Pneumonia Flashcards
Define Pneumonia
infection of distal lung parenchyma.
How can pneumonia be categorised?
Community or hospital
Typical or atypical (Mycoplasma, Chlamydia, Legionella)
Aspiration or Immunocompromised
Which 10 infections may cause CAP?
Streptococcus pneumoniae (70%) Haemophilus influenzae Moraxella catarrhalis (COPD) Chlamydia pneumonia Chlamydia psittaci (causes psittacosis) Mycoplasma pneumonia Legionella (occurs anywhere with A/C) Staphylococcus aureus Coxiella burnetii (causes Q fever) TB
Which infections may cause HAP?
Gram-negative enterobacteria (Pseudomonas, Klebsiella)
Anaerobes (due to aspiration pneumonia)
List 6 risk factors for pneumonia
Age Smoking Alcohol Pre-existing lung disease (e.g. COPD) Immunodeficiency Contact with patients with pneumonia
Describe the epidemiology of pneumonia
5-11/1000
CAP responsible for > 60,000 deaths per year in the UK
List 9 symptoms of pneumonia
Fever Rigors Anorexia Malaise Cough Sputum (yellow/ green/ rusty) SOB Pleuritic chest pain Confusion (in severe cases/ elderly)
List 4 atypical symptoms of pneumonia
Headache
Myalgia
Diarrhoea/ abdominal pain
DRY cough
List 12 signs of pneumonia
Pyrexia Tachypnoea Tachycardia Hypotension Cyanosis Decreased chest expansion Dull to percuss over affected area Increased tactile vocal fremitus over affected area Bronchial breathing over affected area Pleural rub Coarse crepitations on affected side Chronic suppurative lung disease (e.g. abscess)- clubbing
What are the suitable investigations for pneumonia?
Bloods CX Sputum culture Urine dip: Legionella Bronchoscopy
Which bloods are taken in pneumonia?
FBC (high WCC) LFT (abnormal in legionella) U+Es (Urea high in severe) CRP (high) Blood cultures RBC (Mycoplasma agglutinates)
What is seen on CXR of a patient with pneumonia?
Lobar patchy shadowing
Pleural effusion
Klebsiella often effects upper lobes
May detect abscesses.
When in bronchoscopy performed in pneumonia cases?
if Pneumocystitis carinii is suspected
If Pneumonia fails to resolve
What management does each CURB-65 score indicate?
0-1: PO Abx, home
2: Admit
3+: ITU
Describe the use of antibiotics in bacterial pneumonia
Oral Amoxicillin or Clarithromycin (0-1)
Oral or IV Amoxicillin + Clarithromycin (2)
IV Cefuroxime/Co-amoxiclav + Clarithromycin (3+)
When would you add metronidazole to the baseline antibiotics being used to treat a pneumonia?
Aspiration
Lung abscess
Empyema
What supportive treatment may be necessary in treating pneumonia?
Oxygen
IV fluids
CPAP, BiPAP or ITU care for respiratory failure
Surgical drainage for lung abscesses + empyema
What are the clinical features of instability when discharge planning for pneumonia? How many equates to high risk of re-admission and mortality?
High temperature Tachycardia Tachypnoea Hypotension Low oxygen sats >,2
What would you consider in a non-resolving pneumonia?
Other causes: PE PH RHF Drug toxicity Unusual pathogens Alveolar haemorrhage
List 2 approaches to prevention of pneumonia
Pneumococcal vaccine
Haemophilus influenzae type B vaccine
Only usually given to high risk groups (e.g. >65, splenectomy)
List 5 complications of pneumonia
Pleural effusion Empyema Abscess Septic shock ARDS
What are the extra complications of Mycoplasma pneumonia?
Erythema multiforme Myocarditis Haemolytic anaemia Meningoencephalitis Transverse myelitis GBS
Describe the prognosis for patients with pneumonia
Most resolve within treatment within 1-3 weeks
Severe pneumonia has a high mortality
What system is used to assess severity of pneumonia?
CURB-65 score: Confusion < 8 AMTS Urea > 7 mmol/L Respiratory rate > 30/min BP: systolic < 90 mmHg or diastolic < 60 mmHg Age > 65 yrs
