Pneumonia Flashcards
What is pneumonia?
Acute lower respiratory tract infection of the lung parenchyma by one or coinfecting pathogens.
What is the rate of pneumonia in the U.S.?
It is the eighth leading cause of death(including infulenza) and 5 million people each year die from this disease.
What is CAP?
Community acquired pneumonia- chronic or acute based on clinical presentation. Acute presents over a few hours or days. Chronic develops more gradually, with worsening symptoms over days, weeks, months.
What is HAP
Hospital acquired pneumonia or nosocomial pneumonia that develops more than 48 hours after admission and does not appear to be incubating at the time of admission. Causes` typical bacterial pneumonia.
What is VAP?
Ventilator associated pneumonia developed more than 48 to 72 hours after endotracheal intubation.
What is HCAP?
Healthcare associated pneumonia
- Patient hospitalized for 2 or more days in the previous 90 days in an acute care setting.
-attended dialysis clinic or hospitalized
- 30 days in long-term care facilities.
- Received IV antibiotics, wound care or chemotherapy treatment
What is the percentage of HCAP infections in the U.S.?
Accounts for 22% of all such infections.
What is the percentage of VAP occurring in the hospital?
Approximately 10% of patients requiring ventilation develop VAP.
Does hospital stay prolonged due to VAP?
Yes, prolonged hospitalization by 11.5 to 13.1 days.
What are the microorganisms that can cause pneumonia?
Bacteria viruses, Atypical bacteria, fungi, and parasites. BACTERIA IS THE MOST COMMON in the U.S.
What are the cell shapes of bacteria?
Spheres (cocci), rods (bacilli) and various curvatures and helicities and to more exotic shapes such as stars
What is bacteria pneumonia?
Bacteria are microscope unicellular organisms that inhabit all environments. The bacteria that cause pneumonia are pathogens.
What are some typical forms of bacteria?
Rod-shaped (bacillus Klebsiella species), round (coccus; Streptococcus), and spiral (spirillum)
What are facultative anaerobes?
Bacteria can grow with or without free oxygen. while obligate anaerobes are poisoned by bacteria.
What is the difference between gram positive and gram-negative staining?
Gram positive cells retain crystal violet in ethanol solution and are purplish blue under microscope. Gram negative do not retain a counterstain, safranin, and they are pinkish red under microscope.
Why are these colors for stains different?
They are different due to the differences in the structures of the outer surface of bacteria.
What are the clinical symptoms of bacterial pneumonia?
Chest pain, fever, rigors of shaking chills, SOB, hemoptysis, decreased exercise tolerance, malaise (discomfort), and abdominal pain associated with pleuritis.
What is the most consistent symptom of bacterial pneumonia?
A productive cough, it is not a diagnostic causative organism.
What color sputum does the bacteria Pseudomonas, Haemophiles, and pneumococcal produce?
Green sputum
What color sputum does Klebsiella species produce?
Productive red currant-jelly sputum
What kind of sputum does Anaerobic infections produce?
Typically, a foul-smelling or/and bad tasting sputum.
What color is the bacteria Staphylococcus pneumoniae?
Rust-colored aputum
On auscultation what sounds are heard as a common sign of bacterial pneumonia?
Crackles, Rhonchi, wheezes, rub, and bronchial breath sounds
Upon palpitation what is felt for a common sign of bacterial pneumonia and what voice sounds are heard?
Dull over areas of consolidation, tracheal deviation toward atelectasis, and lymphadenopathy. Egophony and whispering pectoriloquy heard over areas of consolidation.
What type of RR and HR is seen in the common clinical signs of bacterial pneumonia?
Tachypnea, use of accessory muscles, labored breathing, and productive cough. HR could be tachycardia or bradycardia.
How does the patient appear when seen in bacterial pneumonia?
Altered mental status (AMS) and central cyanosis.
Where does GNB commonly occur and what are the results?
it occurs in individuals who are immunocompromised or recently hospitalized. Results usually need hospitalization and ICU care..
What are the predisposing risk factors in the etiology of bacterial pneumonia outside the hospital environment?
Chronic respiratory illness, COPD, HIV, bronchiectasis, diabetes, and alcoholism.
What is the percentage of GNB responsible for HAI’s?
30% and 47% of UTI’s
What are atypical pneumonias (walking pneumonia)?
Not clinically familiar, not detectable in gram staining, and does not usually respond to antibiotics. Usually are responsible for 40% of CAI’s and some examples are Mycoplasma, Chlamydophila and L pneumophilia.
What is the epidemiology of bacterial pneumonia?
More than 3 million cases a year, occurs in the winter months and in colder climates. in 2013 occurred mostly in American Indians and Alaskans, lowest in Hispanics.
What are some other epidemiology events that occur in bacterial pneumonia?
Advance age increases incidence of the mortality and aspiration increases the risk of bacterial pneumonia. 65 years or older pneumonia and flu was the 7th leading cause of death in 2013 and 85% occur in this age group. 3% of deaths occurred in age under 45.
What is some GPS that cause typical pneumonia?
Enterococcus faecalis. E. faecilum. S. Aureus, and Streptococcus pneumoniae (most common in children <2 adults > 65 and most common cause of pneumonia)
What is bronchopneumonia?
Simultaneous infections involvement of the airways and lung parenchyma.
What happens during necrosis?
During active inflammation and infections can cause significant destructive changes. Normal lung function may not be restored if there is scaring and lung tissue remodeling.
What are the for mortality for CAP?
Age> 50, Male, Comorbid illness(diabetes), AMS, Hypertension <90, Tachypnea > 30, Hyperthermia temp < 35, Fever>40, HR >125 bpm, ABG <7.35, WBC < 4 x10fifth/L >30 x 10fifth/L.
