Pneumonia Flashcards
What is the definition of community acquired pneumonia
Occurs before hospitalization or within 48 hours of hospital admission
The common pathogens involved in community acquired pneumonia are H. influenzae, staph aureus, klebsiella, mycoplasma, chlamydia, legionella, chlamydia psittaci and coxiella burnetii. What are the associations for H. influenzae, staph aureus, and klebsiella
H. Influenzae = COPD
Staph aereus = recent influenza
Klebsiella = alcoholism, diabetes
The common pathogens involved in community acquired pneumonia are H. influenzae, staph aureus, klebsiella, mycoplasma, chlamydia, legionella, chlamydia psittaci and coxiella burnetii. What are the associations for mycoplasma, chlamidya, and legionella
- ) Mycoplasma - young people
- ) Chlamidya - hoarseness
- ) legionella - contaminated water sources, air conditioning
The common pathogens involved in community acquired pneumonia are H. influenzae, staph aureus, klebsiella, mycoplasma, chlamydia, legionella, chlamydia psittaci and coxiella burnetii. What are the associations of chlamydia psittaci and coxiella burnetii
- ) Chlamydia psittaci: Birds
2. ) Coxiella burnetii: Animals at time of giving birth, veternarians, farmers
What are the most common symptoms of pneumonia
Fever and cough most common
Severe infections have dyspnea. You know its severe if abnormalities of vital signs of mental status. Dullness to percussion is found if there is an effusion
Bronchial breath sounds/egophony: If there is consolidation of air spaces
Chills or rigors are a sign of bacteremia
Chest pain that is pleuritic
What is the difference between bronchitis and pneumonia
Pneumonia has dyspnea, high fever, and an abnormal chest X-ray
What are the associations of klebsiella pneumonia, anaerobes, mycoplasma pneumonia, legionella, and pneumocystis
Klebsiella: Hemopytisis because necrotizing (currant jelly sputum)
Anaerobes: Foul smelling sputum
Mycoplasma: Dry cough with bullous myringitis
Legionella: GI symptoms and CNS symptoms
Pneumocystis: Aids with cd4 less than 200
Which infections cause dry cough and why do they cause dry cough
They cause dry cough because they infect the interstitium more
This includes mycoplasma, chlamidya (atypicals), viruses, coxiella (farmers) and pneumocystis (AIDS)
Will see bilateral interstitial infiltrates instead of consolidation
What is the best initial diagnostic test and the order of tests for pneumonia
Best initial: Chest X-ray
Next do sputum gram stain and sputum culture, even though doesnt work 50% of times
Also, atypical organisms (the ones with dry cough) infect cells intracellularly and go into interstitium and will not be seen in sputum cultures
Blood cultures only positive 15% of times but will be more from strep pneumo
When is a sputum gram stain allowed to be used
When more than 25 WBC and less than 10 epithelial cells
If pneumonia is severe, then you can elect to do a thoracentesis or bronchoscopy. What is the purpose of each
- ) Thoracentesis is used to analyze pleural effusion and see if empyema is present if diagnosis unclear. If LDH above 60% of serum and protein above 50%, then it is infected and should be drained with chest tube
- ) Bronchscoyp: Only if ICU, or if pneumocystis where therapy is critical and must figure this shit out
Treatment for pneumonia depends on whether you have the gram stain, and we need to decide outpatient and inpatient treatment. What is the criteria and classifications of outpatient treatment
Outpatient
Previously healthy in last 3 months and mild symptoms = macrolide or doxycycline
Comorbities or abx in last 3 months = fluoroquinolone
Treatment for pneumonia depends on whether you have the gram stain, and we need to decide outpatient and inpatient treatment. What is the criteria and classifications of inpatient therapy
Just either fluoroquinolone or ceftriaxone + azithromycin
What is the criteria for admitting a patient with peumonia
Severe disease: Hypotension, respiratory rate > 30, pO2 less than 60, and more
What vaccine should everyone above the age of 65 be given
Pneumococcal vaccine
Other reasons: Functional/anatomic asplenia, hematologic malignancy, immunosuppression
Do not give to healthcare workers
What is the definition of hospital acquired pneumonia
Pneumonia developing more than 48 hours after admission
More likely gram negative bacilli such as E. Coli or pseudomonas
What is the treatment for hospital acquired pneumonia
Because it is gram negative bacilli, macrolides are not the treatment anymore. Instead, give antipseudomonal and other medications
Antipseudomonal: Cefepime or piperacillin/tazobactam or carbapenems
Ventilator associated pneumonia is when you have a mechnical ventilation that interferes with mucociliary clearance of respiratory tract such as ability to cough. What are some hints to suggest that this is what is going on
Fever, new infiltrate, and purulent secretions coming out of endotracheal tube
In VAP, sputum culture is completely useless. What are diagnostic tests in order of accuracy and invaseness
- ) Tracheal aspirate using suction catheter
- ) Bronchoalveolar lavage: Bronchoscope placed deep into lungs where there should not be organisms, can contaminate - modify with protected brush specimen to avoid contamination from nasopharynx
- ) Video assisted thoracoscopy: Using scope through chest wall and getting biopsy (like endoscopy)
- ) Open lung biopsy - most accurate
What is the treatment for ventilator associated pneumonia
Combine 3 drugs
Cephalosporin or penicillin or carbapenem (same as HAP) + aminoglycoside or fluoroquinolone (not in HAP) + vanco or linezolid (incase meth resistant staph) However, if specific etiology is known, change abx treatment towards that
How does aspiration pneumonia happen and what can it lead to
It happens when someone is lying flat, someone aspirates with poor dentition and this can lead to abscess
Stroke, seizures, intoxication, and endotracheal intubation can also result in aspiration
They will have a large volume sputum that is foul smelling because of anaerobes
What is the diagnostic test used for aspiration pneumonia
Initial: Chest X-ray - shows cavity with air fluid level
Most accurate: Lung biopsy
What is the treatment for abscess from aspiration pneumonia
Clindamycin or penicillin
What is pneumocysti pneumonia, what is the most likely presentation on exam
PCP - P. Jiroveci that occurs exclusively in AIDS patients with CD4 counts
What is the initial test for pneumocystis pneumonia, and the best test
Best initial test: CXR showing bilateral INTERSTITIAL infiltrates/arterial blood gas showing increased A-a gradient (however, could be other interstitial processes as well)
Best test: Bronchoalveolar lavage
Stain positive means no further testing for sputum
LDH levels are always elevated, so if they’re not then this is not the answer
What is the treatment for PCP
TMP/SMX for treatment and prophylaxis
Steroids decreases mortality if PCP is severe, as in pO2 less than 70 and A-a gradient above 35
If toxicity (neutropenic or rash), switch to clindamycin/primaquine (unless G6PD deficiency) or pentamidine
What are prophylaxis treatments for PCP
1.) TMP/SMXIf rash/neutropenia, switch to atovoquone or dapsone
You can stop drugs if cells go above 200
