Pneumonia Flashcards
What causes Legionnaire’s disease?
Legionnaire’s disease is caused by the intracellular bacterium Legionella pneumophilia.
Where does Legionella typically colonize?
Legionella typically colonizes water tanks.
Is Legionnaire’s disease transmitted person-to-person?
Person-to-person transmission is not seen.
What are common features of Legionnaire’s disease?
Common features include flu-like symptoms, dry cough, relative bradycardia, confusion, lymphopaenia, hyponatraemia, deranged liver function tests, and pleural effusion.
What is the diagnostic test of choice for Legionnaire’s disease?
The diagnostic test of choice is urinary antigen.
What are the chest x-ray findings in Legionnaire’s disease?
Chest x-ray findings may include a mid-to-lower zone predominance of patchy consolidation and pleural effusions in around 30%.
What is the treatment for Legionnaire’s disease?
Treatment is with erythromycin or clarithromycin.
What is Mycoplasma pneumoniae?
Mycoplasma pneumoniae is a cause of atypical pneumonia which often affects younger patients.
What are some characteristic complications of Mycoplasma pneumoniae?
It is associated with complications such as erythema multiforme and cold autoimmune haemolytic anaemia.
How often do epidemics of Mycoplasma pneumoniae occur?
Epidemics of Mycoplasma pneumoniae classically occur every 4 years.
Why is it important to recognize atypical pneumonia?
Atypical pneumonia may not respond to penicillins or cephalosporins due to lacking a peptidoglycan cell wall.
What are the typical features of Mycoplasma pneumoniae infection?
The disease typically has a prolonged and gradual onset, with flu-like symptoms classically preceding a dry cough and bilateral consolidation on x-ray.
What are some complications of Mycoplasma pneumoniae?
Complications may include cold agglutins (IgM), erythema multiforme, meningoencephalitis, bullous myringitis, pericarditis/myocarditis, and gastrointestinal issues.
How is Mycoplasma pneumoniae diagnosed?
Diagnosis is generally by Mycoplasma serology and a positive cold agglutination test may show red blood cell agglutination.
What is the management for Mycoplasma pneumoniae infection?
Management includes doxycycline or a macrolide (e.g. erythromycin/clarithromycin).
What is pneumonia?
Pneumonia is an inflammatory condition affecting the alveoli of the lungs, commonly secondary to a bacterial infection.
What is the most common type of pneumonia?
Bacterial pneumonia is the most common type seen in clinical practice.
What are other infective causes of pneumonia?
Other causes include viral and fungal infections, such as Pneumocystis jiroveci.
Which organism accounts for 80% of pneumonia cases?
Streptococcus pneumoniae (pneumococcus) accounts for 80% of cases.
Particularly associated with high fever, rapid onset, and herpes labialis. A vaccine to pneumococcus is available.
What is a common pneumonia organism in patients with COPD?
Haemophilus influenzae is particularly common in patients with COPD.
What organism often occurs following influenza infection?
Staphylococcus aureus often occurs in patients following influenza infection.
What are the characteristics of Mycoplasma pneumoniae?
Mycoplasma pneumoniae is an atypical pneumonia that often presents with a dry cough and atypical chest signs/x-ray findings.
Autoimmune haemolytic anaemia and erythema multiforme may be seen.
What is Legionella pneumophilia associated with?
Legionella pneumophilia is another atypical pneumonia, classically seen secondary to infected air conditioning units.
Hyponatraemia and lymphopenia are common.
Which organism is classically seen in alcoholics?
Klebsiella pneumoniae is classically seen in alcoholics.
What is Pneumocystis jiroveci typically seen in?
Pneumocystis jiroveci is typically seen in patients with HIV.
Presents with a dry cough, exercise-induced desaturations, and the absence of chest signs.
What is idiopathic interstitial pneumonia?
Idiopathic interstitial pneumonia is a group of non-infective causes of pneumonia, such as cryptogenic organizing pneumonia.
What is the difference between community-acquired pneumonia and hospital-acquired pneumonia?
