Pneumonia Flashcards
Classification of pneumonia
Developed outside of hospital - “community acquired pneumonia”
Develops more than 48h after hospital admission - “hospital acquired pneumonia”
Develops as a result of aspiration - “aspiration pneumonia”
Presentation of pneumonia
Shortness of breath
Cough productive of sputum
Fever
Haemoptysis
Pleuritic chest pain
Delirium
Sepsis
Signs in pneumonia
Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
Confusion
Chest signs in pneumonia
Bronchial breath sounds (harsh breath sounds equally loud on inspiration and expiration)
Focal coarse crackles
Dullness to percussion due to lung tissue collapse and/or consolidation
How do we score pneumonia severity?
CURB-65
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
How do we used CURB-65 to decide whether to admit patients?
Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care assessment
Most common causes of pneumonia
Streptococcus pneumoniae (50%)
Haemophilus influenzae (20%)
Cause of pneumonia in immunocompromised patients or those with chronic pulmonary disease
Moraxella catarrhalis
Causes of pneumonia in patients with cystic fibrosis or bronchiectasis
Pseudomonas aeruginosa
Staphylococcus aureus
What is ‘atypical pneumonia’?
Pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain
How do we treat atypical pneumonias?
Macrolides (e.g. clarithomycin)
Fluoroquinolones (e.g. levofloxacin)
Tetracyclines (e.g. doxycycline)
List the 5 causes of atypical pneumonia
Legions of psittaci MCQs
Legionella pneumophila
Chlamydia psittaci
Mycoplasma pneumoniae
Chlaymdophila pneumoniae
Q fever (coxiella burnetii)
Legionella pneumonia (Legionnaire’s disease)
Typically caused by infected water supplies or air conditioning units
Can cause hyponatraemia) by causing SIADH
Typical patient has recently had a cheap hotel holiday and presents with hyponatraemia
Mycoplasma pneumoniae
Milder pneumonia
Can cause erythema multiforme (target lesions)
Can cause neurological symptoms in young patient
Chlamydophila pneumoniae
School aged child
Midl to moderate chronic pneumonia + wheeze
Coxiella burnetii (“Q fever”)
Exposure to animals and their bodily fluids
Typical patient is a farmer with a flu-like illness
Chlamydia psittaci
Contact with infected birds
Typical patient is parrot owner
Which patients does fungal pneumonia occur in?
What organism is it cause by?
Immunocompromised e.g. new HIV or low CD4 count
Pneumocystis jiroveci (PCP)
Fungal pneumonia (pneumocystic jiroveci) presentation
Dry cough without sputum
SOBOE
Night sweats
Fungal pneumonia (pneumocystic jiroveci) management
Co-trimoxazole (Septrin)
Low CD4 count patients are prescribed prophylactic co-trimoxazole
Investigations for pneumonia
CXR
FBC (raised white cells)
U&Es (for urea)
CRP (raised in inflammation and infection)
If moderate-severe:
Sputum cultures
Blood cultures
Legionella and pneumococcal urinary antigens (send a urine sample for antigen testing)
Antibiotics for pneumonia
Mild CAP: 5 day course of oral antibiotics (amoxicillin or macrolide)
Moderate to severe CAP: 7-10 day course of dual antibiotics (amoxicillin and macrolide)
Complications of pneumonia
Sepsis
Pleural effusion
Empyema
Lung abscess
Death
