Pneumonia Flashcards
Pneumonia :Strep Pneumonia - definition
- Pneumococcus
- Accounts for 80% of cases of pneumonia
- Gram + Bacteria
Pneumonia :Strep Pneumonia - Clinical features
- Acute onset of fever
- Productive cough with purulent sputum
- Pleuritic chest pain
- Shortness of breath
Pneumonia :Strep Pneumonia - Investigations
CXR : Lobar consolidation
Blood cultures : to r/o baactaraemia
Sputum sample + culture
Pneumonia :Strep Pneumonia - Complications
- Herpes Labialis - cold sore/blisters
- Pleural effusions
- Pleural abscess formation
Hamophilius influenza : Definition
- Gram - bacteria
- Most common in patients with COPD
- Influenza vaccine can be given annually
Staphylococcus aureus : Definition
Gram + bacteria
Usually occurs in patients post influenza
Staphylococcus aureus : Risk factors
- Age > 65
- COPD
- Smoking
CAP : Mx
- Confusion
- Urea > 7
- Respiration rate >30
- BP < 90 / < 60
- > 65
* Curb 0-1 : Amoxicillin +/- Clarithromycin for 5 days
* Curb 1-2 : Consider Hospital referral
* Curb >3 : Hospital admission
Atypical pneumonia : Mycoplasma Pneumonia - Pathophysiology
- Small bacterial which lacks a cell wall and unable to produce toxins
- No cell wall means it is able to attach and invade host cells more easily
- Target a range of tissues, including skin, joints and GI tract
Atypical pneumonia : Mycoplasma Pneumonia - Incidence
Normally affects children and young adults
Atypical pneumonia : Mycoplasma Pneumonia - Clinical features
Gradual onset of symptoms over a period of several days
* Dry cough with minimal sputum production
* Mild - moderate fever
* Sore throat, head ache, fatigue
Atypical pneumonia : Mycoplasma Pneumonia - Extrapulomary manifestation
-
Autoimmune haemolytic anaemia -
immune system mistakenly targets and destroys RBCs, due to immune dysregulation and bacterium sharing structural similarities with host antigens RBCs, -
Erythema multiform
skin lesions, target bulls eye rash
Atypical pneumonia : Mycoplasma Pneumonia -* CXR*
CXR : Normal or show interstitial infiltrates
Atypical pneumonia : Legionella pneumophilia - Definition
Gram - aerobic bacteria responsible for causing legionnaire’s disease
Atypical pneumonia : Legionella pneumophilia -Risk factors
Risk factors } within 2 weeks of exposure
* Infected air conditioning units
* Contaminated drinking water
* Recent water exposure - got tub, spa or plumbing work
Atypical pneumonia : Legionella pneumophilia -Clinical features
- Dry cough / SOB / Chest pain / Fever } typical signs of pneumonia
Systemic sx : - Headache - may be prominent symptoms
- Confusion_ -
- GI sx : nausea, vomiting, diarrhoea
Atypical pneumonia : Legionella pneumophilia -Investigation
- Sputum Gram stain and culture
- Urine antigen test
- Throat swab PCR if urine is negative due to higher sensitivity
-
Bloods: normal or may show;
* Hyponatremia : Triggers SIADH due to inflammatory process - excess ADH cause kidneys to retain water and results in dilution hyponatremia
Atypical pneumonia : Klebsiella pnemoniae - Definition
Gram - organisms
Atypical pneumonia : Klebsiella pnemoniae -Clinical features
- High fever and chills
- Pleuritic chest pain and SOB
- Cough - productive and blood stained
Atypical pneumonia : Klebsiella pnemoniae - CXR
CXR : dense caviatry lesions and consolidation in the lungs
Atypical pneumonia : Klebsiella pnemoniae -Risk factors
Alcoholism - higher risk of aspiration of stomach contents due to intoxications
Diabetics
Atypical pneumonia :Pneumocytis jiroveci- Definition
Fungal organism
Atypical pneumonia :Pneumocytis jiroveci- Risk factors
Severe immunocompromised patients : especially HIV +, or chronic immunosuppressant therapy
Atypical pneumonia :Pneumocytis jiroveci- Clinical features
; - /Develops over several weeks/
* Fatigues, fever chills
* Night sweats
* Non productive cough - dry cough
* Oral candidiasis
Atypical pneumonia :Pneumocytis jiroveci-Investigations
CXR : Pulmonary reticular infiltrates
* ABG - shows reduced O2
* Serum LDH : elevated in 90% of patients and decline with treatment
* Induced sputum - for sample and culture
Atypical pneumonia :Pneumocytis jiroveci-Management
- Trimethoprim/Sulfamethoxazole
- Pt with low CD4 count can be prescribed prophylactic co-trimoxazole.
