Pneumonia Flashcards
Define Pneumonia
infection of distal lung parenchyma.
How can pneumonia be categorised?
Community or hospital
Typical or atypical (Mycoplasma, Chlamydia, Legionella)
Aspiration or Immunocompromised
Which 10 infections may cause CAP?
Streptococcus pneumoniae (70%) Haemophilus influenzae Moraxella catarrhalis (COPD) Chlamydia pneumonia Chlamydia psittaci (causes psittacosis) Mycoplasma pneumonia Legionella (A/C) Staphylococcus aureus Coxiella burnetii (causes Q fever) TB
Which infections may cause HAP?
Gram-negative enterobacteria (Pseudomonas, Klebsiella)
Anaerobes (due to aspiration pneumonia)
List 6 risk factors for pneumonia
Age Smoking Alcohol Pre-existing lung disease (e.g. COPD) Immunodeficiency Contact with pts with pneumonia
List 6 Sx of pneumonia
Fever + Rigors Cough Sputum (yellow/ green/ rusty) SOB Pleuritic chest pain Confusion (in severe/ elderly)
List 4 atypical symptoms of pneumonia
Headache
Myalgia
Diarrhoea/ abdominal pain
DRY cough
List 12 signs of pneumonia
Pyrexia 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 Pleural rub Coarse crepitations on affected side Chronic suppurative lung disease (e.g. abscess)- clubbing
Ix for pneumonia
CXR
Blood/ Sputum culture
Urine dip: Legionella
Bronchoscopy
Which bloods are taken in pneumonia?
FBC (high WCC) LFT (abnormal in legionella) U+Es (Urea high in severe) CRP (high) RBC (Mycoplasma agglutinates)
What is seen on CXR of a patient with pneumonia?
Lobar patchy shadowing
Pleural effusion
Klebsiella often effects upper lobes
May detect abscesses.
When in bronchoscopy performed in pneumonia cases?
if Pneumocystitis carinii is suspected
If Pneumonia fails to resolve
What management does each CURB-65 score indicate?
0-1: Abx PO, home
2: Admit
3+: ITU
Describe the use of antibiotics in bacterial pneumonia
Amoxicillin or Clarithromycin PO (0-1)
Amoxicillin + Clarithromycin PO or IV (2)
Co-amoxiclav + Clarithromycin IV (3+)
Levofloxacin IV (3+ with penicillin allergy)
When would you add metronidazole to the baseline antibiotics being used to treat a pneumonia?
Aspiration
Lung abscess
Empyema
What supportive treatment may be necessary in treating pneumonia?
Oxygen
IV fluids
CPAP, BiPAP or ITU care for respiratory failure
Surgical drainage for lung abscesses + empyema
What are the clinical features of instability when discharge planning for pneumonia? How many equates to high risk of re-admission and mortality?
High temperature Tachycardia Tachypnoea Hypotension Low oxygen sats >,2
What would you consider in a non-resolving pneumonia?
Other causes: PE PH RHF Drug toxicity Unusual pathogens Alveolar haemorrhage
2 approaches to prevention of pneumonia
Pneumococcal vaccine
Haemophilus influenzae type B vaccine
Only usually to high risk groups (e.g. >65, splenectomy)
List 5 complications of pneumonia
Pleural effusion Empyema Abscess Septic shock ARDS
What are the extra complications of Mycoplasma pneumonia?
Erythema multiforme Myocarditis Haemolytic anaemia Meningoencephalitis Transverse myelitis GBS
What system is used to assess severity of pneumonia?
CURB-65 score: Confusion < 8 AMTS Urea > 7 mmol/L Respiratory rate > 30/min BP: sys < 90 mmHg or dias < 60 mmHg Age > 65 yrs
