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MODHIII - Unit 3 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

How does pneumonia rank on the cause of death for world and US

A
  • 3rd most common cause of death in the world

- 6th leading cause of death in US: 50,000 in 2010

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2
Q

Number of cases of community acquired pneumonia (CAP) per year

A

5 million

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3
Q

Outpatient vs. Inpatient pneumonia stats

A
  • 80% treated as outpatients & 20% as inpatients

- mortality rate among outpatients

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4
Q

Types of pneumonia

A
  • community acquired pneumonia (CAP)
  • hospital acquired pneumonia (HAP)
  • healthcare associated
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5
Q

Mechanisms of lung to defend against pathogens

A
  • nasal vibrissae and turbinates capture large inhaled particles
  • gag reflex and cough protect from aspiration
  • branching of tracheobronchial tree traps microbes in airway
  • mucociliary escalator sweep entrapped contents up to oropharynx
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6
Q

Role of normal flora that is typically adherent to mucosal cells of oropharynx

A
  • prevent pathogenic bacteria from binding & decreases risk of pneumonia caused by more virulent bacteria
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7
Q

What occurs when barriers are overcome

A
  • alveolar macrophages phagocytize and destroy pathogens
  • if not killed, pathogens are eliminated via mucociliary elevator or lymphatics
  • macrophages release cytokines & chemokines (TNF, IL-8) and leukotriene B4, which recruit neutrophils from blood stream to alveolar spaces, where they uptake and degrade microorganisms
  • specific IgG bind surface of organisms and augment the ability of neutrophils and macrophages to phagocytize the bacteria
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8
Q

How can pathogens reach the lungs

A
  • microaspiration of oropharyngeal contents
  • inhalation of small aerosolized droplets that contain microorganisms
  • consequence of a bloodstream infection/hematogenous spread
  • direct spread from adjacent structures
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9
Q

Most common route to acquire pneumonia

A
  • microaspiration of oropharyngeal contents
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10
Q

Microorganisms associated with microaspiration of oropharyngeal contents

A
  • strep pneumonia, haemophilus influenzae
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11
Q

Microorganisms associated with inhalation of small aerosolized droplets

A
  • mycobacterium tuberculosis, and viral infections
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12
Q

How do patients typically present

A
  • fever, cough, sputum, leukocytosis, radiographic infiltrate, crackles, hypoxemia, hemoptysis, respiratory alkalosis, dyspnea
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13
Q

What causes fever in pneumonia

A
  • IL-1 & TNF
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14
Q

What causes leukocytosis and increased purulent secretions

A
  • chemokines (IL-8, GCSF) stimulate release and migration of neutrophils to the lung
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15
Q

What causes radiographic infiltrate, crackles, and hypoxemia

A
  • inflammatory mediators create alveolar capillary leak
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16
Q

What causes respiratory alkalosis

A
  • increased respiratory drive in the inflammatory response syndrome
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17
Q

What causes dyspnea

A
  • decreased compliance due to capillary leak, hypoxemia, increased respiratory drive, increased secretions, and infection related bronchospasm
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18
Q

What does pneumonia patient become hypoxemic

A
  • alveoli become filled with purulent secretions, which leads to shunts
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19
Q

Steps to diagnosing pneumonia

A
  1. evidence of infection: fever, chills, leukocytosis
  2. signs/symptoms localized to the respiratory system: cough, increased sputum, SOB, angina, abnormal pulmonary exam
  3. new infiltrate on chest radiograph
20
Q

Organisms associated with typical pneumonia presentation

A
  • S. pneumonia, haemophilus influenzae, S. aureus
21
Q

Organisms associate with atypical pneumonia presentation

A
  • mycoplasma pneuminae, chlamydia pneumoniae, legionella
22
Q

Organisms associated with travel to central US

A

histoplasma capsulatum

23
Q

Physical exam findings with pneumonia patient

A
  • use of accessory muscles of respiration
  • increased tactile fremitus with dull percussion reflecting consolidation
  • crackles, bronchial breath sounds, pleural friction rub
24
Q

Physical exam sensitivity and specificity

A
  • sensitivity: 58%

- specificity: 67%

25
Q

What is needed to diagnose pneumonia

A

Chest Radiograph

26
Q

Purpose of chest radiograph

A
  • establish diagnosis of pneumonia
  • differentiates pneumonia from other conditions
  • assesses extent of involvement of lungs
  • occasionally suggest an etiologic diagnosis
27
Q

Possible microbiologic work ups for pneumonia

A
  • sputum gram stain and culture
  • blood culture
  • urinary antigen tests
  • PCR
  • Serology
28
Q

Sputum gram stain and culture: adequacy

A
  • to be adequate: >25 neutrophils,
29
Q

Limitations of sputum gram stain and culture

A
  • 30% of patients have non productive cough
  • only 14% can provide an adequate sample
  • 15-30% already received antibiotics
30
Q

Blood culture: CAP stats

A
  • 5-14% of blood cultures from patients hospitalized with CAP are positive
31
Q

Blood culture: hematogenous staph aureus pneumonia stats

A
  • nearly always positive blood culture

- positive in only about 25% of cases in which inhalation or aspiration is responsible for the CAP

32
Q

How often can specific microbiologic cause be established

A

50%

33
Q

How antibiotic treatment is chosen

A
  • pathogen is identified

- empiric treatment

34
Q

Factors that effect antibiotic chosen for treatment

A
  • comorbidities, immunosuppression
  • risk factors for multidrug resistant pathogens (MDR): hospital workers
  • resistance patterns
  • environmental exposures
35
Q

Importance of timing of treatment

A
  • interval of more than 4 hours b/w initial presentation and first antibiotic dose is associated with increased in hospital mortality
36
Q

Treatment for patients stable enough to be treated as outpatients

A
  • treated empirically
  • cause of infection not sought b/c of substantial cost of testing
  • choose antibiotic which covers most common organisms
37
Q

Treatment for patients being admitted to the hospital

A
  • guidelines recommend empirical therapy with broader spectrum antibiotics
  • test for microbial diagnosis
38
Q

What if influenza is active in the community

A
  • antiviral treatment is recommended as soon as possible for all patients with suspected or confirmed infection
39
Q

Pneumonia prevention

A
  • pneumococcal vaccination
  • influenza vaccination
  • smoking cessation
40
Q

Pneumococcal vaccine

A
  1. pneumovax

2. prevnar

41
Q

Pneumovax

A
  • 23 valent polysachharide
  • covers 88% of strains causing bacteremia/meningitis
  • indicated for elderly or patients with chronic health conditions
42
Q

Prevnar

A
  • 13 different strains

- indicated for elderly

43
Q

Influenza vaccination

A
  • 20,000 deaths annually
  • prevention is most effective management strategy
  • everyone 6 months of age and older should get vaccine every season
44
Q

Importance of pneumococcal vaccine

A
  • key to prevent INVASIVE pneumococcal disease
45
Q

What is the most common infectious cause of death in the world

A

pneumonia

MODHIII - Unit 3 (20 decks)

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