Pneumonia Flashcards
What causes pneumonia in HIV patients?
Penumocystis jiroveci (pneumcystis carinii)
What is the investigation of choice in a HIV patient with peumonia?
Bronchoscopy with bronchoalveolar lavage
List some risk factors for pneumonia.
winter months very young and very old immunosuppression chronic lung, heart, renal or liver disease Diabetes mellitus Institutionalization
Define pneumonia.
an infection of the alveoli, distal airways and interstitium of the lungs that occurs outside the hospital setting.
How is pneumonia acquired?
Inhalation or aspiration of pathogenic organism into the lungs
What is the number 1 cause of pneumonia in a patient with COPD?
Haemophilus influenzae
Patient has suspected pneumonia. They have just returned from a cruise. What is the most likely infecting organism?
Legionella spp.
Patent just got a new parrot. What is the most likely infecting organism of their new onset pneumonia?
Chlamydia psittaci
Patient has just spent a week helping at a farm during the lambing season. What is the most likely infecting organism of their pneumonia?
Coxiella burnetti
What are the most common infecting organisms of CAP?
Strep. pnemoniae
H. influenzae
followed by: Legionella, Staph aureus, M. pneumoniae, and other atypicals
What are the symptoms of CAP?
SOB Cough productive of purulent sputum occasional haemoptysis pleuritic chest pain fever/sweats
If it is a lower lobe pneumonia, what else can the patient present with?
Shoulder tip pain - irritation of the diaphragm
Give the signs of CAP.
Fever tachypnea tachycardia dull to percussion bronchial breathing crackles pleural friction rub
Investigations for CAP.
CXR Sputum culture (prior to initiation of antibiotics) Blood cultures FBC U&Es LFTs CRP Serology for atypical legionella urinary antigen if suspected
What is used to grade the severity of CAP?
CURB-65
What is CURB-65?
Confusion (new) Urea >7mmol/L Respiratory rate >30 Blood pressure Systolic <60 65 years
What is the general management for CAP?
High flow oxygen
Monitor ABGs
IV fluids
Paracetamol for pleuritic pain
What is given for mild/moderate CAP?
0-2 CURBS 65
Amoxicillin
Penicillin allergic doxycycline
What is given for severe CAP?
3-5 CURBS 65
Co-amoxiclav IV and clarithromycin IV/doxycycline PO
Penicillin allergic Levofloxacin IV
How can CAP be prevented?
Influenza and pneumococcal vaccinations
Define HAP.
A pneumonia contracted after 48 hours of being admitted to the hospital
What are the main causal organisms of HAP?
Gram neg bacilli (Klebseilla and pseudomonas 50%) Staph aureus (15%) Often caused by multiple organisms
Risk factors for HAP?
Alcoholism being ventilated aspiration chest surgery immunosuppresion recent sever illness
What is given for non- severe HAP?
Amoxicillin and Metronidazole
What is the treatment for severe HAP?
IV amoxicillin and Metronidazole and Gentamicin
MAG
