Pneumonia Flashcards
What is pneumonia?
Inflammation of the lower respiratory tract involving infection of the AIR SPACES eg oedema and consolidation
How can pneumonia be classifed?
Setting eg hospital or community
Organism
Morphology eg Lobar or bronchopneumonia
What is the difference between lobar and bronchopneumonia?
Lobar- on or two distinct lobes
Broncho- Begins in the airways and can spread diffusely to adjacent alveolar lung
What is the most common causes of lobar pneumonia?
Strep.pneumonia
Legionella, Klebsiella
Who is likely to get lobar pneumonia?
In community
Smokers, alcoholics, COPD
What does the acute inflammatory response involve?
Exudation of fibrin rich fluid Neutrophils infiltrate Macrophages infiltrate Resolution Red hepatisation
Who is likely to get bronchopneumonia?
Those with existing disease CF COPD bronchiectasis cardiac failure aspiration
Where does bronchopneumonia usually affect?
Lower lobes
What organisms cause bronchopneumonia?
Strep.pneumonia H. influenza Staph aureus Anaerobes Coliforms
What are the possible complications of pneumonia?
Bronchiectasis Absesses- inhaled foregin bodies Empyema Organisation eg scarring Respiratory failure Pleural effusion Death
What are atypical causes of pneumonia?
Mycoplasma Coxiella burnetti- sheep and goats Chlamidia psittaci- birds Legionella- water Pneumocysitis carinii- HIV Fungal- Aspergillus- Immunocompromised
What are the common causes of nosocomial pneumonia?
Gram negatives eg pseudomonas
Coliforms
Anaerobes- aspiration
What cause of pneumonia is common in patients with CF or bronchiectasis?
PSeudomonas
Which cause is responsible for epidemics?
Mycoplasma
What are the symptoms of pneumonia?
cough- dry or productive Rusty sputum Haemoptysis Breathless Fever Pleuricy Malaise Anorexia Arthralgia GI symptoms and confusion, renal failure= legionella
What are the signs of pneumonia?
Herpes labialis Tachycardia Hypotension Diminished expansion Dull percusion increased tactile vocal fremetis bronchial breathing PLeural rub Crackles
How do you measure the severity of pneumonia?
CURB 65 OxygenPaO2 less than 8kPa Temp 40 Multi lobe WBC 30
What is curb 65?
Confusion 7mmol/L
Respiratory rate >30/min
BP <60 dyastolic
What is the treatment for community acquired pneumonia CURB less than 2?
Amoxicillin 1g 3 x daily 7 days oral or IV
Allergic? - Doxycycline 200mg 2 x daily I day
100 mg 2 x daily 6 days
If need IV- Clarithromycin
What is the treatment for CAP with CURB 3+?
IV Co- amoxiclav + IV Clarithromycin or Oral Doxycycline 2 x daily
Allergy? IV Levofloxacin
Step down to Doxycycline (10 days total)
How do you treat severe hospital acquired pneumonia?
Amoxicillin IV + Gentamicin + Metronidazole
Step down to Co-amoxiclav (7- 10 days)
How do you treat non severe hospital aquired pneumonia?
Amoxicillin and metronidazole (7 days)
How do you treat legionella?
Clarithromycin/ Erythromycin
Fluroquinolone eg levofloxacin
How do you treat Pneumocysitis?
Pentamidine
Cotrimidazole
How do you treat fungal pneumonia?
IV Ampheterecin
