Pneumonia Flashcards
Hospital acquired + Community acquired + Bronchopneumonia
Pneumonia
What do we commonly use to assess severity?
CRB-65
CURB-65
the U is only used in hospital settings
Pneumonia
What investigations do we usually do in the community?
basic obs
Pneumonia
What might be found on an X-ray?
consolidation
(usually lower lobes)
Pneumonia
What bloods are useful to take and why?
FBC, U&Es, LFTs, CRP
(severe infection)
Pneumonia
What microbiological investigations might be done?
- Blood cultures
- Sputum culture and sensitivity
- Investigations for atypical bacteria and pathogens
Pneumonia
What are some atypical pathogens?
Legionella pneumophila.
Mycoplasma pneumoniae.
Chlamydophila pneumoniae.
Pneumonia
What are the 4 top CAP pathogens?
- Streptococcus pneumoniae
- influenza A
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
Pneumonia
What are the top HAP pathogens?
2
- gram negative enterobacteria
- staph aureus
Pneumonia
ABx should be used for treatment, but the choice of which should be guided by local protocols.
Examples include:
Pneumonia
General management (non-prescribing).
Oxygen for hypoxia.
Fluids if dehydrated.
Pneumonia
When is follow-up recommended for?
6 weeks
Pneumonia
When should you order a CXR?
appropriate in cases of persisting signs and symptoms or if there is a high risk of underlying lung pathology
Pneumonia
What vaccinations should be offered to high risk pts and those over 65y?
Influenza vaccination and pneumococcal vaccination
Pneumonia
What is the definition of HAP?
‘pneumonia that develops 48 hours or more after hospital admission, and that was not incubating at hospital admission
Pneumonia
What is the highest risk for HAP?
mechanical ventilation
Pneumonia
Name 5 gram-negative bacteria often causative of HAP?
Pneumonia
Name 2 gram-positive bacteria often causative of HAP?
Pneumonia
Name some symptoms of HAP.
9
- Fever
- Rigor
- Malaise
- Anorexia
- Dyspnoea
- Cough
- Purulent sputum
- Haemoptysis
- Pleuritic chest pain
Pneumonia
Name some signs of HAP.
8
- Pyrexia
- Cyanosis
- Confusion
- Tachypnoea
- Tachycardia
- Hypotension
- Signs of consolidation
- Pleural rub
the elderly may also be hypothermic, not pyrexial
confusions may be the only sign in the elderly
Pneumonia
Name some signs of consolidation.
4
- diminished expansion
- dull percussion note
- increased tactile vocal fremitus/vocal resonance
- bronchial breathing
Pneumonia
What are the risk factors for HAP?
7
- Poor infection control/hand hygiene (of treating healthcare workers)
- Head of bed at <30° angle
- Intubation and mechanical ventilation; endotracheal cuff pressure <20cm H2O
- H2 antagonist and antacid use
- Poor oral hygiene
- No interruption in sedation
- Reintubation
Pneumonia
What are the 1st line investigations for HAP?
- Chest X-ray
- CT scanning
- WBC count with differential
- Pulse Oximetry
- Sputum Sample
Pneumonia
What other investigations might we do for HAP after 1st line?
- Arterial Blood Gas
- CT chest
Pneumonia
Which view is prefered in CXR?
PA and lateral views are preferred over AP
Pneumonia
Why might a CT be ordered?
to diagnose an opacity and clarify whether a procedure is indicated
Pneumonia
What are some risk factors for MDR pathogens?
multidrug-resistant (MDR) pathogens
- ABx in the past 90 days
- Septic shock at the time of ventilator-associated pneumonia
- ARDS preceding ventilator-associated pneumonia
- > 5 days hospitalisation prior to the occurrence of ventilator-associated pneumonia
- Acute renal replacement therapy prior to ventilator-associated pneumonia
Pneumonia
NICE guildlines for ABx prescription in over 18s.
- 1st choice oral, non-severe clinical features, not at high risk of resistance
with and without penicillin allergy
- Co-amoxiclav
(allergy)
- Doxycycline, Co-trimoxazole, Levofloxacin
Pneumonia
NICE guildlines for ABx prescription in over 18s.
- 1st choice severe symptoms or signs (e.g. those of sepsis) or if the patient is at a higher risk of resistance
Piperacillin + tazobactam is recommended
alternative: ceftriaxone
Pneumonia
NICE guildlines for ABx prescription in over 18s.
- 1st choice if the patient has a suspected or confirmed MRSA infection, then ____ is recommended. For example…
dual IV therapy
Piperacillin / Ceftriaxone
+
Vancomycin / Teicoplanin / Linezolid
Pneumonia
What management is indicated indicated in cases of respiratory failure, where non-invasive ventilation fails to maintain adequate oxygenation?
Intubation and invasive ventilation
Pneumonia
When might a bronchoscopy or a thoracentesis need to be performed?
the patient is not recovering despite treatment and where an alternative diagnosis is being sought
Pneumonia
What is Bronchopneumonia?
a subtype of pneumonia
characterised by inflammation of the bronchi, bronchioles and alveoli.
Pneumonia
What is broncho pneumonia aka and why?
lobular pneumonia
Inflammatory patchy consolidations may be present in lobules, mainly in a basal location in the lungs
Pneumonia
Name the pathogen:
____ is a gram-negative bacillus, often responsible for pneumonia in heavy alcoholics and causes cavitating lesions in the lungs.
Klebsiella pneumoniae
Pneumonia
Name the pathogen:
____ is a gram-positive coccus responsible for bacterial pneumonia in the general population.
It usually causes lobar pneumonia and is not typically associated with cavitating lesions.
Streptococcus pneumoniae
Pneumonia
Name the pathogen:
____ is a gram-negative bacillus commonly implicated in infective exacerbations of chronic obstructive pulmonary disease.
It is often associated with smoking, but is not typically associated with cavitating lesions.
Haemophilus influenzae
Pneumonia
Name the pathogen:
____ is a gram-negative bacillus that causes atypical pneumonia, specifically called ____ disease.
Classically, it presents following exposure to contaminated droplets e.g. in poorly maintained air-conditioning systems.
Other characteristic features include hyponatraemia and deranged LFTs.
Legionella pneumophila
Legionnaires disease.
Diagnosis is usually with urinary legionella antigen detection.
Pneumonia
Name the pathogen:
____ is a fungi-like bacteria that causes atypical pneumonia with dry cough.
Characteristic features include erythema multiforme (a target-shaped lesion) and cold-agglutinin disease.
Mycoplasma pneumoniae
Diagnosis is with mycoplasma serology tests.
