Pneumonia

Question 1

What is pneumonia?

Answer 1

Pneumonia is simply an infection of the lung tissue. It causes inflammation of the lung tissue and sputum filling the airways and alveoli.

Question 2

How do we classify pneumonia?

Answer 2

-If the pneumonia developed outside of hospital it is labeled labelled “community acquired pneumonia”.
-If it develops more than 48h after hospital admission it is labelled “hospital acquired pneumonia”.
-If it develops as a result of aspiration, meaning after inhaling foreign material such as food, then it is labelled “aspiration pneumonia”.

Question 3

How does pneumonia present?

Answer 3

Shortness of breath
Cough productive of sputum
Fever
Haemoptysis (coughing up blood)
Pleuritic chest pain (sharp chest pain worse on inspiration)
Delirium (acute confusion associated with infection)
Sepsis

Question 4

What are the signs of pneumonia?

Answer 4

Tachypnoea (raised respiratory rate)
Tachycardia (raised heart rate)
Hypoxia (low oxygen)
Hypotension (shock)
Fever
Confusion

Question 5

What are the characteristic chest signs of pneumonia?

Answer 5

-Bronchial breath sounds. These are harsh breath sounds equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway.
-Focal coarse crackles. These are air passing through sputum in the airways similar to using a straw to blow in to a drink.
-Dullness to percussion due to lung tissue collapse and/or consolidation.

Question 6

How do we use CURB 65 for severity?

Answer 6

C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65

The CURB 65 score predicts mortality (score 1 = under 5%, score 3 = 15%, score 4/5 = over 25%). The scoring system is there to help guide whether to admit the patient to hospital:

Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care assessment

Question 7

What are the common causes of pneumonia?

Answer 7

Streptococcus pneumoniae (50%)
Haemophilus influenzae (20%)

Question 8

What are the other causes of pneumonia?

Answer 8

-Moraxella catarrhalis in immunocompromised patients or those with chronic pulmonary disease
-Pseudomonas aeruginosa in patients with cystic fibrosis or bronchiectasis
-Staphylococcus aureus in patients with cystic fibrosis

Question 9

What is atypical pneumonia?

Answer 9

• caused by an organism that cannot be cultured in the normal way or detected using a gram stain. They don’t respond to penicillins and can be treated with macrolides (e.g. clarithomycin), fluoroquinolones (e.g. levofloxacin) or tetracyclines (e.g. doxycycline).
  e.g Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Coxiella burnetii, Chlamydia psittaci.

Question 10

How does fungal pneumonia occur?

Answer 10

• Pneumocystis jiroveci (PCP) pneumonia occurs in patients that are immunocompromised.
  -usually presents subtly with a dry cough without sputum, shortness of breath on exertion and night sweats. Treatment is with co-trimoxazole

Question 11

How do we investigate pneumonia?

Answer 11

Chest xray
FBC (raised white cells)
U&Es (for urea)
CRP (raised in inflammation and infection)

Question 12

What is the treatment for pneumonia?

Answer 12

Mild CAP: 5 day course of oral antibiotics (amoxicillin or macrolide)
Moderate to severe CAP: 7-10 day course of dual antibiotics (amoxicillin and macrolide)

Question 13

What are the complications of pneumonia?

Answer 13

Sepsis
Pleural effusion
Empyema
Lung abscess
Death