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Infectious Disease Unit 2 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is the definition of pneumonia?

A

Pneumonia is an infection of the pulmonary parenchyma from the alveoli

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2
Q

What are the differential diagnoses of respiratory infections?

A 
Sinusitis
Pharyngitis
Bronchitis
COPD exacerbation
Pneumonia
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3
Q

What is the typical presentation of pneumonia?

A

Systemic symptoms:
Acute onset, fever, tachypnea

Respiratory symptoms:
Cough, purulent sputum, lung consolidation

Chest X-ray:
Infiltrate (Lobar = typical, patchy/diffuse = atypical)

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4
Q

What are the three settings that pneumonia cases are categorized by?

A 
Community acquired (acute or sub-acute)
Healthcare Associated (eg, nursing homes)
Hospital/Ventilator acquired (nosocomial)
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5
Q

What are the common signs and organisms of typical CA-pneumonia?

A
  • Purulent sputum
  • Gram’s stain may show organism (60%)
  • Lobar infiltrate on CXR

Pneumococcus
H. influenza
Moraxella catarrhalis
S. aureus (CA-MRSA)

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6
Q

What are the common signs and organisms of atypical CA-pneumonia?

A
  • Cough prominent, ± purulent sputum
  • Gram’s stain with PMNs, but few organisms
  • Patchy or diffuse infiltrate on CXR

Mycoplasma pneumonia
Chlamoydophila pneumoniae
Legionella pneumophila
Influenza; RSV, adenovirus

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7
Q

What are common fungal causes of pneumonia?

A 
Histoplasmosis, 
Blastomycosis, 
Coccidiomycosis, 
Apergillus)
(not Candida- lower virulence; “less bad bug”)
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8
Q

What bacteria are commonly associated with aspiration pneumonia?

A

Anaerobes (only with aspiration)

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9
Q

What are some non-infective causes of pneumonia?

A 
Reactive (chemicals, drugs, Farmers' lung); 
Radiation;
Autoimmune; 
infiltrative cancer; 
congestive heart failure
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10
Q

What is the definition of HCAP and what are some common bacterial agents?

A

Nursing home;
Hospital, dialysis, Chemo in 30 days,
hosp. in 180d

  • Less S. pneumo,
  • atypicals (x/c influenza) (Mycoplasma pneumonia,
    Chlamoydophila pneumonia, Legionella pneumophila, RSV, adenovirus), ± H. flu
  • Some GNR and Staphylococcus aureus
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11
Q

What is the definition of HAP/VAP and what are some common bacterial agents?

A

Hospital-acquired (HAP) or ventilator-associated (VAP)

  • Little pneumococcus and few atypicals
  • GNR (inc. Ps. aeruginosa) and Staphylococcus aureus prominent
  • Increased Multi-drug resistance (MDR) (e.g., GNR, MRSA)
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12
Q

What are the symptoms, risk groups, and anti-microbial susceptibility of pneumococcal pneumonia?

A

Classic presentation of community-acquired pneumonia (acute, local, alveolar, sputum)

Risk groups:
- Elderly - Alcoholism - Liver disease - Hematologic malignancy - Immunosuppression (esp. HIV-1) - Smoking

Antimicrobial susceptibility:

  • Increasing incidence of decreased penicillin susceptibility (5-25%) (may not affect response to therapy of pneumonia)
  • Penicillin-resistance associated with multiple drug resistance
  • Other streptococci - Group A β streptococci (acute, very ill, pleural effusions)
  • Not Enterococcus (less bad bug; limited virulence)
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13
Q

What are the symptoms, risk groups, and anti-microbial susceptibility of H. influenza pneumonia?

A

Symptoms:
cough, purulent sputum, fever, but NO PULMONARY INFILTRATE on CXR
- 2nd most common of “typical” pneumonia
- Invasive adult disease often caused by non-encapsulated strains (50%) (non-type b)
Antimicrobial susceptibility:
- 36% ampicillin-resistant (b-lactamase)

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14
Q

What are the symptoms, risk groups, and anti-microbial susceptibility of S. aureus pneumonia?