Atypical pneumonia :Mycoplasma pneumonia - Clinical features
presents with a ‘target lesion’ like rash called erythema multiform and can cause neurological symptoms in younger patients
Atypical pneumonia :Chlamydia psittaci
- Contracted from contact with infected birds
Hospital acquired pneumonia : < 5 days
- Acute lower respiratory tract infection that is acquired at least after 48 hours of admission to hospital
- < 5 days into admission - Early onset HAP
* Often caused by Streptococcus pneumonia
Hospital acquired pneumonia : > 5 days poast admission
Late onset > 5 days post admission
* Due to micro organisms found in the hospital
1. Most commonly : Gram - bacteria
* MRSA
* Pseudomonas aureginosa : HAP, ventilator acquired pneumonia
Hospital acquired pneumonia : Risk factors
Sx starting more than > 5 days after hospital admission
* Cormorbidities such as severe lung disease or immunosuppression
* Recent use of broad spectrum antibiotics
* Aspiration risk : in frail or neurological disorders
Hospital acquired pneumonia : Clinical features
- Cough with increased sputum : thick yellow or green
- Dyspnea
- Fever
Hospital acquired pneumonia : Investigations
- O2 sats : decreased
- Bloods : leukocytosis or leukopenia (high or low wbc)
- CXR : New consolidation
- ABG (Before O2) : Hypoxia, raised lactate, respiratory alkalosis (increased respiratory rate)
- Sputum samples for culture : before antibiotics started
- Nasopharyngeal swab : if unable to produce sputum
Hospital acquired pneumonia : Management
- Severe symptoms or high risk of resistance
* IV Broad spectrum antibiotics : IV Pip-Taz - Moderate symptoms
* PO Co-amoxiclax - If MRSA risk
* Add IV Vancomycin or IV Teicoplanin
Aspiration pneumonia : Pathophysiology
- Inhalation of oropharyngeal contents into the lower airways
- Bacterial enter the lung via the aspiration of colonised secretion from the oropharynx
- This causes inflammation and lung injury resulting in distruption of the sterile environment
- Thus - results in secondary bacterial infection - known as ‘Aspiration Pneumonia’
Aspiration pneumonia : Risk factors
-
Swallowing dysfunctions secondary to neurological pathology
* e.g.; stroke, dementia, epilepsy, Parkinsons
Impaired consciousness } -
General anaesthetic / Opioid OD/ Alcohol intoxication
* High risk of regurgitation
* Impaired GI emptying : haitus hernia, obesity, GORD, upper GI surgery - Vomitting
-
Difficulty of clearance
Poor cough : due to vocal chord palsy or neuromuscular disease
Aspiration pneumonia : Clinical features
- Breathlessness / Fever / cough } pneumonia symptoms
- Cough;
- Frothy or purulent sputum : raises suspicion for aspiration pneumonia
* Foul smelling sputum } associated with presence of anaerobic bacteria
* Hx of vomitting } witnessed aspiration
Aspiration pneumonia : Diagnosis
Clinical signs of pneumonia and a risk factors for aspiration } diagnosis of aspiration pneumonia
Aspiration pneumonia : Antibiotic management
Empirical antibiotics - recommended coverage of both anaerobic and aerobic organisms can be given but is not needed.
- Co amoxiclav / amoxicillin } same as for HAP/CAP
Consider;
- Ceftraixone and metronidazole : provides aerobic and anaerobic micro-organism cover
Aspiration pneumonia : General management
- Controlled O2 therapy
* Aim for 96% sats only - >96% associated with higher level of mortality
* 88-92% if hypercapnic - Thromboprophylaxis - higher risk of VTE
- Assess swallow function and manage dysphagia via SALT team
* If unknown cause of dyspgaia - needs OGD
* Refer to oral/dental hygienist if 2nd to poor oral hygiene
Acute brochitis : Definition
Mainly viral
inflammation of the trachea and major bronchi
Associated with oedematous large airways and the production of sputum.
The disease course usually resolves before 3 weeks,
is accepted that viral infection is the leading cause. Around 80% of episodes occur in autumn or winter.
Acute brochitis : Clinical features
Patients typically present with an acute onset of:
* cough: may or may not be productive
* sore throat
* rhinorrhoea
* wheeze
No focal chest signs on examination - less sputum/wheezining/breathlessness than in pneumonia
Acute Bronchitis : Investigations
- acute bronchitis is typically a clinical diagnosis
- however, if CRP testing is available this may be used to guide whether antibiotic therapy is indicated
Acute Bronchitis : Management
- analgesia
- good fluid intake
- consider antibiotic therapy if patients:
- are systemically very unwell
- have pre-existingco-morbidities
- have aCRPof 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately
- NICE Clinical Knowledge Summaries/BNF currently recommenddoxycyclinefirst-line
- doxycycline cannot be used in children or pregnant women
- alternatives include amoxicillin
Lung Abscess : Definition
Bacterial infection of the lungs causing a localised collection of pus within the lung tissue.
Lung Abscess : Causes
- Aspiration pneumonia - poor dental hygiene, swallowing issues due to neurological impairment
- Haematogenous spread - infective endocarditis
- Bronchial obstruction - Lung tumore
- Extension of existing infection - Pneumonia
Lung Abscess : Causative organisms
- Staphylococcus aureus Klebsiella pneumonia
Pseudomonas aeruginosa
Lung Abscess : Clinical features
Subacute onset - over weeks
1. Swinging fever
2. Night sweats, weight loss
3. Productive cough - foul smelling sputum, +/- haemoptysis
4. Clubbing
Lung Abscess : Investigation
- chest x-ray
- fluid-filled space within an area of consolidation
- an air-fluid level is typically seen
- sputum and blood cultures should be obtained
Lung Abscess : Management
- intravenous antibiotics
- if not resolvingpercutaneous drainagemay be required and in very rare cases surgical resection