Community-acquired pneumonia (CAP) occurs outside of hospitals, while hospital-acquired pneumonia occurs 48 hours or more after admission.
What are common symptoms of pneumonia?
Common symptoms include cough, sputum, dyspnoea, chest pain (may be pleuritic), and fever.
What are common signs of pneumonia?
Common signs include fever, tachycardia, reduced oxygen saturations, reduced breath sounds, and bronchial breathing.
What is the classical x-ray finding in pneumonia?
The classical x-ray finding in pneumonia is consolidation.
What does a full blood count typically show in bacterial infections?
A full blood count would usually show neutrophilia in bacterial infections.
What is the CURB-65 scoring system used for?
The CURB-65 scoring system is used for risk stratification in patients with community-acquired pneumonia.
What does the ‘C’ in CURB-65 stand for?
‘C’ stands for confusion, defined as an abbreviated mental test score <= 8/10.
What does the ‘R’ in CURB-65 indicate?
‘R’ indicates a respiration rate >= 30/min.
What does the ‘B’ in CURB-65 refer to?
‘B’ refers to blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg.
What does the ‘65’ in CURB-65 signify?
‘65’ signifies that the patient is aged >= 65 years.
What is the recommended management for a CRB-65 score of 0?
NICE recommends home-based care for patients with a CRB-65 score of 0.
What is the first-line treatment for pneumonia?
Oral amoxicillin is generally used as first-line treatment.
What is the mortality risk associated with a CURB-65 score of 4?
Patients with a CURB-65 score of 4 approach a 30% mortality rate at 30 days.
What criteria does NICE recommend for assessing pneumonia in primary care?
NICE recommends using the CRB65 criteria:
C: Confusion (abbreviated mental test score <= 8/10)
R: Respiration rate >= 30/min
B: Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65: Aged >= 65 years
How are patients stratified for risk of death in pneumonia assessment?
Patients are stratified as follows:
0: low risk (less than 1% mortality risk)
1 or 2: intermediate risk (1-10% mortality risk)
3 or 4: high risk (more than 10% mortality risk)
What is the recommendation for treatment based on risk level in primary care?
NICE recommends:
0: treatment at home should be considered
1 or 2: hospital assessment should be considered
3 or 4: urgent admission to hospital
What does NICE recommend regarding the CRP test for antibiotic therapy?
CRP < 20 mg/L: do not routinely offer antibiotic therapy
CRP 20 - 100 mg/L: consider a delayed antibiotic prescription
CRP > 100 mg/L: offer antibiotic therapy
What is the difference between CRB65 and CURB65 criteria?
In hospital, CURB65 is used instead of CRB65, adding the criterion:
U: urea > 7 mmol/L
What are the recommendations for CURB65 scores in secondary care?
NICE recommends:
0 or 1: consider home-based care (low risk, < 3% mortality risk)
2 or more: consider hospital-based care (intermediate risk, 3-15% mortality risk)
3 or more: consider intensive care assessment (high risk, > 15% mortality risk)
What investigations are recommended for pneumonia?
Investigations include:
Chest x-ray
Blood and sputum cultures for intermediate or high-risk patients
Pneumococcal and legionella urinary antigen tests
CRP monitoring for admitted patients
What is the first-line management for low-severity community acquired pneumonia?
Amoxicillin is first-line. If penicillin allergic, use a macrolide or tetracycline.
NICE recommends a 5-day course of antibiotics.
What is the management for moderate and high-severity community acquired pneumonia?
Dual antibiotic therapy is recommended with amoxicillin and a macrolide for 7-10 days.
NICE recommends considering beta-lactamase stable penicillins in high-severity cases.
What are the discharge criteria for pneumonia patients?
Patients should not be routinely discharged if they have had 2 or more of the following in the past 24 hours:
- Temperature > 37.5°C
- Respiratory rate >= 24 breaths/min
- Heart rate > 100 beats/min
- Systolic BP <= 90 mmHg
- Oxygen saturation < 90% on room air
- Abnormal mental status
- Inability to eat without assistance
What post-discharge symptom resolution timeline does NICE recommend for pneumonia patients?