A

Symptoms:

  • Increased severity; necrotizing pneumonia, shock, abscess, empyema, respiratory failure
  • Virulent organisms with significant tissue injury;

Risk groups:

  • Often in children, Native Americans; gay men; crowding (jail, barracks); HIV; homeless youth
  • May follow and complicate influenza

Therapy:
IV – Linezolid, Vancomycin,; Not daptomycin (binds surfactant and inactivated)
Oral – TMP-SMX, mino/doxycycline, + clindamycin
- Classically health-care-associated MRSA are more MDR organisms

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15
Q

What are three causes of atypical pneumonia?

A

Mycoplasma pneumonia:
- “walking pneumonia;” CXR worse than pt.

Chlamydia pneumoniae (TWAR)

Legionella pneumophila:

  • Regional; Uncommon in Colorado - Suspect if immunocompromised,
  • Sputum culture - low yield (@ 10%); urine antigen is best test (> 70% if type 1)
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16
Q

What are some pulmonary and infectious complications of CAP?

A 
Pulmonary complications: 
Effusion 
Respiratory failure 
Cavitation 
Pneumothorax 
Pulmonary embolism 
Infectious complications:
Nosocomial
Empyema
Arthritis
Abscess
Endocarditis
17
Q

What tests are appropriate for patients hospitalized with CAP?

A
  • CXR
  • O2 SAT (if ↓, ABG)
  • CBC
  • Cr, LFT
  • Blood culture
  • Gram’s stain, culture of sputum, ± AFB and culture, tests for Legionella (culture, DFA test, or urinary antigen assay), and measurement of mycoplasma IgM
  • Pleural-fluid analysis*
  • HIV (if 15-54 y.o.)
18
Q

What are the parameters of the CURB-65 criteria?

A 
Age at or above 65 years
Confusion
BUN above 19 mg/dl
Respiratory Rate at or above 30/min
BP - hypotension (Less than 90 or diastolic less than 60)

Score of 2 = hospitalization
Score of 3+ = ICU

19
Q

What drugs should be prescribed for pneumonia in a previously healthy patient with no antibiotic use in the past three months?

A

Macrolides (Azithromycin, Clarithromycin, Erythromycin)
and
Doxycycline

20
Q

What drugs should be prescribed for pneumonia in a patient with significant co-morbidities or antibiotic use in the past three months?

A

Fluoroquinolone (Moxifloxacin, gemifloxacin, levofloxacin)
or
B-Lactam plus a Macrolide

21
Q

What drugs should be prescribed for pneumonia in an in-patient (non-ICU)?

A

Fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin)
or
B-Lactam plus a macrolide

22
Q

What drugs should be prescribed for pneumonia in a patient in the ICU?

A

B-Lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam)
plus either
azithromycin or fluoroquinolone

23
Q

What drugs should be prescribed for pneumonia in a patient where pseudomonas is suspected?

A

Anti-Pseudomonas B-lactam (Pip-Taz, Cefepime, imipenem, meropenem)
+/- amino glycoside and azythromycin
or
+/- amino glycoside and anti-pneumococcal fluoroquinolone

24
Q

What drugs should be prescribed for pneumonia in a patient where MRSA is a concern?

A

Add vancomycin or linezolid to therapy

25
Q

Four methods to prevent community acquired pneumonia?

A

Limit - Aspiration, Smoking / Environmental smoke exposure (esp. cooking in home)
Vaccine – S. pneumoniae; H. influenza b; Influenza
Passive Immunity – RSV
Antimicrobial – Influenza (oseltamavir)

26
Q

What are the two pneumococcal vaccines?

A

1) 23-valent polysaccharide for adults;

2) 13-valent conjugate (Prevnar) for children

27
Q

What is a significant limitation of the adult pneumococcal vaccine?

A

It does not prevent pneumonia. Only effective against bacteremia.

28
Q

How are influenza vaccines indicated for?

A

Indicated for patients with high-risk conditions, in
chronic care facilities, healthy ≥ 65 years; almost everyone
- Medical care personnel – protect yourself, protect patients
Asymptomatic people can transmit to others
Decreased illness - 60-80% in children/young adults; 30% institutionalized elderly
Decreased serious illness and death: About 70% in elde

29
Q

What are the advantages of the childhood pneumococcal vaccine?

A
  • Reduces colonization
  • Reduces bacteremia >90%
  • Reduces bacterial pneumonia
  • ≤ 37% in African children
  • Some reduction in serious otitis and meningitis

Infectious Disease Unit 2 (22 decks)

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