pneumonia Flashcards
- Describe why pneumonia is a “great neglected disease of mankind.”
Often misdiagnosed, mistreated and underestimated. Pneumonia kills more children than any other illness
Sx of pneumonia
Acute fever, tachypnea, cough, purulent sputum, lung consolidation. Infiltrate on CXR.
complications of pneumonia
effusion/empyema, respiratory failure, cavitation, pneumothorax. PE, and increased MI, stroke, CHF, arrythmia
For typical CAP- list organisms, signs/sx
Pneumococcus, H. flu, Moraxella catarrhalis, Staph aureus. Lobar infiltrate on CXR. Purulent sputum
For atypical CAP- list organisms, signs/sx
Mycoplasma pneumoniae, chlamydophila pneumoniae, legionella pneumophila, influenza, RSV, adenovirus
List other causes of CAP
fungal (histoplasmosis, blastomycosis, coccidiomycosis, aspergillus), anaerobes (aspiration). Non infectious: reactive (chemicals), radiation, autoimmune, infiltrative cancer, CHF
List the organisms involved in health care associated pneumonia (HCAP)
Usually atypicals, H. flu, some GNRs and staph aureus. Seen in pts on dialysis, chemo in last 30 days, hospital in 180days
List the hospital acquired pneumonia organisms
also ventilator associated. GNR (pseudomonas aeruginosa) and staph aureus are prominent.
pneumonia mortality
Non hospitalized CAP <2%. Hospitalized CAP is 6.7%, HCAP is 17.8% and HAP is 18.4%
Pneumococcal pneumonia risk groups and treatment
elderly, liver dz, immunosuppression, alcoholism, hematologic malignancy, smoking. Treatment: decreasing penicillin sensitivity
haemophilus influenza pneumonia - other conditions, antimicrobial susceptibility
Also causes febrile tracheobronchitis (cough, purulent sputum, fever but NOT pulm infiltrate on CXR). 36% are ampicillin resistant (b-lactamase)
Staph aureus pneumonia - who is affected, toxin involved, sx, therapy
Often in children, native americans, gay men, crowding (jail), HIV, homeless youth. Panton-Valentine leukocydin toxin and type IV staph cassette chromosome mec gene. Sx: can lead to necrotizing penumonia, shock, abscess, empyema, respiratory failure. Therap: IV linezolid, vancomycin. oral TMP-SMX, mino/doxycycline +/- clindamycin
Who should be suspected for M. tuberculosis pneumonia
subacute/ chronic pneumonia, immigrants, HIV-1+, lower SES
who gets chlamydia trachomatis, chlamydia psittaci and chlamydia pneumoniae pneumonia
trachomatis: infants. Psittaci: birds and adults. Pneumoniae: young adults
List the associations for the following bacteria which can cause pneumonia: Coxiella burnetti, Rickettsia rickettsii, yersinia pestis
Coxiella burnetti: farm animals and placenta. Rickettsia rickettsii: causes rocky mountain spotted fever, rash, April-June. yersinia pestis: causes the plague, rats, rodents, fleas
List the important causes of fungal pneumonia
blastomycosis (blastomyces dermatitidis), histoplasma capsulatum, coccidioides immitis, pneumocystis jirovecii (AIDS), Aspergillus
Which bacteria have the highest pneumonia mortality
legionella > s. pneumoniae, influenza A
risk factors for community acquired pneumonia
smoking > cardiovascular dz > COPD > chronic alcoholism > malignancy > diabetes
Tests for diagnosing pneumonia
CXR, O2 sat, CBC, Cr, LFT, blood culture/ gram stain. Sputum culture (no Abx yet), HIV test
List the causes of pneumonia in elderly
s. pneumonia, H. flu, influenza
list causes of pneumonia in young adult
Mycoplasma pneumoniae, chlamydophila pneumonia, strep pneumonia.
List causes of pneumonia in AIDs
s. pneumonia, p. jirovecii.
Pneumonia severity index
Based on age, co-existing ocnditions, and PE findings (mental status, respiratory rate, temp, etc) pts are given a score. If Score is 90 admit to hospital
CURB-65 scoring for pneumonia
Confusion, BUN > 19mg/dl, Resp. rate > 30/min, BP (sys 65. 1 point for each. The higher the points, the higher the mortality
outpatient CAP treatment for previously healthy pt with no Abx within 3 months
Macrolide or doxycycline
Outpatient CAP treatment with co-morbidities OR Abx within previous 3 months
Fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin). Beta lactam (amox/clav) plus macrolide
Inpatient, non-ICU CAP treatment
Fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin). Beta lactam (tertiary cephalosporin) plus macrolide
Inpatient, ICU CAP treatment
Beta lactam (cefotaxime, ceftriaxone or ampicillin-sulbactam) PLUS either azithromycin or fluoroquinolone
CAP treatment if pseudomonas is a concern
anti-pseudomonal b-lactam: piperacillin-tazobactam, cefepime, imipenem or meropenem) PLUS ciprofloxacin or levofloxacin. OR antipseudomonal plus aminoglycoside plus azithromycin
treatment of Hospital acquired pneumonia and ventilator acquired pneumonia.
Direct empiric therapy against gram negative rods (pseudomonas aeruginosa) and Staph aureus (MRSA)
treatment of MRSA pneumonia
Linezolid for IV. Oral- TMP-SMX, mino/doxycycline or clindamycin
treatment of influenza
oseltamavir
types of pneumococcal vaccines and efficacy
- 23-valent for adults. 60% effective for bacteremia. Not effective for pneumonia (mucosal) 2. Prevnar: 13-valent for children. Reduces bacteremia >90% and reduces bacterial pneumonia
Efficacy of influenza vaccines
Decreases illness by 60-80% in children/young adults. Decreases serious illness and death by 70% in elderly
