Pneumonia Flashcards
How does a virus enter the host for pneumonia?
Hemaggluttin attaches to cell surface glycan allowing it to enter
What would you see on lab test for a bacterial infection compared to viral infection?
Elevated CRP and procalcitonin
What are the three types of pneumonia that affect the lung?
Bronchopneumonia, lobar, interstitial
Why are individuals that have a decreased or absent spleen at risk for pneumonia?
They have a faulty alternate pathway (opsonization) of complement putting them at risk for encapsulated organism like pneumonia
Clinically important encapsulated bacteria?
S. pneumoniae, H. influenzae, N. meningitidis
What is the most common cause of pneumonia?
Streptococcus pneumoniae, (gram positive, diplococcus)
What is the most virulent type of haemophilus influenzae and what are its characteristics?
H. influenza type b (Hib). Gram negative, pleomorphic rod
Other types of invasive H. influenza include?
Bacteremia, meningitis, epiglottitis, cellulitis, infectious arthritis
S. aureus has a ____ complication rate and can lead to ______ in the lungs?
HIGH, lung abscesses, empyema (collection of pus and fluid), commonly seen following influenza infection
What type of pneumonia is seen in alcoholics? What are some of the signs?
Klebsiella pneumonia. Thick, blood tinged sputum
What bacteria commonly invades blood vessels and spreads beyond the lungs
Pseudomonas aeruginosa gram -
These patient present with GI symptoms of abdominal pain, nausea, diarrhea, and vomiting. They can have chest pain and neurological abnormalities. Fever present most the time.
Legionella pneumophilia
This type of pneumonia presents in children and young adults. They will have a cough but appear well. They can have pharyngeal injection and normal lung auscultation. Gradual onset, low grade fever, fatigue
Mycoplasma pneumoniae
Major signs of bacterial pneumonia?
Abrupt onset of fever, skaking chills, productive cough, hemoptysis, pleuritis causing pleuritic pain and pleural friction rub
Common microorganisms that cause pneumonia in tobacco users or COPD?
Streptococcus pneumonia, legionella pneumonia, H. influenzae
Common pathogen causing pneumonia in alcoholics?
Streptococcus pneumoniae, Klebsiella pneumoniae (alcoholics are klebc “clumsy”)
Common pathogen causing pneumonia in nursing home residents?
Streptococcus pneumonia, gram negative bacilli, staphylococcus aureus
What are some viral pathogen causing pneumonia?
Influenza virus, respiratory synctitial virus (RSV), parainfluenza virus, adenovirus, varicella
Two most common type of aspergillus and risk factors?
A. fumigatus and A. flavus. Immunosuppression, influenza A, transplant patients, AIDs patients
Encapsulated yeast that is found in pigeon dropings?
Cryptococcus
Found in the mississippi, ohio,, Missouri river valley?
Histoplasma capsulatum
Found in the soil of California, southwestern US, Mexico, Central/south america?
Coccidioides
Life threatening emergency in HIV+ patients?
Pneumocystis jirovecci
Common pathogens of nosocomial pneumonia?
E. coli (-), Klebsiella p. (-), Enterobacter (-), P. aeruginosa (-), acinetobacter (-), s. aureus (+), streptococcus (+)
What is the gold standard for diagnostic testing in pneumonia? What would you see?
Chest xray. Posteroranterior and lateral view. Will see consolidation which is normal air filled alveoli filled with pus and fluid.
When would you get a sputum culture?
ICU admission, failure of outpatient treatment, cavitary lesions, alcohol abuse, ALL nosocomial pneumonia pts
Bacteria responsible for bacteremia with pneumonia?
Streptococcus pneumoniae
What two bacteria will urinary antigen testing detect?
Streptococcus pneumonia and legionella pneumonia
If you suspect a Legionella infection, what two test should be performed?
Urinary antigen test and sputum culture
What kind of procalcitonin levels would you suspect with a bacterial and viral infection?
Increased in bacterial infections. Parenchymal cells release it in response to bacteria and toxins. Down regulated in response to viral infections.
What would you treat a patient who is healthy, no hx antibiotics last 3 months, no co-morbidities?
Macrolides. Azithromycin 500mg day 1, 250mg days 2-5. Clarithromycin 500mg BID x 5 days. OR Doxy 100mg BID x 5 days if macrolide resistance > 25% in the region
What would you treat CAP in an individual who has co-morbidities, on antibiotics last 3 months, lives in area where resistance is >25%.
Respiratory fluoroquinolone. Levofloxacin 750mg QD x 5 days, Moxifloxacin 400mg QD x 5 days, Gemifloxin 320 qd x days. Can combine beta lactam + macrolide (Augmentin 2mg BID + Clarithromycin 500mg BID x 5 days
Physical findings considered higher risk?
Altered mental status, RR >30, HR >125, BP104
Common CAP that require hospitalization?
Streptococcus pneumoniae, Legionella, gram - bacilli, S. aureus, influenza virus
Treatment for an individual who is hospitalized with CAP but not in ICU?
Fluoroquinoline: Levofloxacin 750mg or Moxifloxacin 400mg daily. OR Macrolide + pick 1 (Ceftriaxone, Cefotaxime, Ceftaroline, Ertapenem, Ampicillin-sulbactam)
Treatment for CAP who is hospitalized and in ICU
Respiratory fluoroquinolone or macrolide + 1 of following (Ceftriaxone, Cefotaxime, Ceftaroline, Ampicillin-sulbactam)
Unusual causes of pneumonia in children?
SARS, avian influenza, legionella, afebrile pneumonia
Manifestations of viral pneumonia in children?
Cough, wheezing, stridor
Manifestations of bacterial pneumonia in children?
Fever, chills, dyspnea
Manifestations of atypical pneumonia in children?
tachypnea, cough, crackles, possible conjunctivitis
Blood culture results for pneumonia?
viral- lymphocytosis
bacterial- WBC >20,000
Chlamydia trachomatis-eosinophilia
What pathogen would you be looking for in a urine antigen test for children?
Legionella, cytomegalovirus, enterovirus
Causes of recurrent pneumonia in children?
Cystic fibrosis, asthma, SCD, immunocomprimised, neutrophil dysfunction, immotile cilia, anatomic disorders
