Pneumonia Flashcards
Common causes of CAP
S pneumonia M pneumoniae Chlamydia pneumoniae Legionella Burholderia pseudomallei (tropical Aus)
Risk factors
Strong
age over 65 years HIV/immunocompromise recent respiratory infection exposure to respiratory infection recent travel high-risk occupation recent antibiotic exposure smoking comorbid medical conditions
Clinical features
Fevers Rigors Malaise Anorexia Dyspnea Cough Purulent sputum Hemoptysis Pleuritic chest pain
Initial investigations and results
CXR: infiltration, consolidation, effusion, cavitation
FBC: leukocytosis
RFTs: usually normal
Glucose: usually normal
Oximetry of ABG: hypoxemia, respiratory acidosis
Blood culture: infecting organism
Sputum culture: infecting organism
Sputum gram staining: visualising infecting organism
Secondary investigations and findings
- rapid urinary antigen tests:
positive for Legionella pneumophila, S pneumoniae, or M pneumoniae infection - pleurocentesis
exudate - serology:
rise in serum/convalescent titres, C pneumoniae, M pneumoniae, Legionella - PCR:
detection of C pneumoniae, M pneumoniae, Legionella organisms - M pneumoniae cold agglutinins:
elevated IgM titre if M pneumoniae infection - rapid viral diagnostic tests:
rapid detection of influenza A and B, parainfluenza, RSV - CT chest:
consolidation, cavitation, effusions, neoplasm - bronchoscopy:
may clarify causative organism or non-infectious aetiology
Red flags for pneumonia in adults (6)
Respiratory rate >30
BP
Assessing severity CURB-65
Confusion
Uremia
Respiratory rate >30
BP 65 yo
Criteria for severe CAP
Minor criteria:
- Respiratory rate 30 breaths/minute or greater
- PaO2/FiO2 ratio 250 or less
- Multi-lobar infiltrates
- Confusion/disorientation
- Uraemia (urea ≥20 mg/dL)
- Leukopenia (WCC
Management of pneumonia
ABC Oxygen to maintain >92% IV access Investigations Fluids Analgesia (paracetamol) + antiemetic Antibiotics Admission if required Monitor: symptoms, FBC, o2 saturation
Patient instructions
Adhere to medications Call if not improved in 72 hours \+Water intake Smoking cessation Paracetamol or aspirin Avoid cough suppressants Fatigue is common, however more rest not required
Complications
Pleural effusion Empyema Sepsis Abscess Respiratory failure Myocarditis Pericarditis Cholestasis Atrial fibrillation
Empirical therapy in CAP if outpatient
Amoxycillin or doxycicline
Inpatient moderate disease empirical CAP
Benzylpenicillin + doxycycline PO
Tropical–>
1. Risk factors present= ceftriaxone IV + Gentamicin IV as initial. Consider adding doxycycline.
Risk factors to consider with empirical therapy in tropical area (B. pseudomallei and A baumanni)
Diabetes Alcohol ++ CKD Chronic lung disease Immunosuppressive therapy
Inpatient severe disease empirical CAP
Ceftriaxone IV + azithromycin
Tropical–>
- Wet season= meropenem IV + azithromycin
- Dry season= piperacillin + tazobactam IV + azithromycin