NICE recommends the following timelines:
1 week: Fever resolved
4 weeks: Chest pain and sputum production reduced
6 weeks: Cough and breathlessness reduced
3 months: Most symptoms resolved, fatigue may persist
6 months: Most feel back to normal
What follow-up is recommended after pneumonia treatment?
All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution to ensure consolidation has resolved.
What is the most common cause of community-acquired pneumonia?
Streptococcus pneumoniae (pneumococcus) accounts for around 80% of cases.
What are some infectious agents that can cause community-acquired pneumonia (CAP)?
- Streptococcus pneumoniae
- Haemophilus influenzae
- Staphylococcus aureus (commonly after influenza infection)
- Atypical pneumonias (e.g. due to Mycoplasma pneumoniae)
- Viruses
Which group of people is Klebsiella pneumoniae classically associated with?
Klebsiella pneumoniae is classically associated with alcoholics.
What are the characteristic features of pneumococcal pneumonia?
- Rapid onset
- High fever
- Pleuritic chest pain
- Herpes labialis (cold sores)
What is pneumonia?
Pneumonia is a common inflammatory condition affecting the alveoli in the lungs caused by pathogens entering the lower respiratory tract.
What are common causative pathogens of pneumonia?
Causative pathogens include bacteria (e.g. Streptococcus pneumoniae), viruses, and fungi (e.g. Pneumocystis jiroveci).
What initiates the inflammatory response in pneumonia?
Once a pathogen enters the lower respiratory tract, an inflammatory cascade begins with neutrophils migrating to the infected alveoli.
What are the risk factors for pneumonia?
Risk factors include age under 5 or over 65, smoking, recent viral respiratory infection, chronic respiratory diseases, immunosuppression, aspiration risk, IV drug use, and other non-respiratory co-morbidities.
What are the common symptoms of pneumonia?
Symptoms include a cough with purulent sputum, dyspnoea, chest pain, fever, and malaise.
What are the signs of pneumonia?
Signs include high temperature, tachycardia, hypotension, confusion, tachypnoea, low oxygen saturation, reduced breath sounds, bronchial breathing, crepitations, and dullness on percussion.
What is the CRB65 criteria for assessing pneumonia in primary care?
CRB65 criteria include: C - Confusion, R - Respiration rate >= 30/min, B - Blood pressure systolic <= 90 mmHg, 65 - Age >= 65 years.
How are patients stratified for risk of death using CRB65?
Patients are stratified as follows: 0 - low risk (less than 1% mortality), 1 or 2 - intermediate risk (1-10% mortality), 3 or 4 - high risk (more than 10% mortality).
What is the recommendation for patients with a CRB65 score of 0?
NICE recommends home-based care for patients with a CRB65 score of 0.
What does a CRP level indicate in pneumonia assessment?
CRP < 20 mg/L - do not offer antibiotics; CRP 20 - 100 mg/L - consider delayed prescription; CRP > 100 mg/L - offer antibiotics.
What is the CURB65 criteria used in secondary care?
CURB65 criteria include: C - Confusion, U - Urea > 7 mmol/L, R - Respiration rate >= 30/min, B - Blood pressure systolic <= 90 mmHg, 65 - Age >= 65 years.
What are the recommendations for CURB65 scores in secondary care?
Consider home-based care for CURB65 score 0 or 1 (low risk), hospital care for score 2 (intermediate risk), and intensive care for score 3 or more (high risk).
What is typically seen on a chest X-ray for pneumonia?
A chest X-ray typically shows consolidation (opacity) in the area of infection and may also show effusion.
What does a raised white cell count in FBC indicate?
It indicates infection.
What is urea used for in U&E?
It is used for the CURB-65 score.
What does a raised CRP indicate?
It indicates inflammation.
Monitoring is recommended for admitted patients to help determine response to treatment.
What are blood cultures used for?
They are used to identify infections.
What is the purpose of a sputum sample?
It is used to diagnose the causative organism after culture.
When are Legionella antibodies recommended?
They are recommended in intermediate or high-risk patients.
