Pneumonia Flashcards
What is the pathophysiology of Pneumonia?
- Defined as inflammation of substance
- Caused by:
- Bacteria usually
- Viruses
- Fungi
How is Pneumonia Classified?
- Community acquired
- Hospital acquired
- Immunocompromised
Which organisms can causes infection?
- Pneumococcus (most common)
- Haemophilus Influenzae
- Mycoplasma pneumoniae
- Staphlycoccus Aurues
- Legionella spp
- Pseudomonas Aeruginosa
What are symptoms of Pneumonia?
- Cough
- Purulent sputum
- Breathlessness
- Fever
- Chest Pain
- Headache
- Myocarditis and Pericarditis
- Abdominal Pain
- Diarrhoea and Vomiting
- Myalgia, Arthralgia and malaise
- Labial Herpes Simplex
- Skin rashes such as erythema multiforme and erythema nodosum
How does the fever present in empyema?
Swing Fever
How is Pneumonia Assessed?
CURB-65
What are components of CURB-65?
CURB-65
- C: Confusion present
- U: Urea level >7mmol/L
- R: Respiratory rate >30 breaths/min
- B: Systolic blood pressure <90mmHg; diastolic <60mmHg
- 65: Age >65
How is CURB-65 used to make decisions?
Score 0-1: Treat as Outpatient
Score 2: Admit
Score 3+: Require case in intensive treatment unit
What are investigations for Pneumonia?
- Chest X-ray: Repeated 6 weeks later to rule out malignancy.
- Blood Tests
- Microbiological Tests: Sputum culture and Gram stain
- Blood Culture
- Pulse Oximetry and arterial blood gas analysis if oxygen sats is <94%
- HIV Test should be offered
What are management steps for Pneumonia?
- Oxygen to maintain oxygen between 94% and 98%. Should be given to maintain 88% and 92% for COPD
- Intravenous fluid in hypotensive patients
- Antibiotics: Amoxicillin and Doxycycline
- Thromboprophylaxis: should be given if admitted for >12h and TED stockings should be fitted
- Nutritional supplementation
- Analgesia: to treat pleuritic pain
- Physiotherapy: Chest physiotherapy not needed unless sputum retention is an issue
What are complications of pneumonia?
- Parapneumonic pleural effusion (exudative) and Empyema
- Lung abscess
- Respiratory failure
- Sepsis
Which criteria is used to differentiate between translate and exudate?
Light’s Criteria
How is the Parapneumonic pleural effusion and empyema managed?
Thoracentesis to make diagnosis.
Use Light’s criteria to assess whether its transudative or exudative.
Empyema should be drained instantly if it appears
What should fluid from thoracentesis be examined for?
Fluid should be sent for:
- Gram Stain
- Culture
- Fluid protein
- Glucose
- LDH
What are clinical features of a lung abscess?
- Persisting or worsening pneumonia with large quantities of sputum, swinging fever, malaise and weight loss.
- Managed according to culture
What are causes of Lung abscesses?
- Tuberculosis
- Septic emboli containing Staphylococci
- Inadequately treated CAP
- Pneumonia from certain species
- Spread from amoebic liver abscess
- Bronchial obstruction by endoluminal cancer
- Foreign body inhalation
What are the causes of non-resolving pneumonia?
CHAOS
- Complication: empyema, lung abscess
- Host: immunocompromised
- Antibiotic: inadequate dose, poor oral absorption
- Organism: resistant or unexpected organism not covered by empirical antibiotics
- Second diagnosis: PE, cancer, organising pneumonia
What is Hospital Acquired Pneumonia?
New onset of cough with purulent sputum along with compatible X-ray demonstrating consolidation beyond 2 days of initial admisson to hospital or within 3 months of being in healthcare setting.
Which organisms are implicated in Hospital Acquired Pneumonia?
- Pseudomonas Spp.
- Escherichia Spp.
- Klebsiella spp.
- Enterobacter spp.
- Staphylococcus Aureus
- MRSA
- Acinetobacter spp.
How is Hospital Acquired Pneumonia treated?
- Ceftazidime/Avibactam
- MRSA – Telavancin
What is the pathophysiology of Aspiration Pneumonia?
- Acute aspiration of gastric content into lungs can produce extremely severe and sometimes fatal illness due to intense destructiveness of gastric acid
- Persistent pneumonia often due to anaerobes and progress to lung abscess or even bronchiectasis if protracted
What is the most usual site for aspirated material?
- Right Middle Lobe
- Apical or Posterior segments of Right Lower Lobe
What is the treatment for Aspiration Pneumonia?
- Directed specification against positive culture if available
- Co-amoxiclav covers gram negative and anaerobic bacteria if cultures not available
What can lead to Pneumocystis Jiroveci Pneumonia?
- Long-term corticosteroids
- Monoclonal antibody therapy or methotrexate for autoimmune disease
- Those on anti-rejection medication post solid organ transplantation
- Stem cell transplantation
- Those affected with HIV
How does Pneumocystis Jiroveci Pneumonia arise?
Pneumocytis Jiroveci is found in air and pneumonia can arise from re-infection rather than reaction of persisting organism acquired in childhood
What is the threshold for the CD4+ count to be harmful?
Individual with CD4+ counts of <200/mm3 are at particular risk
What are clinical features of Pneumocystis Jiroveci Pneumonia?
- High Fever
- Breathlessness
- Dry cough
- Rapid desaturation on exercise or exertion
What are imaging findings for Pneumocystis Jiroveci Pneumonia?
- Diffuse bilateral alveolar and interstitial shadowing beginning in perihilar region and spreading out in a butter fly pattern.
- Localized infiltration, nodules, cavitation or pneumothorax
What is the management for Pneumocystis Jiroveci Pneumonia?
- Diagnosis confirmed by indirect immune-flourescence on induced sputum or brochoalveolar lavage fluid
- High-dose Co-Trimoxazole is 1st line.
What is microbiology of Klebsiella Pneumoniae?
- Gram-negative rod
- Part of the normal gut flora.
- Can cause a number of infections in humans including Pneumonia (typically following aspiration) and Urinary Tract Infections
What are clinical features of Klebsiella Pneumonia?
- Common among Alcoholics and Diabetics
- Red Currant Jelly-like sputum
- Implicated in many other disorders such as Ascending Cholangitis
- May occur following Aspiration
What are complication of Klebsiella Pneumoniae?
Commonly causes:
- Lung Abscess formation
- Empyema
What is the difference between an abscess and empyema?
- An abscess is a collection of pus inside a newly formed cavity. \
- An empyema is a collection of pus in an already existing cavity such as the pleural space.
