Pneumonia Flashcards by Elizabeth Stevens

What are some common flora of the respiratory tract?

Viridans streptococci
Neisseria spp
Anaerobes
Candida spp

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What are the natural defences of the respiratory tract?

Muco-ciliary clearance mechanisms

nasal hair
ciliated columnar epithelium

Cough and sneezing reflex

Respiratory mucosal immune system

lymphoid follicles of pharynx
alveolar macrophage
secretory IgA and IgG

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Less common flora of the respiratory tract?

Streptococcus pneumoniae
Streptococcus pyogenes
Haemophillus influenza 
Pseudomonas 
E. coli

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What are the main infections of the upper respiratory tract?

Rhinitis
Pharyngitis
Epiglottis
Laryngitis
Tranchesitis
Sinusitis
Otitis media

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What are the main pathogens that cause upper resp tract infection?

Viruses

rhinovirus
coronavirus
influenza
parainfluenza
respiratory syncytial virus

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What is pneumonia?

Inflammation of pulmonary parenchyma with consolidation, usually due to an infection.

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What is inflammation of the pulmonary parenchyma due to from a cause other than infection? What can these causes be?

Pneumonitis

Physical or chemical

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In pneumonia, what causes the consolidation?

Accumulation of inflammatory exudate in the alveoli and adjoining ducts
Alveolar space contains liquid instead of gas

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What is lobar pneumonia?

Confluent consolidation involving a complete lung lobe.

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What is lobar pneumonia usually caused by?

Streptococcus pneumoniae
Community acquired
Acute onset

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Pathology of lobar pneumonia?

Typical acute inflammatory response
Exudation of fibrin-rich fluid
Get neutrophil and macrophage infiltration

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How does the immune system help in the clearance of lobar pneumonia?

Antibodies lead to opsonisation and phagocytosis of bacteria

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What is broncho-pneumonia?

Infection starting in the airways and spreading to adjacent alveoli and lung tissue

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When is broncho-pneumonia normally seen?

In the context of a pre-existing disease

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What is broncho-pneumonia normally caused by?

Streptococcus pneumoniae
Haemophilus influenzae
Staph aureus
Anaerobes
Coliforms

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How does bronchopneumonia appear on an X ray?

Diffuse and patchy

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Who is aspiration pneumonia common in?

Patients with neurological dysphagia - strokes
Epilepsy
Alcoholics
Drowning
Patients with a lower level of consciousness eg anaesthesia

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What can be aspired to cause aspiration pneumonia?

Food
Drink
Saliva
Vomit

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What organisms can cause aspiration pneumonia?

Oral flora

Anaerobes

What is interstitial pneumonia?

Inflammation of the interstitium of the lungs
Includes
-alveolar epithelium
-pulmonary capillary endothelium
-basement membrane
-perivascular and perilymphatic tissue

What is chronic pneumonia?

Inflammation of lungs that persists for an extended period of time

Common causative organisms of community-acquired pneumonia?

Streptococcus pneumoniae
Haemophilus influenzae
Klebsiella pneumoniae

Rare:
Chlamydia pneumophilia
Mycoplasma pneumoniae
Legionella pneumophilia

Causative organisms of hospital acquired pneumonia?

Gram negative bacilli
Staphylococcus aureus
Pseudomonas
MRSA
Drug resistant organisms are more common

What would make you suspect that pneumonia is caused by Streptococcus pneumoniae?

Community acquired
More common in elderly
Commonly preceded by viral infection
Rapid temperature - 39.5*C
Pleuritic pain
Dry cough becoming increasingly productive
Rust-coloured sputum
Breathing becomes more rapid and shallow with decreased chest expansion on side of infection

What would make you suspect the organism is H influenzae?

Common in elderly COPD patients Community acquired

What would make you suspect Legionella pneumophilia the causative organism?

Recent travel Young person or a smoker Illness Multi-system involvement

What would make you suspect Mycoplasma pneumoniae as the causative organism?

Young people Prior antibiotics Extra-pulmonary involvement - haemolysis, skin and joints

What would make you suspect Staph aureus as the most common causative pathogen of pneumonia?

IV drug user | Occurred after influenza

What would make you suspect Chlamydia pneumophilia to be the causative organism of pneumonia?

Contact with birds

What would make you suspect coxiella to be the causative organism of pneumonia?

Animal contact - sheep

What would make you suspect S milleri to be the causative organism of pneumonia?

Dental infection Abdominal source Aspiration

Presentation of pneumonia?

Almost always - malaise - fever - productive cough - sputum may be purulent/rust coloured/stained with lots of blood - fever, chills, sweats, rigors - cough, dry in infants and elderly - vomiting - headache - loss of appetite - haemoptysis - pleuritic chest pain - upper abdominal tenderness

What might you find on examination of a patient with pneumonia?

Signs of consolidation - bronchial breath sounds - crackles - wheeze - dullness to percussion - reduced vocal resonance - seen on CXR Tachypnoea Tachycardia Diarrhoea

When is pneumonia classed as hospital acquired?

48hrs after hospital admission | Very common, 15% of hospital acquired infections

Who is hospital acquired pneumonia common in?

Ventilated and post-surgical patients

What is the scoring system used to assess chance of mortality from pneumonia?

``` C - confusion U - urea >7mmol/L R - resp rate >30/min B - blood pressure, systolic <60 65 - aged over 65 ```

What specimens can be used for lab diagnosis of pneumonia?

``` Sputum Nose and throat swabs Endotracheal aspirates Bronchoalveolar lavage fluid Open lung biopsy Blood culture Urine - detects legionella and pneumococcus antigens Serum - antibody detection ```

Microbiological investigations for pneumonia?

``` Microscopy - Gram staining and acid fast Culture bacteria and viruses PCR of respiratory viruses Antigen detection for legionella Serology - Antibody detection ```

Common pathogens which cause pneumonia in the immunosuppressed?

Cytomegalovirus (CMV) Mycobacterium avium intracellulare Aspergillus, candida, pneumocystis, jiroveci Crytosporidia, toxoplasma

Supportive treatment of pneumonia

Fluids (oral/IV) Anti-pyretic drugs - reduce fever and malaise Strong analgesics for pleural pain Oxygen if cyanosed

Antibiotics for community acquired pneumonia?

Target organism is normally pneumococcus | Penicillin - amoxycillin

Antibiotics for hospital-acquired pneumonia?

More likely to be Gram negative | IV co-amoxiclav

Treatment of legionella pneumonia?

Levofloxacin

Antibiotics for atypical pathogens of pneumonia?

Tetracyclines | Macrolides

Possible outcomes of pneumonia?

``` Resolution Organisation (scarring) Complications -lung abscess -bronchiectasis -empyema -respiratory failure -hypotension -septicaemia ```

How to prevent pneumonia?

Flu vaccine for high risk patients Pneumococcal vaccine Chemoprophylaxis -oral penicillin/erythromycin

When is chemoprophylaxis for pneumonia given?

Asplenic patients | Immunosuppressed