pneumonia

Question 1

1. Describe why pneumonia is a “great neglected disease of mankind.”

Answer 1

Often misdiagnosed, mistreated and underestimated. Pneumonia kills more children than any other illness

Question 2

Sx of pneumonia

Answer 2

Acute fever, tachypnea, cough, purulent sputum, lung consolidation. Infiltrate on CXR.

Question 3

complications of pneumonia

Answer 3

effusion/empyema, respiratory failure, cavitation, pneumothorax. PE, and increased MI, stroke, CHF, arrythmia

Question 4

For typical CAP- list organisms, signs/sx

Answer 4

Pneumococcus, H. flu, Moraxella catarrhalis, Staph aureus. Lobar infiltrate on CXR. Purulent sputum

Question 5

For atypical CAP- list organisms, signs/sx

Answer 5

Mycoplasma pneumoniae, chlamydophila pneumoniae, legionella pneumophila, influenza, RSV, adenovirus

Question 6

List other causes of CAP

Answer 6

fungal (histoplasmosis, blastomycosis, coccidiomycosis, aspergillus), anaerobes (aspiration). Non infectious: reactive (chemicals), radiation, autoimmune, infiltrative cancer, CHF

Question 7

List the organisms involved in health care associated pneumonia (HCAP)

Answer 7

Usually atypicals, H. flu, some GNRs and staph aureus. Seen in pts on dialysis, chemo in last 30 days, hospital in 180days

Question 8

List the hospital acquired pneumonia organisms

Answer 8

also ventilator associated. GNR (pseudomonas aeruginosa) and staph aureus are prominent.

Question 9

pneumonia mortality

Answer 9

Non hospitalized CAP <2%. Hospitalized CAP is 6.7%, HCAP is 17.8% and HAP is 18.4%

Question 10

Pneumococcal pneumonia risk groups and treatment

Answer 10

elderly, liver dz, immunosuppression, alcoholism, hematologic malignancy, smoking. Treatment: decreasing penicillin sensitivity

Question 11

haemophilus influenza pneumonia - other conditions, antimicrobial susceptibility

Answer 11

Also causes febrile tracheobronchitis (cough, purulent sputum, fever but NOT pulm infiltrate on CXR). 36% are ampicillin resistant (b-lactamase)

Question 12

Staph aureus pneumonia - who is affected, toxin involved, sx, therapy

Answer 12

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

Question 13

Who should be suspected for M. tuberculosis pneumonia

Answer 13

subacute/ chronic pneumonia, immigrants, HIV-1+, lower SES

Question 14

who gets chlamydia trachomatis, chlamydia psittaci and chlamydia pneumoniae pneumonia

Answer 14

trachomatis: infants. Psittaci: birds and adults. Pneumoniae: young adults

Question 15

List the associations for the following bacteria which can cause pneumonia: Coxiella burnetti, Rickettsia rickettsii, yersinia pestis

Answer 15

Coxiella burnetti: farm animals and placenta. Rickettsia rickettsii: causes rocky mountain spotted fever, rash, April-June. yersinia pestis: causes the plague, rats, rodents, fleas

Question 16

List the important causes of fungal pneumonia

Answer 16

blastomycosis (blastomyces dermatitidis), histoplasma capsulatum, coccidioides immitis, pneumocystis jirovecii (AIDS), Aspergillus

Question 17

Which bacteria have the highest pneumonia mortality

Answer 17

legionella > s. pneumoniae, influenza A

Question 18

risk factors for community acquired pneumonia

Answer 18

smoking > cardiovascular dz > COPD > chronic alcoholism > malignancy > diabetes

Question 19

Tests for diagnosing pneumonia

Answer 19

CXR, O2 sat, CBC, Cr, LFT, blood culture/ gram stain. Sputum culture (no Abx yet), HIV test

Question 20

List the causes of pneumonia in elderly

Answer 20

s. pneumonia, H. flu, influenza

Question 21

list causes of pneumonia in young adult

Answer 21

Mycoplasma pneumoniae, chlamydophila pneumonia, strep pneumonia.

Question 22

List causes of pneumonia in AIDs

Answer 22

s. pneumonia, p. jirovecii.

Question 23

Pneumonia severity index

Answer 23

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

Question 24

CURB-65 scoring for pneumonia

Answer 24

Confusion, BUN > 19mg/dl, Resp. rate > 30/min, BP (sys 65. 1 point for each. The higher the points, the higher the mortality

Question 25

outpatient CAP treatment for previously healthy pt with no Abx within 3 months

Answer 25

Macrolide or doxycycline

Question 26

Outpatient CAP treatment with co-morbidities OR Abx within previous 3 months

Answer 26

Fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin). Beta lactam (amox/clav) plus macrolide

Question 27

Inpatient, non-ICU CAP treatment

Answer 27

Fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin). Beta lactam (tertiary cephalosporin) plus macrolide

Question 28

Inpatient, ICU CAP treatment

Answer 28

Beta lactam (cefotaxime, ceftriaxone or ampicillin-sulbactam) PLUS either azithromycin or fluoroquinolone

Question 29

CAP treatment if pseudomonas is a concern

Answer 29

anti-pseudomonal b-lactam: piperacillin-tazobactam, cefepime, imipenem or meropenem) PLUS ciprofloxacin or levofloxacin. OR antipseudomonal plus aminoglycoside plus azithromycin

Question 30

treatment of Hospital acquired pneumonia and ventilator acquired pneumonia.

Answer 30

Direct empiric therapy against gram negative rods (pseudomonas aeruginosa) and Staph aureus (MRSA)

Question 31

treatment of MRSA pneumonia

Answer 31

Linezolid for IV. Oral- TMP-SMX, mino/doxycycline or clindamycin

Question 32

treatment of influenza

Answer 32

oseltamavir

Question 33

types of pneumococcal vaccines and efficacy

Answer 33

1. 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

Question 34

Efficacy of influenza vaccines

Answer 34

Decreases illness by 60-80% in children/young adults. Decreases serious illness and death by 70% in elderly