Pneumonia Flashcards
What are characteristics of Pneumococcal pneumonia? Incidence? Who is it common in? Clinical features? What does it show on CXR?
Commonest bacterial pneumonia
Commoner in the elderly, alcoholics, post-splenectomy
Clinical features - fever, pleurisy, herpes labialis, rusty coloured sputum
CXR shows lobar consolidation
What are the characteristics of Staphylococcal pneumonia?
Who does it occur in?
Typical pathology?
Treatment?
May complicate influenxa infection or may occur in the young, elderly, IV drug users, or patients with unerlying disease e.g. CF/leukaemia
It causes bilateral cavitating bronchopneumonia
Treatment - flucolxacillin +/- rifampicin
What are the characteristics of Klebsiella pneumonia? Who does it occur in? Common symptom? Common pathology? Significance with treatment? Treatment?
Rare - occurs in the elderly, diabetics and alcoholics
Presents with red jelly sputum
Causes a cavitating pneumonia, particularly of the upper lobes
It is often drug resistant
Treat with cefotaxime or imipenem
What are the characteristics of Pseudomonas pneumonia?
Which conditions is it associated with?
What type of infection does it cause?
Common pathogen in bronchiectasis & CF.
It also causes hospital acquired infections
What are the characteristics of Mycoplasma pneumoniae?
Epidemiology
Symptoms?
Common CXR appearance?
Associated buzzword to do with haemolytic anaemia.
Occurs in epidemics every 3-4y
Presents with flu-like symptoms (headache, myalgia, arthralgia) followed by a dry cough
CXR - reticular nodular shadowing, or patchy consolidation, often of one lower lobe
Cold agglutinins may cause an autoimmune haemolytic anaemia
Complications include skin rash
What are the characteristics of Legionella pneumophilia? Where does it colonise? Pathogenesis? What disease does it cause? Extra pulmonary symptoms? CXR appearance? Urinalysis? What is diagnosis based on?
Colonises in air conditioning and dodgy water systems, causing outbreaks of Legionnaires disease
Invades alveolar macrophages and replicates
Flu-like symptoms precede a dry cough and dyspnoea
Extra pulmonary symptoms include anorexia, D&V, hepatitis, renal failure
CXR shows bi-basal consolidation
Urinalysis may show haematuria
Diagnosis - Legionella urine antigen/culture
What are the characteristics of Chlamydophila pneumonia?
Preceeding symptoms?
Person to person spread occurs causing a biphasic illness - pharyngitis, hoarseness, otitis, followed by pneumonia
What are the characteristics of Chlamydophila psittaci?
Typically acquired for affected birds
Symptoms include headache, fever, dry cough, lethargy,
What are the characteristics of viral pneumonia?
Rapidly progressive pneumonia acquired from birds
What does CURB65 stand for?
Confusion present
Urea (plamsa) > 7 mmmol/l
Respiratory rate >30/min
BP - systolic
What are complications of pneumonia?
Pleural effusion - inflammation of the pleura adjacent to the pleural space may cause this
Empyema - should be expected if a patient with a resolving pneumonia develops a recurrent fever
Lung abscess - clinical features include swinging fever, foul smelling sputum, pleuritic chest pain
Resp failure - type I (PaO2 )
80 yo man presents with bilateral cavitating bronchopneumonia after an influenza infection
Staph aureus
Headache, skin rash, dry cough, cold agglutinins, anaemia
Mycoplasma pneumoniae
Treatment for a 35-year-old patient on the ward admitted to hospital 10 days ago presents
with severe pneumonia.
IV ciprofloxacin
Treatment for a 40-year-old builder who presents with a severe community-acquired pneumonia.
Atypical pathogens are suspected.
IV cefuroxime + erythromycin
Treatment for a 22-year-old HIV-positive individual on anti-retroviral therapy presents with
Pneumocystis carinii pneumonia.
Oral tetracycline
Cold agglutinins
Mycoplasma pneumonia
What is the standard treatment for non-severe pneumonia?
Amoxicillin or clarithromycin for those allergic to penicillin
In which type of pneumonia is CRP usually normal?
Mycoplasma
How would you describe Strep pneumoniae microbiologically?
Gram-positive diplococci
How would you describe Staph aureus microbiologically?
Gram positive, commonly in clusters like a bunch of grapes
Buzzword for type of pneumonia presenting with pre-existing structural lung disease e.g. COPD, bronchiectasis
Haemophilus influenzae; Moraxella something
What type of pneumonia is more common in young men and is recognized cause of endocarditis?
Coxiella burnetti (Q fever)
What is a common opportunistic pathogen which causes pneumonia in the immunosuppressed; on long term corticosteroids; post organ transplantation?
Pneumocystic jirovecci
What type of pneumonia causes lung abscesses?
Staphylococcal pneumonia
Lung abscess What type of necrosis? What is it often caused by? Risk factor? Typical presentation? Sequence of events leading to it?
Liquefactive necrosis Caused by aspiration RF - alcoholism Presentation: - Weight loss - Lethargy, tiredness - Cough plus or minus sputum Sequence: pneumonia --> staph pneumonia --> cavitating pneumonia --> abcess
What antibiotics are given for empyema?
Amoxicillin and metronidazole
What is bronchopulmonary sequestration?
A piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary arterial blood supply, as is the case in normally developing lung. As a result, this sequestered tissue is not connected to the normal bronchial airway architecture, and as a result, fails to function in, and contribute to, respiration of the organism
Most common causative organism in COPD patient who develops pneumonia?
Haemophilus influenzae
Most common causative organism in patient with pneumonia who recently had influenza infection?
Staphylococcus aureus
