Pneumonia Flashcards
Pneumonia is fluid e____ into alveoli due to ______ from infection
exudation
inflammation
Is pneumonia typically caused by a bacterial or viral infecton?
Bacterial
What does CAP stand for?
Community acquired pneumonia (in community or less than 48 hours in hospital)
What bacteria are most commonly responsible for CAP?
S. pneumoniae
H. influenzae
Mycoplasma pneumoniae
Also (can’t use beta lactam antibiotics):
S aureus
Legionella
Chlamydia pneumoniae
What is commonly the cause of Legionella?
Air conditioning, holidays to spain
For the infections that can’t be given beta lactam antibiotics, what should be given?
Macrolides instead like clarithromycin
How do beta lactam antibiotics work?
They inhibit bacterial cell wall biosynthesis.
However some bacteria are resistant to beta lactam antibiotics because they can make enzymes that hydrolyse the beta lactam ring, inactivating the antibiotic.
What does HAP stand for?
Hospital acquired pneumonia
What bacteria commonly cause HAP?
Gram negative aerobic bacilli:
P. aeruginosa
E. coli
Klebsiella
Why is HAP usually more severe?
Many of the bacteria causing HAP are multi drug resistant
What are 2 viral causes of pneumonia?
CMV
Haemophilus influenzae
What fungi can cause pneumocystis pneumonia (PCP) in immunocompromised patients?
Pneumocystis jirovecii
PCP is an ____ defining illness
AIDS
How is pneumonia caught?
Typically via inhaling or aspirating the pathogen
What are risk factors for pneumonia?
Immunocompromised (HIV/long term steroids)
IVDU (staph aureus)
Pre-existing respiratory disease
Extremes of age
In typical pneumonia, where does exudate form in response to the bacteria?
Inside alveoli lumen
Sputum present
In atypical pneumonia where does the exudate form in response to the bacteria?
interstitium of alveoli
Is sputum present in typical or atypical pneumonia?
Typical
In atypical there is a dry cough
What are symptoms of pneumonia?
Productive cough with rusty coloured sputum (purulent)
Pyrexia (fever) due to infection
Pleuritic chest pain, worse with breathing/coughing
Tachypnoea
Dyspnoea
Tachycardia
Hypotension
Confusion in elderly
How is pneumonia diagnosed?
1st line = Chest XR showing consolidation and an air bronchogram (can see the structure of the air-filled bronchioles as surrounded by opacified lung parenchyma)
Sputum sample and culture to 10 organism
What does consolidation mean on a Chest XR?
The air in small airways of the lungs is filled with a fluid/solid/other material which shows up as dense and white
Which bacteria may cause multilobar pneumonic lesions?
S. pneumoniae
S. aureus
Legionella
Which bacteria may cause multiple abscesses seen in the lungs on a chest XR?
S. aureus
On a Chest XR what may cause upper lobe pneumonic lesions?
TB
Klebsiella
What tool is used to assess severity of CAP?
CURB65
What does CURB65 stand for?
Confusion
Urea nitrogen greater than 7mmol/l
Respiratory rate greater than 30
Bp is lower than 90/60 mmHg (if either drops)
65+ y/o
What is used to assess confusion in CURB65?
abbreviated mental test score (AMTS)
confusion = 8/10 or lower
If only 1 of the CURB65 criteria applies to a patient what happens?
Given oral antibiotics and discharged. 3% mortality
If 2 of the CURB65 criteria apply, what happens?
Consider short hospital stay and give antibiotics
If 3 or more of the CURB65 criteria apply, what happens?
15% mortality rate
hospitalised in ICU
Given IV antibiotics
How is pneumonia treated?
O2 (stats 94-98%)
Broad spec antibiotics
NSAIDs for pleuritic chest pain
What antibiotic is given for CAP with a CURB65 score of 0-2?
Amoxicillin
What antibiotics is given for CAP with CURB65 score of 3-5?
Co-amoxiclav and Clarithromycin
Which organism causing pneumonia should be treated with clarithromycin as 1st line, irrespective of the CURB65 score?
Legionella
(also notifiable to PHE)
What conditions can cause aspiration pneumonia?
Stroke
Bulbar palsy
Myasthenia Gravis
