum in the airways similar to using a straw to blow in to a drink.
Dullness to percussion due to lung tissue collapse and/or consolidation.
CURB-65
CURB-65 scoring system in hospital (CRB-65 out of hospital)
C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65
it predicts mortality and guide if hospital admission is appropriate.
Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care assessment
what are the common causes of pneumonia?
Streptococcus pneumoniae (50%) Haemophilus influenzae (20%)
Moraxella catarrhalis in immunocompromised patients or those with chronic pulmonary disease
Pseudomonas aeruginosa in patients with cystic fibrosis or bronchiectasis
Staphylococcus aureus in patients with cystic fibrosis
atypical pneumonias
caused by an organism that cannot be cultlured in the normal way or detected using ram stain
they do not respond to penicillin
can be treated with macrolide (clarithromycin), fluroquinolones (levofloxacin) or tetracyclines (doxycyline0
legionella pneumonphilia
atypical
infected water supplies or air conditioning units.
can cause hyponatraemia (low sodium) by causing an SIADH.
mycoplasma pneumonia
atypical
milder pneumonia
erythema multiforme “target lesions”
neurological symptoms
chlamydophila pneumonia
school aged child
moderate - chronic pneumonia and wheeze
coxiella brunetti (Q fever)
exposure to animals and bodily fluids
farmer with flu like illness
chlamydia pscittaci
contact with infected birds
parrot owner
fungal pneumonia
Pneumocystis jiroveci (PCP) pneumonia occurs in patients that are immunocompromised. (poorly controlled or new HIV with a low CD4 count)
subtly with a dry cough without sputum, shortness of breath on exertion and night sweats.
Treatment: co-trimoxazole (trimethoprim/sulfamethoxazole) known by the brand name “Septrin”.
Patients with low CD4 counts are prescribed prophylactic oral co-trimoxazole to protect against PCP.
investigations for pneumonia
bedside: sputum cultures
bloods: FBC (WCC), U+E (urea), CRP (raised), blood cultures, legionella and pneumococcal urinary antigens
imaging: CXR (consolidation)
treatment of pneumonia
resistance
moderate-severe / septic = IV abx then change to oral if improvement
mild CAP: amoxicillin / macrolide 5 day course
mod-severe CAP: 7-10 dual antibiotics (amoxicillin and macrolide)
pneumonia complications
Sepsis Pleural effusion Empyema Lung abscess Death
HAP mx
gram-ve enterobacteria
pseudomonas
s.aureue
- also in care home
- developed with 48hrs
immunocompromised pneumonia
strep CMV HSV pneumocystis aspiration pneumonia
pneumonia buzzwords
- klebsilella
- pseudomonas
- legionella
- jirovecci
- staph aureus
each klebsiella- elderly and alcoholic
*caveatting pneumonia
pseudomonas
immunocompromised in hospital. CF** (common in bronchiectasis)
legionella jacuzzi, water-tanks *clarithromycin *hyponatraemia *abnormal LFT *diagnose with urinary antigen
pneumocystis jirovecci (fungus)
AIDS / HIV
cotrimoxazole
staph aureus
post-infective pneumonia
aspiration pneumonia
stroke, post-surgical
pack years
20 in a pack
pack every day for a year = 1 pack year
2 packs a day for 40 years = 80 pack year
- klebsiella
- pseudomonas
- legionella
- pneumocystic jirovecci
- staph aureus
Klebsiella- Elderly and Alcoholics
Chest X-Ray may show a cavitating pneumonia
Pseudomonas- Common in bronchiectasis and Cystic Fibrosis
Legionella- Think WATER TANKS (AC, swimming pools, hot tubs etc.) & Recently travelled Bloods will generally show hyponatraemia Abnormal LFTs Lymphopenia Diagnosis by Urinary Antigen Treatment – Clarithromycin
Pneumocystis Jirovecci – Immunocompromised patients (THINK HIV)
Exertional dyspnoea and low sats
Inhibits folate
Minimal CXR findings
Dry cough
Treatment is co-trimoxazole (co-amoxiclav and trimethoprim)
Staph Aureus- post infection
