Pneumonia Flashcards
What are the typical organisms which cause community acquired pneumonia?
Streptococcus pneumonia (gram pos diplococci, most common cause of CAP)
Haemophilus Influenzae (gram neg cocobacilli)
Moraxella catarrhalis
What are the atypical causes of community acquired pneumonia?
Mycoplasma pneumonia
Legionella pneumonia
Chlamydophila pneumoniae
Chlamydophilia psttaci - contact with infected birds (think parrot owner)
Coxiella burnetti/Q fever - bodily fluids of animals (farmer with flu like illness)
What is idiopathic interstitial pneumonia?
Non infective cause of pneumonia eg, cryptogenic organizing pneumonia
What are the signs and symptoms of pneumonia?
Cough, purulent sputum, dyspnoea, pleuritic chest pain, fever.
Signs - tachypnoea, tachycardia, hypotension, dull percussion, increased vocal resonance, bronchial breathing, pleural rub
Describe features of mycoplasma pneumoniae infections
Symptoms - prolonged and gradual.
Complications - Autoimmune haemolytic anaemia, erythema multiforme, erythema nodosum, GBS, meningoencephalitis, bullous myringitis, pericarditis/myocarditis, glomerulonephritis
What are the investigations and treatment for mycoplasma pneumoniae?
Mycoplasma serology. May have positive cold agglutination test.
Treatment - Doxycycline or macrolide
What are the feature of legionella?
Flu-line symptoms,
Dry cough,
Bradycardia,
Confusion,
Lymphopaenia,
SIADH leading to hyponatraemia,
Deranged LFTs,
Pleural effusions
What are the investigations and treatment for legionella pneumophilia?
Investigations - urinary antigen
Treatment - erythromycin or clindamycin
What are the risk factors for pneumonia?
Age under 5 or over 65,
Smoking,
Recent viral respiratory infection,
Chronic respiratory disease,
Immunosuppression,
Aspiration risk,
IVDU,
Non-respiratory co-morbidities eg, diabetes
What is the scoring system for pneumonia?
CURB65
Confusion,
Urea > 7mmol/L
Respiratory rate > 30
BP: systolic < 90 or diastolic <60
Age > 65.
Score > 2 = severe
What are the investigations for pneumonia?
- Chest X ray,
- Bloods and cultures: FBC, U&Es, CRP
- Sputum sample
- Pneumococcal and legionella urinary antigen tests
What organism causing pneumonia is likely to be seen after influenza? and seen in alcoholics
Post influenza - S. aureus
Alcoholics - Klebsiella
What are characteristic features of pneumococcal pneumonia?
Rapid onset, high fever, pleuritic chest pain, herpes labialis
What is the management of low severity CAP?
1st line = amoxicillin for 5 days
2nd line = Macrolide or tetracycline for 5 days
What is the management of moderate to high-severity CAP (CURB65>2)?
Dual antibiotic therapy with amoxicillin/co-amoxiclav and macrolide for 7-10 days.
What is the follow up required for all cases of pneumonia?
Repeat chest X ray after 6 weeks to ensure consolidation has resolved an there is no underlying secondary abnormalities.
Fatigue can last up to 6 months
What are the causative organisms for hospital acquired pneumonia?
Enterobacterales (Klebsiella - red current sputum, E.coli or enterobacter)
Pseudomonas aeruginosa
S.Aureus
Acinetobacter (ventilator acquired)
Stenotrophomonas (ventelator acquired)
What is the treatment for non severe and severe HAP?
Non severe - Doxycycline for 5 days.
Severe is cotrimoxazole and gentamicin or tazocin. Or 2nd line levofloxacin (7 days)
Which organisms will not be treated by beta lactams?
Myoplasma pneumoniae - Lack of cell wall
Legionella pneumophilia - intracellular
What is the treatment for aspiration pneumonia
Normal empirical antibiotic guidelines with metronidazole
What are the complications of pneumonia?
Spesis, ARDS, pleural effusion, Empyema, lung abscess, death
