Pneumonia Flashcards
What is pneumonia?
It refers to infection of the lung tissue, resulting in inflammation and sputum production within the airways and alveoli
What are the two classifications of pneumonia?
Community Acquired Pneumonia (CAP)
Hospital Acquired Pneumonia (HAP)
What is the most common pneumonia classification?
Community acquired pneumonia
What is community acquired pneumonia?
It is defined as pneumonia that is contracted outside of the hospital
What is hospital acquired pneumonia?
It is defined as pneumonia that is contracted within 48 hours or more after hospital admission
Why is it important to distinguish between pneumonia classifications?
The causative organisms vary and therefore the first line antibiotic guidelines are different
What are the seven bacterial organisms associated with pneumonia?
Streptococcus Pneumonia
Haemophilus Influenza
Group B Strep
Staphylococcus Aureus
Mycoplasma Pneumonia
Legionella Pneumophila
Klebsiella Pneumoniae
What is the most common bacterial organism associated with community acquired pneumonia?
Streptococcus pneumonia
What is another term for streptococcus pneumonia?
Pneumococcus
Is streptococcus pneumonia gram positive or gram negative?
Gram positive
What are the four characteristic features of streptococcus pneumonia?
Coccus shaped
Catalase test negative
Partial haemolysis reaction on blood agar
Optochin sensitive
What colour does streptococcus pneumonia present as on blood agar?
Green
What virulence factor is associated with streptococcus pneumonia?
IgA protease
What are the three clinical features associated with streptococcus pneumonia pneumonia?
Rapid onset
Fever
Herpes labialis
What is the second most common bacterial organism associated with community acquired pneumonia?
Haemophilus influenza
Which two patient groups tend to be affected by haemophilus influenza?
COPD patients
Pre-vaccinated/unvaccinated children
Which patient group tend to contract group B streptococcus pneumonia?
pre-vaccinated infants, often contracted during birth from group B streptococcus colonising the vagina
Which patient group tend to be affected by staphylococcus aureus?
Those affected by a recent influenza infection
What are the two signs of staphylococcus aureus pneumonia on CXR?
Pneumatoceles in multiple lobes
Consolidation in multiple lobes
What are pneumatoceles?
They are air-filled cavitary lesions
What is atypical pneumonia?
It is pneumonia caused by an organism that cannot be cultured in the normal way or be detected using a gram stain
Which antibiotic are atypical pneumonia bacteria resistant to? What three alternatives can be administered?
Penicillin
Macrolides
Fluoroquines
Tetracyclines
What five bacteria cause atypical pneumonia?
Mycoplasma pneumonia
Legionella pneumophilia
What are the four clinical features of mycoplasma pneumonia pneumonia?
Dry cough
Autoimmune haemolytic anaemia
Bullous myringitis
Erythema multiform
What is erythema multiform?
It is a rash characterised by varying sized target lesions formed by pink rings with pale centres
What classification of autoimmune haemolytic anaemia is associated with mycoplasma pneumonia?
Cold AIHA
What investigation can be used to identify
Cold agglutinin test
What type of agar is used to grow mycoplasma pneumonia?
Eaton agar
Due to mycoplasma pneumonia pneumonia being atypical, what two pharmacological agents are used to treat it?
Macrolide antibiotics
Doxycycline
Is legionella pneumophilia gram positive or gram negative?
Gram negative
What is another key feature of legionella pneumophilia?
Coccobacillus shaped
How is legionella pneumophilia transmitted?
It is transmitted via showers, hot tubs and air conditioning systems
What are the three clinical features associated with legionella pneumophilia pneumonia?
Dry cough
Hyponatraemia via SIADH
Lymphopenia
Which two patient groups tend to be affected by Klebsiella pneumonia pneumonia?
Alcoholics
Diabetics
What clinical feature is associated with Klebsiella pneumonia pneumonia?
Red currant jelly sputum
What three viral organisms are associated with pneumonia?
Respiratory Syncytial Virus*
Parainfluenza Virus
Influenza Virus
What is the most common viral organism associated with pneumonia?
Respiratory syncytial virus (RSV)
What fungal organism is associated with pneumonia?
Pneumocystis Jiroveci
Which patient group tends to be affected by Pneumocystis jiroveci pneumonia?
Immunocompromised patients (HIV)
What CD4 count makes HIV patients vulnerable to Pneumocystis jiroveci pneumonia?
100 - 200
What are the five clinical features associated with Pneumocystis jiroveci pneumonia?
