Pneumonia Flashcards
Define pneumonia
Lower respiratory tract infection, Esp during winter months Can imvolve trachea, (tracheitis) bronchi, (bronchitis) CAP, nosocomial Or those occuring in immunosupressed.
Inflammation of substance of lung. Classified by site- lobar, diffuse, bronchopneumonia. Or by ateliology. Bacterial, fungal, aspirations…
Or radiotherapy, allergic agents. Or ventilator associated( multiple organisms- Pseudomonas, Klebsiella, Acinetobacter.
Legionella- infected water tanks, air conditioning..
Whats the epidemiology of pneumonia?
CAP: 5-11 per 1000,
GP- 10-12 annually
22-42 CAP admitted to hosp, 5-10% require intensive therapy.
CAP mortality
Whats the pathogenesis of pneumonia?
Streptococcus pneumoniae commones CAP
Mycoplasma pneumoniae 2nd
Legionella spp. Ass with water systems in modern buildings
Staphylococcus Aureus- pneumonia- caused by influenza epidemics and has high mortality
Chem causes- aspiration pneumonia
What are the CFs of pneumonia?
CAP: acute illness, preceeded by symptoms of upper resp tract infc. Breathless, + cough, sputum production, rusty coloured in pneumococcoal pts. (Pus- neutrophils) assc wt leuritic chest pain.
Pneumonia caused by chlamydia + mycoplasma
More general: malaise, sweating, myalgia, arthralgia, + headaches.
Haemoptysis! ❌ in pneumonia, malignancy!!??
O/E of pneumonia?
Signs of lung consolidation:
Dullness to percussion, bronchial breathing, localaised inspiratory crackles.
Severe pneumonia- septicaemia, comfusion, hypotension. Rapid REsp rate.
How would you investigate pneumonia?
🔹bedside: Sputum: Gram stain(rapid indication) & culture
🔹Bloods:FBC, WCC, CRP, U+Es,
Blood cultures - done in hospital, before giving antibiotics.
🔹CXR- consolidations or pleural effusion (parapneumonic effusion)
Pleural fluid is aspirated, examined & cultured, and sent for cytology. -straw colour( parapneumonic)
🔸Urinalysis for sugar (diabetic?)
Blood for viral Serology and Legionella/Mycoplasma
Serology for pneumoccocoal antigen (blood, sputum and urine)
Rapid urine test available for Legionella.
Whats parapneumonic pneumonia?
1st stage- exudative state- low LDH, low WCC. Sterile pleural fluid rapidly accumulates in the pleural space. The pleural fluid originates in the interstitial spaces of the lung and in the capillaries of the viscera pleura due to increased permeability.
These effusions resolve with antibiotic therapy and chest tube insertion is not required. 2-5 days of the onsent of pneunonia. pH normal
Then bacterial invasion of pleural space–> accumulation of leukocytes, bacteria & cellular debris. Tendency towrds loculation + septations, pH inelastic membrane called pleural peel. Pleural fluid is thick–>untreated, will drain into the thoracic wall. Empyema thoracis necessitas
What happens in empyema thoracis?
May not be associated with pneumonic process
Eosophagela perforation, trauma, septicaemia, surgical procedure in pleura.
Last stage- 2-3 weeks to develop.
(Viscus pus with intense inflammatory rind; are enlarges through osmosis)
How do you asses pneumonia severity?
How ill is the pt?
CURB -65- 1 pt for each (5) assc wt ⬆️ risk of death
🔹Confusion: new disorientation in place, person and time
🔹Urea >7mmol/l –> multiorgan F & septicaemia.
🔹RR > 30/min: stromgly assc wt hypoxia & ⬆️ mortality
🔹BP: systolic 65
Score 0-1 treat as outpatients
2- admit
3+- often require ICU care.
Other markers for severe pneumonia:
CXR >1 lobe involved
PaO2 20x10.9/L)
Blood culture-+ve
Use of CURB-65
Score.
0-1: suitable for home treatment- chillin. (2% Low mortality)
2 : consider Nosocomial admission- intemediate (9%)
>~3 : Manage as severe pneumonia; asses for admission to ICU esp if 4-5. SHIT. High risk of death (22%)
How do we manage pneumonia?
Rest Fluids intake ⬆️ Not smoke Patacetamol for pleuritic pain Continuous O2 if saturation
How is non severe pneumonia treated at home?
Oral antibiotics: amoxicillin for 7 days or clarithromycin or levofloxacin for penicillin allergy.
hospital-treated severe pneumonia
I.V antibiotics coamoxiclav + clarithromycin + asses need for high- dependancy or intensive care.
What are some complications of pneumonia?
Fail to improve- alternative diagnosis?
LC or Poedema?
Uncomplicated parapneumonic effusions pH >7.2
Do not require drainage.
Complicated pleural eff (pleural fluid pH
How could we prevent pneumonia?
Annual influenza vaccine those at high risk from influenza & pneumonia (chronic lung, heart, liver diseases, DM, immunosupression or >65. )
Pneumococcoal polysaccharide at 2Y or older + >65Y.
