Pneumonia Flashcards
CURB-65
C = confusion (new disorientation in person, place or time)
U = urea > 7mmol/L
R = respiratory rate ≥30
B= Blood pressure <90 systolic (60 diastolic)
65 = age ≥65 y
1 point for each feature
Streptococcus pneumonia
- acute onset , severe,
- lobar consolidation
- rust coloured sputum
- usually penicillin sensitive
haemophilus influenzae pneumonia
more common with pre existing lung disease
green sputum
many produce B lactamase which break down penicillins
Moxarella catarrhalis pneumonia
associated with smoking, in immunocompromised patients or those with chronic pulmonary disease
klebsiella pneumonia
history of alcoholism
presentation of the redcurrant sputum, red purulent sputum
This organism is a gram negative anaerobic rod.
Treated with carbapenems eg Meropenem.
Staph aureus pneumonia
- often secondary to influenzae
- often involves pus leading to cavitational areas which may represent abscesses on CXR and empyema in pleural space
Pseudomonas aeruginosa pneumonia
in patients with cystic fibrosis or bronchiectasis
Mycoplasma pneumoniae
epidemics occur in young adults
present with malaise and a dry cough
may be associated with autoimmune things like haemolytic anaemia/ITP, splenomegaly, cardidits, Guillain-Barre syndrome
erythema multiforme
deranged LFTS
Legionella pneumophila pneumonia
hotel, infected water supplies or air conditioning
Dry cough, dyspnoea
associated with severe systemic illness which may include abdominal pain and diarrhea, lymphopenia ,fever, mnyalgia,malaise
hyponatraemia secondary to SIADH
deranged LFTs
Coxiella burnetii ( Q fever)
pneumonia
Zoonoses
obtain from farm/domestic animals,transmitted by aerosols or milk,
cause of endocarditis
Chlamydia psittaci ( psittacosis)
pneumonia
zoonoses, spread by birds by inhalation
Usually mild
The MCQ patient is a parrot owner
Chlamydophila pneumoniae pneumonia
presentation might be a school aged child with a mild to moderate chronic pneumonia and wheeze.
CURB score 0 Mx
5 day course of oral antibiotics eg first choice is amoxicillin , 500mg 3x day
doxycylcine is alternative
erythromycin (in pregnancy)
CURB score 1 or 2
Prescribe oral amoxicillin 500 mg three times a day for 5 days
and (if atypical pathogens suspected) oral clarithromycin
Arrange a chest X-ray after 6 weeks for adults:
With symptoms and signs that persist despite treatment.
Who are at higher risk of underlying malignancy (particularly smokers and people aged more than 50 years).
CURB65 score of 3 or higher Mx
co amoxiclav intravenously for 5 days with clarithromycin
Alternative antibiotic if high severity, for penicillin allergy is levofloxacin
Complications of pneumonia
Sepsis
Pleural effusion
Empyema
Lung abscess
Death
Atrial fibrillation can be triggered by pneumonia (both in known patients and as the first presentation)
Bacterial pericarditis can arise because of local spread of bacteria
Jaundice may arise from sepsis or antibiotic treatment.
Hospital acquired pneumonia organisms
Klebsiella
Serratia
Enterobacter
Pseudomonas
Escherichia
Pneumocystis jiroveci
occurs in patients that are immunocompromised eg HIV
Characteristic on examination is rapid desaturation on exercise or exertion.On examination, the chest is often clear, however sometimes there are end inspiratory crackles present
diffuse, perihilar and bilateral ( bat swing) infiltrates on CXR
Treat with septrin and co-trimoxazole ( sulfamethoxazole and trimethoprim, both folate antagonists)
