Pneumonia Flashcards
What is pneumonia
Inflammation of the lung lower respiratory tract usually caused by an infection\
How can pneumonia be prevented
Vaccination, adequate nutrition
State the difference between CAP and HAP
CAP is pneumonia acquired outside of hospital while HAP, is pneumonia that occurs 48 hours or more after hospital admission
What are the risk factors of CAP
- Age: infants 2 years or younger, age 65-year-old or older
- Living/working in nursing home or in contact with children
- Smoking (including passive)
- Preexisting pathological conditions
· COPD, stroke, chronic cardiovascular diseases; neurological disorders e.g., dementia, parkinsons (they don’t brush teeth properly, always in bed, they don’t take care of self properly= increase risk of infection - Influenza
- Hospitalisation in the previous 5 years
What is the causes CAP
Gram positive bacteria (Blue on gram staining), pneumococcus
Explain the pathology of CAP
pathogen gets into alveoli space, starts to multiply, the local alveoli macrophages start producing cytokines(pro inflammatory compounds), they start inflammation that’s why you have cough, mucus and other pneumonia symptoms. They also mobilise additional pro inflammation
Give FIVE symptoms of Pneumonia
- All lower respiratory tract symptoms
cough
- Temperature >38 degrees
- breathlessness, wheeze or chest discomfort
- sputum production
- Generally feel unwell
less frequent
- pleural pain
- fatigue
- Chest X-ray shows consolidation (Shadow white colour from x-ray in pneumonia patient.
How would you diagnose CAP Pneumonia in GP
- Acute illness ≤21 days
- Cough
- At least ONE ‘symptom’ of lower respiratory tract infections
- Severity Assessment
- CRB65 score mortality risk assessment
(1 point each) - Confusion (≤8 points)
- Respiratory rate (>30bpm)
- Low Blood pressure
(Syst < 90 OR Diast ≤ 60 mmHg) - Age ≥ 65
- CRB65 score mortality risk assessment
Score of 8 or less = mental confusion
How would you diagnose CAP in hospital
- Chest X‑ray.
- Consolidation: essential to confirm diagnosis!
- Microbiological test
* Blood and sputum test
CURB65 used to decide whether patient has to be hospitalised
· Confusion · Urea ≥ 7 mmol/l · Respiratory rate · Blood pressure · Age ≥ 65
Outline the treatment for CAP
- Patient with low-severity community-acquired pneumonia (treated at home)
5-day course of a SINGLE antibiotic
Amoxicillin 500 mg 3 times a day for 5 days
- Patient with suspected moderate severity CAP (in hospital)
5-day course of DUAL ORAL antibiotic
Amoxicillin 500 mg/3 times a day WITH clarithromycin 500 mg/2 times a day
· Patient with suspected high-severity CAP (in hospital)
5-day course of DUAL ORAL OR IV antibiotic
Co-amoxiclav WITH clarithromycin
What can cause therapeutic failure
- Wrong diagnosis
- Antibiotic resistance
- Inadequate dose
- Non-compliant patient
- Overwhelming infection
What other treatment can be given if theres therapeutic failure
- Relieve pleuritic pain and reduce fever: paracetamol or NSAIDs
- Reduce breathlessness: salbutamol
- Fluids*
- Oxygen therapy:
What are the risk factors of HAP
- Stroke
- Chronic lung disease
- Mechanical ventilation
- Recent surgery
- Previous antibiotic treatment
What are the causes of HAP
- Bacteria and virus
- Highly resistant pathogens
May need treatment with extended-spectrum antibiotics
How is HAP treated
- 5-day course of SINGLE or DUAL therapy. Depending on severity.
NO severity or low risk of resistance
- Single ORAL antibiotic
SEVERE pneumonia or high risk resistance
- Single antibiotic intravenous
piperacillin with tazobactam
MRSA infection suspected
- Dual IV antibiotic
add vancomycin