Dry cough
Dyspnoea on exertion
Exercise induced desaturations
Absence of chest signs
Night sweats
Due to Pneumocystic jiroveci pneumonia being atypical, what pharmacological agent is used to treat it?
Co-trimoxazole
How do we prevent pneumonia in HIV patients with a low CD4 count?
We administer them prophylactic co-trimoxazole
What are the nine clinical features associated with pneumonia?
Productive Wet Cough
High Fever > 38.5°C
Dyspnoea
Pleuritic Chest Pain
Tachypnoea
Tachycardia
Bronchial Breath Sounds
Focal Coarse Crackles
Percussion Dullness
What are bronchial breath sounds? What is the cause?
They are harsh breath sounds that are equally loud on inspiration and expiration
These are caused by consolidation of the lung tissue around the airway
What is the cause of focal coarse crackles?
They are caused by air passing through sputum
What is the cause of percussion dullness?
Lung tissue collapse and/or consolidation
What are the five investigations used to diagnose pneumonia?
Bloods
Arterial blood gases
Sputum cultures
Throat swab
CXR
What three blood tests are used to diagnose pneumonia?
Full Blood Count (Increased Neutrophil Count)
Urea & Electrolytes (Increased Urea Levels)
CRP (Increased CRP Levels)
Which infective organism group would cause an increased neutrophil count?
Bacterial
What is the typical trend seen in CRP levels during infection?
There is a delayed response, therefore they may be low on first presentation then spike a day or two layer
What additional blood test should all pneumonia patients receive?
Blood culture
Which patient group may have pneumonia but normal inflammatory markers?
Immunocompromised
In which pneumonia patients, should an arterial blood gas investigation be conducted?
Those that are unwell, specifically those with decreased saturation levels or pre-existing respiratory disease
Why do we conduct arterial blood gases in pneumonia patients?
It is used to assess or monitor respiratory/metabolic acidosis and the blood lactate level
How are sputum cultures/throat swabs used to investigate pneumonia?
They are used to identify the causative organism, and therefore guide treatment
A bacterial culture or viral PCR is conducted on the sputum sample in order to obtain this information
What is the investigation of choice when diagnosing pneumonia?
CXR
Why is it recommended that CXR’s are not conduced unless there is diagnosis doubt or in severe/complicated patients?
It only confirms clinical findings and doesn’t actually change the management plans
What is the sign of pneumonia on CXR?
Consolidation
What are the two supportive management options for pneumonia?
Oxygen Therapy
IV Fluids
When is oxygen therapy indicated to treat pneumonia?
If patients are hypoxic, with sats < 92%
When are IV fluids indicated to treat pneumonia?
If patients are hypotensive or dehydrated
In most cases, what is the first line antibiotic used to treat CAP?
Amoxicillin
What is the second line antibiotic used to treat CAP?
Macrolide antibiotics
Name three macrolide antibiotics
Erythromycin
Clarithromycin
Azithromycin
What is the typical antibiotic course for mild community acquired pneumonia?
Oral amoxicillin or macrolide for a course of five days
What is the typical antibiotic course for moderate to severe community acquired pneumonia?
Oral amoxicillin AND macrolide for a course of 7 - 10 days
In which circumstance would IV antibiotics be recommended to treat pneumonia?
When the patient is vomiting
How can we monitor the efficacy of antibiotic treatment?
We repeat blood tests after 3 days of treatment, which should show reduced levels
WBC is more reliable than CRP due to its delayed response
What risk stratification scoring system is used to determine community acquired pneumonia management?
CURB-65
In a primary care setting, what risk stratification scoring system is used to determine community acquired pneumonia management? Why?
CRB-65
This is due to the inability to obtain a serum urea result
What does ‘C’ in the CURB-65 score represent?
Confusion (Abbreviated Mental Test Score < 8/10)
What does ‘U’ in the CURB-65 score represent?
Serum Urea > 7mmol/L
What does ‘R’ in the CURB-65 score represent?
Respiratory Rate > 30/Min
What does ‘B’ in the CURB-65 score represent?
Blood Pressure: Systolic < 90, Diastolic < 60
What does ‘65’ in the CURB-65 score represent?
> 65 Years Old
What does a CRB65 score of 0 indicate?
The patient can be managed within the community, with administration of antibiotics
What does a CRB65 score > 1 indicate?
The patient should undergo hospital assessment, with treatment including the administration of antibiotics and supportive management options
Pneumonia is a complication associated with which condition?
Measles
