Pneumonia Flashcards
What is the definition of pneumonia (PNA)?
- infection of the pulmonary parenchyma
What are the types of PNA?
- community acquired (CAP)
- nosocomial/hospital acquired (HAP), healthcare associated (HCAP), ventilator associated (VAP)
- anaerobic PNA and lung abscess
- HIV related
- TB
What is the pathophysiology of PNA?
- increased microbial pathogens at alveolar level
- host’s inability to fight off said pathogens
How can microorganisms gain access to the lungs in PNA?
- MC: aspiration from oropharynx
- inhaled as contaminated droplets
- hematogenous spread
- extension from infected pleural or mediastinal space
What is the physiologic result of PNA?
- alveolar capillary leak results in an infiltrate and rales
- alveolar filling results in hypoxemia
- leakage of erythrocytes can lead to hemoptysis
What are the etiologies of CAP-typical?
- MC: S. pneumonia
- H. influenza
- S. aureus
- Klebsiella pneumonia
- P. aringinosa
What is CAP-atypical resistant to?
- beta-lactams (PCN, amoxicillin)
How does CAP-atypical present?
- zero to moderate sputum production
- no lobar consolidations
- only small increases in WBC
- few physical signs; patient looks better than symptoms/CXR suggest
What type of PNA is restricted to small areas rather than a whole lobe?
- CAP-atypical
What are the etiologies of CAP-atypical?
- MC: Mycoplasma pneumonia
- Chlamydia pneumonia
- Legionella spp
- Moraxella
- virus: flu, adenovirus, RSV
What is the patient population likly to be infected by the MC etiology of CAP-atypical?
- younger
Mycoplasma pneumonia
What is the patient population likely to be infected by C. pneumonia?
- outpatient
Chlamydia pneumonia
What is the patient population likely to be infected by Legionella spp?
- inpatients
What infection is associated with exposure to contaminated water droplets from cooling and ventilation systems?
- CAP-atypical Legionella
What are CAP-typical S&S?
- acute or subacute onset of cough w/ or w/o production
- dyspnea
- fever, chills, sweats
- chest pain
- hemoptysis
- GI complaints
- fatigue
- HA
- myalgias
- kids present with belly pain
What are CAP-atypical S&S?
- low grade fever
- relatively mild pulm symptoms
- myalgias & fatigue
T/F: CAP S&S in elderly patients are often discrete/obvious.
- False, subtle/vague
What are the common PE findings of CAP?
- fever
- tachypnea
- tachycardia
- hypoxia
- increased tactile fremitus
- egophony
- altered breath sounds
- dullness to percussion
What testing would an outpatient CAP patient get?
- CXR
What testing would an inpatient CAP patient get?
- POC diagnostic tests
- blood cultures
- ABG
- HIV testing
T/F: Treatment for CAP must with held until blood cultures return.
- false
What can be found on CXR for CAP patients?
- patchy airspace infiltrates
- lobar consolidation
- diffuse alveolar or interstitial infiltrates
- pleural effusion
When is a CT scan indicated for CAP patients?
- in severe, unresolving cases of PNA or complicated cases
What is the treatment for outpatient CAP?
- healthy w/o abx in last 3 mo: macrolide
- comorbidities or abx w/in 3 mo: fluoroquinolones OR b-lactam + macrolide
How can CAP be prevented?
- flu and pneumo vaccine
What is the outpatient f/u in CAP?
- 2-3d w/o improvement or sooner if sx worsen
- fever resolves in 2-4d
When is a repeat CXR taken for CAP?
- smokers
- elderly
What is the inpatient f/u in CAP?
- repeat CXR in 4-6w
What should be ? if relapse or recurrence of CAP, particularly in same segment of lung?
- underlying neoplasm
Define HAP
- sx after hospitalization for 48 hours
Define VAP
- PNA that has developed more than 48 hours following endotracheal intubation and mechanical ventilation
What are the common etiologies of HCAP/HAP/VAP?
- S. pneumo
- S. aureus
- P. aeruginosa: MC in ICU
- Klebsiella
- E. coli
- Enterobacter
- VRE
What are the S&S of HCAP/HAP?
- similar to CAP but may be nonspecific
- 2+ clinical findings in the setting of a new or progressiv pulm opacity on CXR
What test should be done for HCAP/HAP/VAP?
- gram stain & sputum culture
- blood cultures from 2 sites
- ABG/pulse ox
- CXR
What is the tx of HCAP/HAP/VAP?
- start empirical and modify with culture results
What is the cause of anaerobic PNA & lung abscess?
- aspiration into dependent lung zones
What is a dependent lung zone?
- based on body position at time of aspiration
Describe the onset of anaerobic PNA & lung abscess?
- insidious
What is the clinical presentation of anaerobic PNA & lung abscess?
- fever
- wt loss
- malaise
- cough w/ FOUL-SMELLING PURULENT SPUTUM
- poor dentition
What diagnostic tests should be done for anaerobic PNA & lung abscess?
- sputum culture
- CXR
What is the treatment for anaerobic PNA & lung abscess?
- abx
- drainage
_______ disease is one of the most frequent complications of _______.
- pulmonary
- HIV
What are the 3 MC AIDS defining illnesses?
- recurrent bacterial pneumonia
- TB
- Pneumocystis jiroveci
How does HIV related pneumonia present?
- nonspecific symptoms
- fever, cough, SOB
- unexplained wt loss
- hypoxia
What diagnostics should be done in HIV related PNA?
- sputum samples
- CXR
- CT scan
What will be seen on CXR in HIV related PNA?
- ground glass appearance
What is the tx for HIV related PNA?
- Bactrim (TMP/SMX)
- steroids when hypoxic
How long should tx be for HIV related PNA?
- 21d
What should follow HIV related PNA initial tx?
- prophylaxis with Bactrim or dapsone in all pts with CD4<200 or hx of PCP
What causes Tuberculosis?
- Mycobacterium tuberculosis
How is TB transmitted?
- airborne droplets
What are the risk factors for TB?
- HIV +
- foreign born
- disadvantaged populations
What are the stages of TB?
- primary
- primary progressive
- latent
- secondary/reactivation
Define primary TB
- clinically & radiographically silent
- granulomas form around organism to limit multiplication
How does TB present?
- slow, progressive, constitutional symptoms
- chronic cough
- patient appears ill & malnourished
What testing should be done for TB?
- culture
- CXR
What will be seen on CXR of primary TB?
- small, homogeneous infiltrates
- paratracheal LN enlargement
- Ghon & Ranke complexes
What is a Ghon complex?
- calcified primary focus
Whar is a Ranke complex?
- calcified primary focus & hilar LN
What is used to determine if someone has even been infected with TB?
- PPD/Mantoux test
What must be seen on a + TB test?
- transverse induration
What are the 4 major drugs used as 1st line tx for TB?
- Isoniazid
- rifampin
- pyrazinamide
- ethambutol
What is the tx regimen in HIV (-) TB(+)?
- 2mo of all 4 drugs
- 4 mo of isoniazid & rifampin
What is the tx regiment in HIV and TB (+)?
- similar to HIV (-) but longer
- direct observation therapy to increase pt compliance
