Pneumonia Flashcards
What are the 4 different types of pneumonia and what are their most common causes?
Community acquired (CAP)= streptococcus pneumoniae or haemophilus influenzae
Hospital acquired (>48hrs after admission)= gram -ve enterobacteria or staph aureus or pseudonomas
Aspiration= stroke/myasthenia/bulbar palsies etc ie aspiration of oropharyngeal anaerobes
Immunocompromised= Strep pneumoniae, staph aureus, h influenza
What symptoms might someone present to the GP with which would raise suspicion of pneumonia?
Fever Rigors (shivering) Malaise (generally feeling unwell) Dyspnoea Cough Purulent sputum i.e. yellowish/greenish sputum which can be blood tinged Haemoptysis Pleuritic pain i.e. sharp stabbing pain in inhalation
What signs might you expect to find on examination which would point towards pneumonia?
Pyrexia Hypoxia= can present with cyanosis Confusion= can be the only sign in some elderly Tachynopnea Tachycardia Hypotension = shock
(See later for what you would find auscultation)
What investigations should be done in suspected pneumonia?
Think: BEDSIDE/ BLOODS/ IMAGING
Bedside:
- O2 sats-» ABG if <92%
- BP
- sputum culture
- urinalysis
- blood culture
Bloods:
- FBC= WCC= neutrophilia for bacterial infection
- U+Es= possible indications of dehydration and needed as part of CURB-65
- LFT
- CRP
- legionella and pneumococcal urinary antigens (in moderate-severe pneumonia)
Imaging:
-CXR= lobar or multilobar consolidations/ cavitations/ pleural effusion (blunting of costophrenic angle)
What are the components of CURB-65 and what is its use?
Confusion Urea >7mmol/L RR =>30/min BP <90 systolic or <60 diastolic >65 yo
Used to score the severity of pneumonia and therefore the consequent management (>2= severe pneumonia)
0-1= antibiotics/home treatment 2= Hospital therapy >=3 = severe pneumonia where ITU might need to be considered
What are the main forms of management used for pneumonia?
Antibiotics Oxygen = aim to keep >8kPa or >94% IV fluids VTE prophylaxis Analgesia if pleurisy
What would you expect to hear in patient with pneumonia when percussing and auscultating?
Percussion:
-stony dullness= due to lung collapse or consolidation
Auscultation:
- Bronchial breathing= equally loud on inspiration as expiration
- Coarse crackles
- increased vocal resonance= increases with solid i.e. consolidation
What is atypical pneumonia?
Pneumonia which has been causes by an organism NOT cultured in the normal way or detected using gram staining
-won’t respond to penicillins
What is legionella pneumonia and what might help you to differentiate from other types of pneumonia?
Pneumonia which is associated with Legionnarie’s disease which is caused by infected water
Differentiating:
- causes hyponatraemia due to causing SIADH
- possible history of patient having stayed in cheap hotel accommodation
What 2 types of pneumonia are associated with exposure to animals? Who is most like to develop this form of pneumonia?
Coxiella burnetii (Q fever)
- associated with exposure to animals and their bodily fluids
- classically seen in farmers
Chlamydia psittaci
- contracted from infected birds
- classically seen in parrot owners
What are the 5 cause of atypical pneumonia?
“ Legions of psittaci MCQs”
Legionella pneumonia
Chlamydia psittaci
Mycoplasma pneumoniae= associated with rash called erythema multiforme (pink rings with pale centres “party rings”/ “target lesions”)
Chlamydydophila pneumoniae= consider in school aged children
Q fever (coxiella burnetii)
Who is most at risk of fungal pneumonia? How does it present and how is it treated?
Immunocompromised patients
-most commonly newly diagnosed HIV patients or HIV patients with low CD4
Signs:
- dry cough w/o sputum
- exertional SOB
- night sweats
What components of FBC are important to re-assess after treatment started?
WCC (neutrophils) and CRP
-they are raised in proportion to the severity of infection and show response to treatment
I.e. measure after first few days of antibiotics to see if there has been downwards trend
NOTE:
-CRP shows delay i.e. may not be initially raised and levels respond more slowly to treatment
-WCC has quicker response to treatment
What complications can occur due to pneumonia?
Respiratory failure= type 1
Hypotension=
- dehydration and vasodilation in response to infection
- need to give fluid challenge if BP <90mmHg
AF
Pleural effusion
- due to inflammation of adjacent pleura leading to fluid exudation
- only significant if developing faster than can be absorbed
Empyema (pus in pleural space)
-suspected when patient recovering from pneumonia has recurrent fever
Lung abscesses
-when pneumonia not adequately treated
Septicaemia
-when infection in lung parenchyma spreads to the blood stream
