Pneumonia

Question 1

Clinical features (symptoms and signs) of mycoplasma pneumoniae.

Answer 1

Clinical signs:
Early onset of headaches and malaise
Fever, temp often greater than 39.5
Cough, however may not be obvious
On CXR:
Generally more likely to be lobar pneumonia. 
White blood cell count not raised. 
Diagnosis based on: raised antibody titre.

Question 2

Treatment of mycoplasma pneumoniae.

Associated complications of mycoplasma pneumoniae.

Answer 2

erythromycin 500mg- 4 times daily. For a week to 10 days.
Unlikely, however myocarditis and pericarditis may occur.
Rashes and erythema.

Question 3

Clinical signs of Staphylococcus aureus pneumoniae.

Answer 3

Clinical signs:
Breathlessnes
Cough
Other general pneumonia signs e.g. pleuritic pain

Chest X-ray may show abscess formation and cysts. This is characteristic of staph. aureus.
Consolidation.

Question 4

Treatment of staph- aureus.

Answer 4

Patient will be acutely unwell therefore use flucloxillin 1g I.V every 6 hours. Also possibly add sodium fusidate 500mg every 8 hours.

Question 5

Clinical signs of chlamydia psittaci.

Answer 5

CONTACT WITH BIRDS, especially the parrot family.
Symptoms include malaise, fever, cough and muscular pains. Occasionally an enlarged liver or spleen may occur.
Chest X-ray shows diffuse or segmental pneumonia.
Diagnosis confirmed by a rising titre of complement fixing antibody.

Question 6

Treatment of chlamydia psittaci.

Answer 6

Tetracycline or macrolides.

Question 7

Clinical signs of chlamydia pneumoniae.

Answer 7

Presents as normal pneumonia symptoms e.g. cough, fever, malaise.
Hard to distinguish between this and the c. psittaci and c. trachomatis. Need to do an microimmunoflourescence test.

Question 8

Treatment of chlamydia pneumoniae.

Answer 8

erythromycin or tetracycline.

Question 9

Streptococcus pneumoniae

Answer 9

Acute onset, often preceded by flu like symptoms, cough with rust coloured sputum.
High fevers and pleuritic chest pain common.
Bacteraemia more common in females, excess alcohol, dry cough and COPD, diabetes and HIV

Question 10

Mycoplasma pneumoniae

Answer 10

Usually mild disease in young patients; occurs in cycles every 3-4 years. Usually prominent extrapulmonary symtpoms (headache, malaise, myalgia)
Complications common: Haemolytic anaemia, erythema multiforme, hepatitis, meningoencephalitis

Question 11

Legionella spp. (legionaires disease)

Answer 11

Usually legionella pneumophila but other species implicated in around 10% of cases.
Causes more severe disease with need for early intensive care. Usually acfquired by inhaling water mist containing bacteria. Neurological symptoms frequently seen, along with GI involvement and deranged liver enzymes, elevated creatine kinase.