Pneumonia Flashcards
What part of the respiratory tract is usually sterile
The lower respiratory tract (below the larynx)
How can infections reach the lungs
Inhalation, aspiration, direct inoculations and blood borne
Define pneumonia
A general term denoting inflammation of the gas exchange region of the lung. Usually it implies parenchymal lung inflammation caused by infection
Who can get pneumonia
All age groups
What do the circumstances of the illness include
Site of infection in the respiratroy tract Age of the patient community or hospital acquired Concurrent disease environemental and geographical factors severity of the illness microbiology of the pneumonia
What is the most common cause of primary pneumonia
Streptococcus pneumoniae
What is the most common cause of pneumonia in children under 2
Viruses (RSV)
What is the causative organism for the majority of cases in community acquired pneumonia
Streptococcus pneumonia
Define hospital acquired pneumonia
Pneumonia that develops 2 or more days after admission to hospital for some other reason
Are gram negative or gram positive organisms usually the causative organisms in hospital acquired pneumonia
Gram negative
Are gram negative or gram positive organisms usually the causative organisms in hospital acquired pneumonia
Gram negative
What 4 things can predispose to pneumonia and are associated with a greatly increased mortality
Alcohol misuse
Malnutrition
Diabetes
Underlying cardiorespiratory disease
Who is likely to develop aspiration pneumonia
Those with impaired swallowing or in patients with impaired consciousness
What organism is found in birds
Chlamydophila psittaci
What organism is found in farm animals
Coxiella burnetti
What organism is found in farm animals
Coxiella burnetti
What organism is found in contaminated water sources
Legionella pneumophila
What occurs in outbreaks every 4 years
Mycoplasma pneumoniae
How do we assess the severity of pneumonia
CURB 65 Confusion - new onset Urea >7 Respiratory Rate >30 BP systolic
What are the typical clinical features of pneumonia
Cough Purulent sputum Fever Pleuritic pain SOB
What are the typical clinical features of pneumonia
Cough Purulent sputum Fever Pleuritic pain SOB
What is often auscultated in the chest?
Crackles
Dullness
Bronchial breathing
If the CURB65 score is 2 where should the patient be treated
Hospital ward
When should the patient be treated in ITU
When the CURB 65 score is 3 or more
What should be tested in a patient with suspected pneumonia
Sputum cultures
serology samples
What are the general investigations performed for suspected pneumonia
CXR - confirms diagnosis form consolidation
Haematology and biochemistry - helpful in assessing the severity of the disease
Oxygenation - pulse oximetry. Those lower than 94% should have ABGs done
What PO2 is aimed for
> 8kPa
Who is chest physiotherapy useful for
Those with COPD with copious secretions
What is the treatment for community acquired pneumonia
500mg tds amoxicillin orally
What is the alternative for those allergic to penicillin
Doxycycline or clarithromycin
For severe pneumonia, what is the initial antibiotic treatment
IV Coamoxiclav 1.2g tds and clarithromycin 500mg bd
What is an appropriate alternative to co-amoxiclav
Cefuroxime
What is the appropriate treatment for hospital acquired pneumonia
combination of aminoglycoside (tobramycin) and a third generation cephalosporin (ceftazidime)
When should patient be switched from IV to oral antibiotics
When they are improving
When should patient be switched from IV to oral antibiotics
When they are improving
What are asplenic patients usually given
Pneumococcal vaccination and long term prophylactic phenoxymethylpenicillin
Who are advised to get the pneumococcal vaccination
Those 65 and above chronic lung disease diabetics renal and cardiac disease immunodeficient
What causes bronchopneumonia
Spread of infection into the lung parenchyma
What type of organism often occurs as a sequel to influenza
Staph aureus
Who is affected by Klesbiella pneumonia
Those who have imparied resistance to infection (alcohol misuse, malnutrition, diabetes) or underlying lung disease
What does Klesbiella pneumonia often show on an Xray
Lung tissue
Cavitation and abscess formation
Where does pseudomonas aeruginosa pneumonia come from
Endotracheal ventilation in ITU
How is the diagnosis made for organisms which are difficult to culture in the laboratory
Through rising antibody titre on serological tests
What is the treatment for organisms which are not sensitive to penicillins
Tetracycline or macrolide (clarithromycin)
How is mycoplasm pneumoniae spread
Infection through person to person by infected respiratory droplets
What are the 3 chlamydial species that cause respiratory disease
Chlamydophila psittaci
Chlamydophila pneumoniae
Chlamydia trachomatis
What are other symptoms of legionella pneymophila
Prostration confusion diarrhoea abdominal pain respiratory failure
How can we diagnose legionella
Antigen in urine
How do we treat legionella pneumonia
Combination of clarithromycin or a fluoroquinolone and rifampicin
How did the SARS coronavirus spread so quickly
Through airplane travel
Who should be offered HIV testing
Patients with a wide range of conditions, pneumonia, bronchiectasis, TB
What fungus can cause disease in immunocompromised individuals
Pneumocystis jirovecci
How does PCP typically present
As a subacute illness over a few weeks with cough, dyspnoea, fever, hypoxaemia, bilateral perihilar interstitial infiltrates on CXR
How is penumocystis pneumonia usually diagnosed
Confirmed by detecting Pneumocysstis jirovecii using a monoclonal antibody immynofluorescent technique on specimens obtained by sputum induction or by bronchoscopy and bronchoalveolar lavage
What is the treatment of PCP
High dose IV co-trimoxazole for 3 weeks
What do patients with moderate or severe PCP benefit from
THe addition of corticosteroids to reduce the pulmonary inflammation response
What are patients with HIV infection and impaired CD4 lymphocyte function highly susceptible to?
Developing reactivation of previously axquired latent TB and to contracting the disease from an exogenous source with rapid progression to active disease
Who does mycobacterium avium-intracellulare complex usually infect
Patients with advanced AIDS
What viruses might cause pneumonia in AIDS patients
Epstein-Barr, adenovirus , influenzae and herpes simplex
What is the commonest malignancy in HIV infected patients
Kaposi’s sarcoma
What is Pulmonary Kaposi’s sarcoma nearly always accompanised by
lesions in the skin or buccal mucosa
What do Kaposi’s sarcoma apeear as at bronchoscopy
Red or purple lesions
What is the treatment of Kaposi’s sarcoma
ANti-retroviral therapy (HAART) but also anti-neoplastic chemotherapy is needed
What presents as episodes of dyspnoea with pulmonary infiltrates, reduced gas diffusion and hypoxaemia
Interstitial pneumonitis
Who is lymphoid interstitial pneumonitis most commonly seen in
Children with HIV infection
How should patients be reviewed with pneumonia
Arrange a clinical review and chest X rays 6 weeks after discharge from hospital
Opportunistic infections develop when the CD4 count falls below what?
200/mm3
