Pneumonia Flashcards
What makes up the lower respiratory tract
• larynx
• bronchi
• bronchioles
• alveoli
What are the characteristics of pneumonia?
• consolidation of lung tissue
• filling of alveoli, with fluid, inflam cells and fibrin
< that occurs due to
• bacteria or virus
• damage to the chest wall
• inhalation of chemicals
Which part of the lungs is inflamed in CAP and HAP
Lung parenchyma
Facts
• most symptomatic human disease in children and adults
• more common in children
Which virus causes viral pneumonia
• COVID
• influenza
• parainfluenza
• swine flu
• SARS
• herpes
Symptoms
• gradual flu like
• fever
• chills
• muscle pain
• upper respiratory symptoms (runny nose)
Treatment
• oxygen
• antipyretics
• analgesics
• nutrition
• vaccine
• antivirals
Which organisms cause CAP
• h. Influenza
• s.pneumonia (streptococcus) (mst cmmn)
• myocoplasama
• chalmydophila
Which bacteria cause HAP
• staphylococcus aureus - MRSA
• pseudomonas aeruginosa
• klebisella
• E.coli
How do the bacteria enter the lower respiratory tract?
3 ways:
• inhalation of infected aerosol particles
• entry to lungs via blood stream from infected location outside the lungs
• aspiration of oropharyngeal contents (can occur during sleep)
What 2 models are used for risk stratification, used before treatment to determine level of care? (For CAP only)
CURB-65 & PSI
CURB-65?
Determines site of care
One point is given to each factor:
• confusion
• respiratory rate - 30 and above
• Uremia
• hypotension
• 65>
Score
• 0-1 = outpatient treatment
• 2 = admit to medical ward
• 3+ = ICU
PSI
Assess risk of mortality
Uses:
• age
• gender
• co morbidities
• physical exam
• lab findings
Scores
• 1-2 = outpatient
• 3 = short hospital stay
• 4+ = impatient
What is considered CAP
• it is developed in the community
• <48 hrs in hospital
Risk of CAP
• old age
• respiratory conditions
• contact with influenza
• contact with infected birds
• farm environment
• immune compromised
• smoking
• alcoholism
Symptoms of CAP
• cough with rusted colours sputum
• headache
• confusion
• loss of appetite
• pleuritic chest pain
• fever
• dysponea
• hypoxemia, tachycardia, hypotension, tachypnoea
• decreased breathing sounds
Tests and investigations for CAP
• x-ray (to confirm consolidation in lungs
• sputum
• RBC
• ABG
• C-reactive protein
When should oxygen be give
• hypoxemia
• high levels of CO2 in blood
What are the options for empirical treatment for outpatients
One of the following:
• macrolides (mycins)
• doxycycline
• fluoroquinolone (levofloxacin)
What are the options for empirical treatment for inpatients (not ICU)
• extended spectrum cephalosporin (ceftaraxone) + macrolide
OR
• b-lactam inhibitor + macrolide or fluoroquinolone
What are the options for empirical treatment for ICU patients
ESC or b-lactamse inhibitor + macrolide or fluoroquinolone
How long after cap diagnosis should abx treatment begin?
<4
Treatment is based on what score?
CURB-65
Treatment for CURB-65 score of 0-1/low severity
• amoxicillin 500mg, TDS - 5 days
Alternatives:
• doxycycline, 200mg on first day, next four days 100mg OD
• clarithromycin 500mg BD - 5 days
• erythromycin (pregnancy) 500mg QDS - 5 days
(All doses repeated are the same)
Treatment for moderate severity
CURB - 2
Amoxicillin + clarythromycin or Erythromycin (if typical pathogen is suspected) - 5 days
Alternative:
• doxycycline - 5 days
• erythromycin (pregnancy) - 5 days
Treatment for severe?
Co-amoxiclav 500/125mg TDS (or IV 1.2g) + clarythromycin or erythromycin (if atypical bacteria is suspected)
Alternative
• levofloxacin 500mg TDS or IV 500mg
HAP is considered when?
Occurring in hospital >48 hours of admission
Is the common causative organism gram negative or positive
Negative e
What are the risk factors of HAP
• in hospital >5 days
• on ventilator
• in ICU
• have an immunosuppressive conditions
• chronic respiratory condition
• HIV/AIDS
• high frequency on abx resistance in the hospital or community
Which investigation or labs would you do
• Clincal symptoms
• sputum culture
• WBC
• FBC
• ABG
• C-reactive protein
• urjnary antigen test
• chest x ray (cloudy spaces in the lungs)
• chest CT scan
What is the treatment for non severe or not a risk of abx resistance
• co-amoxiclav
Alternative
• doxycycline
• co-trimoxazole (960mg BD)
Treatment of HAP with severe symptoms (sepsis) or high risk of resistance
• piperacillin + tazobactam 4.5mg TDS
Alternative
• ceftriaxone 2mg OD
What is the add on IV therapy if MRSA is suspected/confirmed
Vancomycin 15-20mg/kg TDS
or linezolid 600mg BD
(5 days for all treatment)
For oral Abx when should treatment be reviewed
5 days
Or IV abx when should treatment be reviewed
After 48 hours, then consider switching to oral
What is aspiration pneumonia
Occurs when aspiration of oropharyngeal contents
Who is at risk of this?
• unconscious patients
• swallowing difficulties
• weak immune system
• GI conditions
Test/investgations
Similar to CAP/HAP
+ broncoscopy
Treatment?
• piperacillin + tazobactam
What are the end complications of pneumonia
• respiratory failure
• death
• bronchitis
• emphysema
• destruction of lung paranchyme
• ventilations dependency
Drug related questions
What other drug is in co-trimoxazole
Sulfamethoxazole (used together for their synergic activity and prevents drug resistance)
Is co-trimoxazole licenced in HAP
No
Common ADR of co-trimoxazole
• diarrhoea
• fungal overgrowth
• electrolyte imbalance
Monitoring for co-trimoxazole
Serium K and Na
Amoxicillin ADR
• GI disturbances
• thrombocytopenia
• hypersensitivity (rash or anaphylactic)
How many lobes does the right vs left lung have
Right - 3
Left -2
What is the main symptoms difference in CAP and HAP
Onset
• quicker in cap
Sputum
• cap - yellow green
• hap - foul smelling (common in anaerobic organisms)
Pleuritic chest pain
• more common in cap
Cynosis
• common in hap
What is the normal oxygen saturation
95-100%
What are the body’s natural defence mechanisms against infections
• mucus
• coughing reflex
• muco illary movement
• T lymohocytes
• iGA
• sneezing
Lobularpnumonia
Beonchopnumonia
Atypical
Which has no sputum
Atypical
Which has rusted sputum
Lobular
Which has homogeneous consolidation in one or more lobe
Lobular penumonia
Which has yellow sputum
Broncopnumonia
Which has patchy consolidation in bases of both lungs
Bronchopnumonia
Which as pleuritic chest pain
Lobular pnumonia
Which has wide spread patchy consolidation
Atypical
Which is also know as walking pneumonia
Atypical
