Pneumonia

Question 1

Pneumonia as “great neglected disease of mankind”

~*~DrAmA qUeEn AlErT~*~

Answer 1

• Often misdiagnosed, mistreated, underestimated
• Kills more children worldwide than any other illness
  
  • 2-4 million deaths/year
  • Most young children in poor countries
  • Accounts for 1/5 deaths in children < 5y/o
• Kills more children than measles + malaria + HIV/AIDS combined
• Community acquired pneumonia (CAP) in US:
  
  • 6th leading cause of death overall
  • Leading cause of ID deaths (~4 million cases, 600,000 hospitalizations/year)

Question 2

Other causes of cough

Answer 2

• Pharyngitis
• Sinusitis
• Bronchitis
• COPD exacerbation

Question 3

Features of pneumonia

Answer 3

• Acute fever
• Tachypnea
• Cough
• Purulent sputum
• Lung consolidation
• CXR infiltrates
• S/S fewer in elderly (may just “feel bad”)

Question 4

Common risks for pneumonia

Answer 4

• Elderly
  
  • Waning immunity
• Liver disease
• Immunosuppression (especially HIV-1)
  
  • Can’t kill the bugs
• Alcoholism
  
  • Aspiration
• Hematologic malignancy
• Smoking
  
  • Cilia paralyzed by smoke
• Infant not breast fed
  
  • No antibodies

Question 5

Common causes of CAP (4)

Answer 5

• Mycoplasma
• S. pneumoniae
• M. tuberculosis
• Pneumocystis jirovecii

Question 6

Mycoplasma pneumonia: related risks

Answer 6

• Young person

Question 8

Mycoplasma pneumonia: syndrome (acute, subacute, or chronic?)

Answer 8

• Acute

Question 10

Mycoplasma pneumonia: treatment

Answer 10

• Macrolides or tetracycline

Question 12

S. pneumoniae pneumonia: related risks

Answer 12

• Older person
• HIV+

Question 14

S. pneumoniae pneumonia: syndrome (acute, subacute, chronic?)

Answer 14

• Acute

Question 16

S. pneumoniae pneumonia: treatment

Answer 16

• Macrolides or tetracycline

Question 18

M. tuberculosis pneumonia: age group/related risks

Answer 18

• Asian or African immigrant

Question 20

M. tuberculosis pneumonia: syndrome (acute, subacute, chronic?)

Answer 20

• Chronic

Question 22

M. tuberculosis pneumonia: treatment

Answer 22

• Isoniazid
• Rifampin
• Pyrazinamide
• Ethambutol

Question 24

Pneumocystis pneumonia: related risks

Answer 24

• HIV positive

Question 26

Pneumocystis pneumonia: syndrome (acute, subacute, chronic?)

Answer 26

• Subacute

Question 28

Pneumocystis pneumonia: treatment

Answer 28

• Trimethoprin/sulfamethoxazole

Question 29

Pneumococcal vaccine

Answer 29

• 23-valent polysaccharide vaccine given to adults
  
  • Effective for bacteremia
  • Not effective for pneumonia
• 7-valent conjugate vaccine (Prevnar) given to children
  
  • Reduces colonization in children
  • Reduces bacteremia > 90%
  • Reduces infection in older adults (indirect; herd immunity)
  • Reduces bacterial pneumonia < 37% in African children
  • Some reduction in serous otitis and meningitis

Question 30

Influenza vaccine

Answer 30

• Routine annual influenza vaccination recommended for all persons age > 6 months
• Decreased illness 60-80% in children/young adults
• Decreased serious illness and death:
  
  • 30% institutionalized elderly
  • 70% in general elderly