Pneumonia Flashcards
initial phase of pneumonia
presence of a proteinaceous exudate and often of bacteria in the alveoli
edema,
initial phase of pneumonia
presence of bacteria—in the alveoli
edema,
presence of erythrocytes in the cellular intraalveolar exudate; neutrophil influx
red hepatization
no new erythrocytes are extravasating, and those already present have been lysed and degraded
gray hepatization
the macrophage reappears as the dominant cell type in the alveolar space, and the debris of neutrophils, bacteria, and fibrin has been cleared, as has the inflammatory response
resolution,
the macrophage reappears as the dominant cell type in the alveolar space, and the debris of neutrophils, bacteria, and fibrin has been cleared, as has the inflammatory response
resolution
pattern is most common in nosocomial pneumonias
bronchopneumonia
more common in bacterial CAP
lobar pattern
pattern is most common in nosocomial pneumonias
bronchopneumonia
pattern more common in bacterial CAP
lobar pattern
Exposure to birds
Chlamydia psittaci
Exposure to rabbits
Francisella tularensis
Exposure to sheep, goats, parturient cats
Coxiella burnetii
Local influenza activity
Influenza virus, S. pneumoniae, S. aureus
Stay in hotel or on cruise ship in previous 2 weeks
Legionella spp.
Travel to Southeast Asia
Burkholderia pseudomallei, avian influenza virus
Travel to southwestern United States
Hantavirus, Coccidioides spp.
Travel to Ohio or St. Lawrence river valley
Histoplasma capsulatum
Lung abscess
CA-MRSA, oral anaerobes, M. tuberculosis, endemic fungi, atypical mycobacteria
Lung abscess
CA-MRSA, oral anaerobes, M. tuberculosis, endemic fungi, atypical mycobacteria
To be adequate for culture, a sputum sample must__
> 25 neutrophils and
yield of positive cultures from sputum samples is
50%.
sensitivity and specificity of the findings on physical examination
58% and 67%, respectively
curb
confusion (C); urea >7 mmol/L (U); respiratory rate 30/min (R); BP (90/60 mmHg) (B); age 65 years (65)
curb scoring
0: 30-day mortality rate is 1.5%, can be treated outside the hospital.
2: the 30-day mortality rate is 9.2%: admitted to the hospital
most important risk factor for antibiotic-resistant pneumococcal infection
se of a specific antibiotic within the previous 3 months
Bacteria are occasionally seen in pathologic specimens collected during this phase
red hepatization
necrotizing pneumonia
MRSA
necrotizing pneumonia
MRSA
antibiotics active against atypicals
macrolide
fluoroquinolone
tetracycline
possible cause
Structural lung disease (e.g., bronchiectasis)
P. aeruginosa, Burkholderia cepacia, Staphylococcus aureus
possible cause
Dementia, stroke, decreased level of consciousness
Oral anaerobes, gram-negative enteric bacteria
possible cause
Lung abscess
CA-MRSA, oral anaerobes, endemic fungi, M. tuberculosis, atypical mycobacteria
possible cause
Lung abscess
CA-MRSA, oral anaerobes, endemic fungi, M. tuberculosis, atypical mycobacteria
RF for CAP
alcoholism, asthma, immunosuppression institutionalization, age of 70 years versus 60-69 years
Risk factors for pneumococcal pneumonia include
dementia, seizure disorders, heart failure, cerebrovascular disease,
alcoholism, tobacco smoking, COPD, and
HIV infection.
“losing head and heart over vices”
particular problem in patients with severe structural lung disease, such as bronchiectasis, cystic fibrosis, or severe COPD.
P. aeruginosa
RF: diabetes, hematologicmalignancy, cancer, severe renal disease, HIV infection, smoking, male gender, and a recent hotel stay or ship cruise.
Legionella
nfect patients who have recently been hospitalized and/or received antibiotic therapy or who have comorbidities such as alcoholism, heart failure, or renal failure
Enterobacteriaceae
% of cultures of blood from patients hospitalized with CAP are positive
5-14%
The sensitivity and specificity of the Legionella urine antigen test
90% and 99%
The pneumococcal urine antigen test sensitivity and specificity
80% and >90%
When to drain pleural fluid
pH 1000 U/L
(+) bacteria
CXR pneumonia resolution
4-12 weeks
Empirical RX HCAP:
Patients without Risk Factors for MDR Pathogens
Ceftriaxone
Ampisul
Moxifloxacin/ciprofloxacin / levofloxacin/
Ertapenem
Empirical RX HCAP:
Patients WITH Risk Factors for MDR Pathogens
B Lactam (Ceftazidime/Piptaz/Imipenem/Meropenem) Gram neg (Genta/Tobra/Cipro) Gram positive (Linezolid/Vancomycin)
standard recommendation for patients with risk factors for MDR infection
three antibiotics: two directed at P. aeruginosa and one at MRSA
VAP caused by MRSA is associated with ___ clinical failure rate when treated with standard-dose vancomycin
40%
preferred agent in patients with renal insufficiency and in those infected with high-MIC isolates of MRSA
Linezolid
