Pneumonia Flashcards
Define pneumonia
Infection of the distal lung parenchyma
Categories of pneumonia
6
community acquired hospital acquired/nosocomial aspiration pneumonia in the immunocompromised typical atypical (Mycoplasma, Chlamydia, Legionella)
Causes of community acquired pneumonia
10
Streptococcus pneumoniae (70%) Haemophilus influenzae Moraxella catarrhalis (in COPD patients) Chlamydia pneumonia Chlamydia psittacosis (causes psittacosis) Mycoplasma pneumonia Legionella (anywhere w/ air conditioning) Staphylococcus aureus Coxiella burnetti (causes Q fever) TB
Causes of hospital acquired pneumonia
2
Gram negative enterobacteria (Pseudomonas, Klebsiella)
Anaerobes (due to aspiration pneumonia)
Risk factors for pneumonia
6
Age Smoking Alcohol Pre existing lung disease (e.g. COPD) Immunodeficiency Contact w/ patients w/ pneumonia
Epidemiology of pneumonia
prevalence + deaths
5-11/1000
CAP is responsible for > 60,000 deaths per year in UK
Presenting symptoms of pneumonia
9
Fever Rigors Sweating Malaise Cough Sputum Breathlessness Pleuritic chest pain Confusion (in severe cases or elderly)
Presenting symptoms of ATYPICAL pneumonia
4
Headache
Myalgia
Diarrhoea/abdominal pain
DRY cough
Signs of pneumonia on physical examination
12
Pyrexia Respiratory distress Tachypnoea Tachycardia Hypotension Cyanosis Decreased chest expansion Dull to percuss over affected area Increased tactile vocal fremitus over affected area Bronchial breathing over affected area Coarse crepitations on affected side Chronic suppurative lung disease (empyema, abscess) —> clubbing
Investigations for pneumonia
6 types
Bloods CXR Sputum/pleural fluid Urine Atypical viral serology Bronchoscopy & bronchoalveolar lavage
Investigations for pneumonia - bloods
6
FBC - raised WCC U&Es LFTs Blood cultures ABG (assess pulmonary function) Blood film - Mycoplasma causes red cell agglutination
Investigations for pneumonia - CXR
3
Lobar or patchy shadowing (Klebsiella often affects upper lobes)
Pleural effusion
May detect complications (e.g. lung abscess)
Investigations for pneumonia - sputum/pleural fluid
MC&S
Investigations for pneumonia - urine
Pneumococcus & Legionella antigens
Investigations for pneumonia - bronchoscopy & bronchoalveolar lavage
if Pneumocystis carinii pneumonia is suspected, or if it fails to resolve
Investigations for pneumonia
6 groups
Assess severity using British Thoracic Society Guidelines
Start empirical antibiotics
Supportive treatment
Discharge planning
Consider other causes if pneumonia not resolving
Prevention
Investigations for pneumonia - start empirical antibiotics
5
Oral amoxicillin (0 markers)
Oral or IV amoxicillin + erythromycin (1 marker)
IV cefuroxime/cefotaxime/co-amoxiclav + erythromycin (>1 marker)
Add metronidazole if:
- aspiration
- lung abscess
- empyema
Switch to appropriate antibiotic based on sensitivity
Investigations for pneumonia - supportive treatment
4
Oxygen
IV fluids
CPAP, BiPAP or ITU care for respiratory failure
Surgical drainage may be needed for lung abscesses & empyema
Investigations for pneumonia - discharge planning
If 2 or more features of clinical instability are present there’s high risk of re admission & mortality
Investigations for pneumonia - prevention
3
Pneumococcal vaccine
Haemophilus influenze type B vaccine
Usually only given to high risk groups (e.g. elderly, splenectomy)
Complications of pneumonia
6
Pleural effusion Empyema Localised suppuration (e.g. access) Septic shock ARDS Acute renal failure
Complications of pneumonia - mycoplasma pneumonia
6
Erythema multiforme Myocarditis Haemolytic anaemia Meningoencephalitis Transverse myelitis Guillain-Barre syndrome
Prognosis of pneumonia
3
Most resolve w/ treatment in 1-3 weeks
Severe pneumonia has high mortality
CURB-65 score used to assess severity
Symptoms of abscesses
3
Swinging fever
Persistent pneumonia
Copious/foul smelling sputum