What are the predisposing risk factors for bacterial pneumonia?
Adults > 65, Chronic lung disease, Increased risk of microaspiration or upper airway secretions, immunocompromised conditions, metabolic disorders, lifestyle factors and environmental exposure, incubations or bronchoscopy, and viral tract infection.
What are complications of bacterial pneumonia?
Bacteremia is the most common which can lead to septic shock. Necrosis, ARDS, bronchiectasis, coagulopathy, lung abscess, multiorgan failure, pleurisy, and exacerbation of comorbid illness.
What diagnostic testing is done to determine bacterial pneumonia?
Chest x-ray is the criterion to identify, but not reliable in identifying atypical or typical pneumonia. Infiltrate is the GOLD standard for diagnosis in chest -x-ray.
What lab test are helpful in help in infectious pneumonia?
C- reactive protein (CRP) and procalcitonin (PCT or ProCT) values may be helpful in distinguishing infectious pneumonia underlining disease exacerbations.
What lab test are helpful in help in infectious pneumonia?
C- reactive protein (CRP) and procalcitonin (PCT or ProCT) values may be helpful in distinguishing infectious pneumonia underlining disease exacerbations.
When is BAL and thoracentesis used?
BAL can be performed for fluids analysis and cultures and thoracentesis is almost always essential procedure in patients with pleural effusions.
What are the treatments of bacterial pneumonia?
Treatment may differ but empirical antimicrobial treatment may be initiated to avoid progression. Acute inflammation with bronchospasm requires bronchodilators, mild progression may require O2 and severe may need ventilation support. Mucolytic, bronchodilators, and CPT can enhance elimination of purulent sputum.
What is the prognosis for bacterial pneumonia?
Dependent on variable factors, prognosis is good for healthy individuals and improve within 2 weeks.
What is a viral pneumonia and who does its effect?
Viral pneumonia is a group of infectious organisms distinguished by its submicroscopic size and lack of ability to replicate outside and without assistance of a living cell. It occurs most frequent in extreme ages of life in young children and elderly adults.
How many cases does viral pneumonia cause?
Viruses that cause pneumonia account for almost 50% of the total cases of pneumonia.
What are common clinical presentations associated with viral pneumonia?
Occur specific times of year, among clustered populations, or specific groups of individuals with immunocompromised disease.
What are common constitutional symptoms associated with viral pneumonia?
Fever, chill, nonproductive cough rhinitis, muscle soreness, headaches, and increased fatigue
What are the most common causes of viral pneumonia?
Influenza A and B, RSV, Coronavirus, Rhinovirus, Adenovirus, and Parainfluenza
What is the epidemiology of viral pneumonia?
100 million adult and child cases occur annually. viruses are more commonly detected than bacteria in adults and children hospitalized with CAP.
what is the pathophysiology of viral pneumonia?
Most viruses tend to multiply in the upper airways epithelium where they secondarily infect the lung via airway secretions or hematogenous spread.
What are the risk factors of viral pneumonia?
Men more than woman, pregnant women, and immunocompromised and elderly individuals. Also, very young and chronic pulmonary disease patients.
What diagnostic testing are done for viral pneumonia?
X-ray showing interstitial infiltrates, ABG resulting mild respiratory alkalosis, sinus tach on ECG with pleuritic chest pain, elevated WBC
What is the treatment for viral pneumonia?
Can depend by the severity of the illness. Can include administering O2 as necessary, hydration, as well as ventilatory support. Antibiotics are ineffective
What is the prognosis for viral pneumonia?
The prognosis is normally considered good in patients without associated risk factors. Patient with risk factors mortality is significantly increased. Patients’ who are immunocompromised can have hypoxemia, respiratory failure, and various pulmonary maladies.
What is fungal pneumonia?
Acute infection mycosis involving the lung parenchyma caused by a single or a combination of endemic or opportunistic fungi.
What are the common fungi that cause illness are endemic fungal pathogens?
Histoplasma capuslatum, Paracoccidioides brasiliensis, Blastomyces dermatitisis, and Coccidiodes immitis. Can cause infection in healthy and immunocompromised
What are the clinical factors of fungi pneumonia?
May asymptomatic but cause fu-like symptoms; cough (usually nonproductive), and chest and muscle discomfort. They are nonspecific and may be confused with bacteria or viral pneumonia.
What are the physical findings of fungal pneumonia?
Include fever, tachycardia, respiratory distress, pleural rub, and signs of pulmonary consolidation. Nonpulmonary signs are meningitis, skin lesions, and rheumatologic and allergic findings.
What is the etiology for fungal pneumonia?
In the U.S. the organisms include H.capsulatum, C. immitis, and B. dermatitidid. Opportunistic fungal organisms cause pneumonia in individuals with acquired or congenital defects in their host defense, include Candida, Aspergillus, Mucor species, C. neoformans, and Pneumocystis jirovecii
What is the epidemiology for fungal pneumonia?
Men more than women, work-related exposure, second most common cause is mucormycosis (group of molds) approx. 10% of all invasive pulmonary infections. Invasive aspergillious represents the leading cause of pulmonary lung infection.
What is pathophysiology of fungal pneumonia?
The infections occur after inhalation of fungi due to the disturbance of their natural habitat. Goes through the spores and then enters the blood stream. Fungi grow and multiply in the alveolar microphages. The presence of chronic pulmonary disease impairs the clearance of the infection.
what are the risk factors for fungal pneumonia?
Outdoor workers such as farmers that become significantly exposed to bird, bat, or rodent dropping (farmers lung). laboratory personnel working with C immitis in a presumed protected enviroment. Nosocomial Candida infection may be transmitted from healthcare workers hands or contaminated fluids.
