Pneumonia Flashcards
What is pneumonia?
acute infection of the lung parenchyma
What is the most common cause of death due to infection?
pneumonia
What are the risk factors for pneumonia?
alcohol abuse
immunocompromised
lung disease
institutionalization
age >70
How does infection for pneumonia occur?
inhalation of airborne particles
-ex: TB, influenza, Legionella
aspiration of oropharyngeal secretions
-silent aspiration happens all the time
-most common cause
hematogenous spread
How do gross aspirations occur?
changes in consciousness
-alcoholics, drug abuse, seizures, respiratory arrest
Describe respiratory defences.
preventing foreign material from entering lungs:
-hairs lining nasal passages
-ciliated cells
-mucous production
-salivary enzymes
present in lung tissue:
-macrophages
-PMNs
-antibodies
ANY DEFECT CAN COMPROMISE HOST TO INVADING PATHOGENS
True or false: our lungs are normally incoluated with microorganisms from URT and inhaled aersols but pneumonia rarely occurs
true
What happens when there is a host defect in their respiratory defences?
lung being exposed to increased amount of microorganisms for sufficient period to cause inflammatory changes
Which organisms are responsible for community acquired pneumonia?
streptococcus pneumoniae (30-60%)
haemophilus influenzae (2-20%)
staphylococcus aureus (1-5%)
mycoplasma pneumoniae (5-10%, 17-37% in young + healthy)
chlamydia pneumoniae (4-6%)
legionella-uncommon in SK
viral (2-15%, likely higher)
Which organism is likely to cause pneumonia in a young, and healthy individual?
mycoplasma pneumoniae
Which organism is likely to cause pneumonia in someone with COPD or a smoker?
haemophilus influenzae
Which organism represents the “atypical” of pneumonia? What is the main difference?
mycoplasma pneumonia
hits both lobes of lung, S. pneumonia only hits one
True or false: you can differentiate between M. pneumonia and S. pneumonia being the cause of pneumonia through an X-ray
false
Which organisms are the likely cause of hospital acquired pneumonia?
klebsiella pneumoniae
E coli
enterobacter
proteus
pseudomonas aeruginosa
staph aureus (higher than CA)
anaerobes
s. pneumoniae
Which organisms represent 60% of hospital acquired pneumonia?
klebsiella pneumonia
proteus
E. coli
enterobacter
Which host factors can influence the causative organism of pneumonia?
heart, lung disease, DM
recent antibiotics (within last 3 months)
aspiration, cystic fibrosis
COPD
Which illnesses are most commonly associated with recurrent pneumonia?
COPD
heart failure
What are patient factors that can modify the causative organism of pneumonia?
heart, lung disease, DM
recent antibiotics (within last 3 months)
aspiration, cystic fibrosis
Which illnesses are most commonly associated with recurrent pneumonias?
COPD
heart failure
What are the signs and symptoms of pneumonia?
fever (may be high [>39C] or low grade)
chills
dyspnea
cough (productive or non-productive)
rust colored sputum or hemoptysis
pleuritic chest pain (stabbing)
other nonspecific symptoms (aches, fatigue, loss of appetite)
ABRUPT ONSET
What is the clinical presentation of pneumonia during a physical exam?
tachypnea
tachycardia
dullness to percussion
diminished breath sounds over affected area
inspiratory crackles
What can laboratory findings help determine for pneumonia?
low oxygen saturation
elevated WBC
sputum sample-may reveal PMNs and causative organism
Where does the difficulty lie with diagnosing pneumonia?
distinguishing bacterial from viral
if bacterial, which micro-organism
What is the issue with using sputum specimens to diagnose pneumonia?
difficult in children
normal flora always present=sample often contaminated
When are sputum specimens used to diagnose pneumonia?
not recommend for CAP
for inpatients with severe disease or suspected MRSA or P.aeruginosa
When are blood cultures used for diagnosing pneumonia?
not routinely recommended unless severe CAP or empirically treated for MRSA or P.aeruginosa
What are the many tools that are used in diagnosing pneumonia?
sputum specimen
blood culture
pleural fluid can be cultured
serology
WBC
chest x-ray
other (oxygen saturation or arterial blood gases)
What is required to make a diagnosis of pneumonia?
chest x-ray
What should a normal chest x-ray look like?
lots of black in the rib cage (black=air)
What is the pneumonia severity score used for?
predict the risk of death from pneumonia for anyone over the age of 50
-algorithm used to determine if a patient should be admitted
to hospital
Even if the pneumonia severity score says a patient can be treated as an outpatient, what else must this patient be able to do if they are to be treated as an outpatient?
take oral fluids and antibiotics
comply with outpatient care
carry out activities of daily living
What are the goals of therapy for treating pneumonia?
eradicate the microorganism
resolve signs and symptoms
reduce risk of complications and hospitalizations
reduce risk of adverse effects
minimize the development of antimicrobial resistance
What are the general treatment measures for pneumonia?
bed rest
hydration
nutrition
analgesic/antipyretics
oxygen for hypoxemia (not CAP)
cough suppression (better at night, not ideal to suppress)
drainage of empyema/abscess
What is the mainstay of therapy for pneumonia?
antibiotics
-should be initiated promptly, as soon as diagnosis is
confirmed
-appropriate antimicrobial samples should be obtained but
should not delay antibiotics
