Pneumonia Flashcards
Tool used to assess severity of pneumonia
CRB-65
Components of CRB-65
Confusion
Raised resp rate
Low BP
Age 65 or more
Definition of confusion in CRB-65
New disorientation in person, place, or time; or abbreviated mental test score 8 or less
Definition of raised resp rate in CRB-65
30 breaths per min or more
Definition of low BP in CRB-65
Diastolic 60 mmHg or less
Or systolic less than 90 mmHg
Interpretation of CRB-65
0 - low risk of death
1-2 - intermediate risk
3-4 - high risk
Clinical features indicative of severe community-acquired pneumonia
Difficulty breathing O2 sats less than 90% Raised heart rate Grunting; very severe chest indrawing Inability to drink Lethargy; reduced level of consciousness
When should sputum culture be requested for CAP
Moderate severity community-acquired pneumonia for whom community management is appropriate
Do not routinely recommend microbiological tests for people with low-severity CAP
Features of acute bronchitis
May or may not have sputum, wheeze, or breathlessness
Substernal or chest wall pain may be present with coughing
Sometimes mild constitutional symptoms
Cough
Features of CAP
Dyspnoea Sputum Pleural pain Sweating Fever Shivers, aches and pains Cough
Which clinical features indicate atypical penumonia
Dry cough No fever Headache Confusion Diarrhoea Hyponatraemia in legionella Upper resp involvement
Typical examination and investigation findings for acute bronchitis
Mildly ill
Wheeze often present
Rhonchi that improve with coughing may be present
CXR normal
typical examination and ix findings for CAP
Focal chest signs such as decreased or asymmetric breath sounds Bronchial breath sounds Dullness to percussion Course crepitations Vocal fremitus Tachypnoea and tachycardia
CXR abnormal
When should adults be with CAP be referred to hospital
Symptoms and signs suggest a more serious illness or condition(for example, cardioresp failure or sepsis)
Symptoms are not improving as expected with antibiotics
Follow up for a person with CAP in primary care
CXR after 6 weeks for adults:
With symptoms and signs that persist despite treatment
Who are a higher risk of underlying malignancy(smokers and people aged above 50)
Which immunisation can be considered for individuals after recovery from pneumonia
Pneumococcal or influenza immunisation
Management of CAP
Analgesia - NSAIDs
Antibiotic - Amoxicillin 500mg
Doxycycline or clarithromycin if allergy
Risk factors for mycoplasma and chlamydophila pneumonia
Spread by person-to-person contact and spread is most common in closed populations(schools, offices)
Risk factor for legionellae pneumonia
Found most commonly in fresh water and man-made water systems
What is HAP occurring less than 5 days after hospital admission usually caused by
S.pneumoniae
What is HAP occurring more than 5 days after hospital admission usually caused by
H.influenzae
MRSA
Pseudomonas aeurginosa
Management of atypical penumonia
Treated as for other CAP initially(little value in serological testing)
Doxycycline, clarithromycin and erythromycin
Which antibiotic may be used in severe legionella infections
Rifampicin as well as a macrolide
Complications of pneumonia
Pleural effusion(usually sterile)
Empyema
Lung abscess
Pneumothorax
What are focal outbreaks of L.pneumophila often caused by
Poorly maintained air-conditioning or humidification systems
Features of pneumonic/Legionnaires’ disease
More likely to have a cough(90%) Severe Not self-limiting Often display a relative bradycardia Headache, confusion, impaired cognition GI symptoms
Features of non-pneumonic(pontiac disease)
Influenza-like illness with myalgia, fever and headache
Self-limiting
IX - Legionnaires’ disease
Isolation and culture of legionella species(usually sputum)
Seroconversion(in titre of indirect immunoflourescent antibody test)
Confirmation of L.pneumophila urinary antigen
Management of legionnaires’ disease
Paracetamol
Oxygen/assisted ventilation
Erythromycin(although care has to be taken to avoid GI upset)
Classification of pneumonia by CRB-65
0 - low severity
1 or 2 - moderate
3+ - severe
Antibiotic choice for low severity CAP
amoxicillin 500mg TDS
Oral Doxycycline 200mg if allergic or oral clarithrymocyin
Antibiotic choice for moderate severity CAP
Oral amoxicillin 500mg three times a day + oral clarithromycin 500mg BDS
Doxycycline if allergic to penicillin
How does legionnaires’ disease cause hyponatraemia
Causes SIADH
Rash associated with mycoplasma pneumoniae
Erythema multiform - target lesions
Can also cause neurological symptoms
What is pneumonia caused by coxiella burnetti caused by
Linked to exposure to animals and their bodily fluids
What is pneumonia caused by chalmydia psittaci associated with
Typically contracted from contact with infected birds
What is bronchitis
It is a result of inflammation of the trachea and major bronchi and is therefore associated with oedematous large airways and the production of sputum.
Self-limiting
Presentation of bronchitis
Cough - may or may not be productive
Sore throat
Rhinorrhoea
Wheeze
Most have normal chest exam but can have wheeze/low-grade fever
Differentiating acute bronchitis from pneumonia in the history
Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia.
Differentiating acute bronchitis from pneumonia in the examination
No other focal chest signs (dullness to percussion, crepitations, bronchial breathing) in acute bronchitis other than wheeze.
Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.
Management of acute bronchitis
Analgesia
Fluids
Antibiotics if systemically unwell, CRP raised
Doxycycline as first line for acute bronchitis
