Pneumonia Flashcards
What types of pathogens can cause pneumonia?
Viruses, bacteria, fungi, parasites
What are predisposing factors for pneumonia?
Obstruction
Aspiration
Cigarette smoking
Immunosuppresion
What types of pneumonia are there?
Lobar pneumonia (localised) Bronchopneumonia (affecting lobules, bronchi and bronchioles- diffuse)
What types of pneumonia are caused by bacteria?
Lobar pneumonia, bronchopneumonia or both
What is a typical causative organism of classic lobar pneumonia?
Strep. pneumoniae
List the symptoms of pneumonia
Malaise Anorexia Sweats Rigors Myalgia Arthalgia Headache Confusion Cough Pleurisy Haemoptysis Dysponoea Preceding URTI Abdominal pain (diaphragmatic pleurisy) Diarrhoea
What are clinical signs on examination of pneumonia?
Fever Rigors Herpes labialis Tachypnoea Crackles Rub Cyanosis Hypotension Diminished chest expansion Dull percussion note Increased tactile vocal fremitus/ vocal resonance Bronchial breathing
List some investigations that would help in a diagnosis of pneumonia.
CXR Assess oxygenation ABGs Blood tests: FBC, U&E, LFT, CRP, blood cultures if septic. Sputum microscopy and culture
What would you look for on a CXR?
lobar or multilobar infiltrates
cavitation
Pleural effusion
How is the severity of pneumonia assessed?
CURB-65. C = new onset of confusion U= Urea > 7 R = Respiratory rate >30/min B= Blood pressure: systolic < 90 or diastolic < 61 65 = 65 years of age or older 1 point for each of the above.
a) What does CURB 65 predict?
b) Which patients is it not useful in?
a) Mortality in normal well people who have a new pneumonia.
b) Patients with hospital acquired pneumonia or patients with a COPD exacerbation.
What CURB 65 score indicates a severe pneumonia?
A score of more than 3.
List some other severity markers of pneumonia which are not included in the CURB 65 score.
Temperature 40
Cyanosis, Pa02 < 8 kPa
WBC 30
Multi-lobar involvement
What are complications of pneumonia?
Respiratory failure
Pleural effusion
Empyema
Death
What vaccines are available for the prevention of pneumonia?
Influenza and pneumococcal vaccines
Who are the influenza and pneumococcal vaccines available to?
Both: Over 65 Chronic chest or cardiac disease Diabetes Immunocomprimised (e.g. splenectomy)
Infleunza vaccine: Healthcare workers
What is the treatment for mild/moderate CAP?
Amoxicillin 1g tds (three times a day) Iv/PO (7 days)
If penicillin allergic: doxycycline PO 200mg then 100mg OD
What is the treatment for severe CAP?
Co-amoxiclav IV + either Clarithromycin IV or Doxycycline PO bd (twice daily)
If penicillin allergic, IV Levofloxacin
Step down to Doxycycline 100mg bd for all severe CAP
Total IV/PO = 10 days
Which pathogens cause CAP, in order of most common to least common?
Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Remainder: Staph aureus, Legionella, Moraxella catarrhalis, Chlamydophila psittaci, coxiella burnetti.
Viruses: 15%
Flu may be complicated by Community acquires MRSA pneumonia
After how many hours since hospital admission is a new pneumonia defined as hospital acquired/nosocomial?
> 48 hours
Which pathogens cause nosocomial pneumonia?
Most commonly gram negative enterobacteria or staph aureus.
Others: Psuedomonas, klebsiella, Bacteroides and Clostridia.
What needs to be taken into account when treating aspiration pneumonia?
Need anaerobic cover
What is particular about pnuemonia as caused by Legionella?
Chest symptoms may be absent
GI disturbance is common
Who is most commonly affected by mycoplasma pneumoniae?
Older children and young adults
As well as pneumonia, what other disease does coxiella burnetti cause?
Q fever (pyrexia of unknown origin)
Which animals carry coxiella burnetti?
Sheep and goats
What complication does coxiella burnetti cause?
Culture negative endocarditis
i.e. the culture does not grow any pathogen as the bacteria is a parasite and will only grow in living cells
Which disease does chlamydophila psittaci cause, and how does this disease usually present?
Psittacosis, which usually presents as pneumonia
What animals is chlamydophila psittaci caught from?
Pet birds such as parrots, budgies and cockatiels.
Which is a more sensitive test, sputum culture or sputum microscopy?
Sputum microscopy.
Sputum culture is also limited as a test because mycoplasma is the only organism that can be grown with any ease.
What are the most encountered clinical signs of pneumonia, bronchial breathing or crepitations?
Crepitations.
Which organism occurs in large epidemics every 3-4 years?
Mycoplasma pneumoniae.
What does streptococcus pneumoniae look like on microscopy?
Gram positive cocci in short chains/pairs
Is strep. pneumoniae alpha, beta or gamma haemolytic?
Alpha haemolytic
What antibiotics is strep. pneumonia generally sensitive to?
Penicillins
a) Which pathogen is a cause of pneumonia in patients with AIDS?
b) How is it diagnosed?
c) What is the treatment?
a) Pneumocystitis carinii pneumonia
b) Bronchioalveolar lavage or induced sputum and identification of cysts
c) Cotrimoxazole, pentamidine
Which fungus can cause a severe pneumonia?
Aspergillus fumigatus
