Pneumonia Flashcards
Difference between pneumonia and pneumonitis
pneumonia - INFECTION of lung parenchyma by bacteria, viruses, fungi, and parasites
pneumonitis - INFLAMMATION of lungs from NON-INFECTIOUS causes such as autoimmune, chemicals, blood, or radiation
Most common mechanism triggering pneumonia
upper airway colonization by pathogenic organisms that are then aspirated
most common viral causes of community acquired pneumonia (CAP)
influenza A and B, parainfluenza, adeno, RSV
most common bacterial causes of CAP
s pneumo (most common), h influenza (often seen with underlying COPD), moraxella catarrhalis
rust colored sputum, fever, shaking chills, lobar infiltrate on chest xray…
PNEUMOCOCCAL PNEUMONIA
bacterial causes of atypical pneumonia
mycoplasma pneumoniae, chlamydia pneumoniae, legionella + different viruses
most common in adolescents and adults, whereas typical is more common in very old and young
How do atypical organisms present on xray
bilateral diffuse infiltrates rather than focal lobar infiltrates (seen in typical)
Risk factors for health acquired pneumonia
hospitalization within 90 days, home infusion therapy, dialysis, living at nursing home
Causative organisms for health acquired pneumonia
everything that causes CAP + gram negative aerobes (pseudomonas, klebsiella, acinetobacter) and gram positive cocci (staph aureus). MRSA getting more common
symptoms of pneumonia
productive cough, fever, pleuritic chest pain, dyspnea
pneumonia that is abrupt onset or abruptly worsening
pneumococcal pneumonia
pneumonia + diarrhea, hyponatremia, elevated liver enzymes, and/or older patients
legionella
common cause of post influenza pneumonia
staph aureus
physical exam findings of pneumonia
tachycardia, tachypnea, fever, hypotension, low o2 sat
rhonchi/rales on lung exam
egophony (focal lung consolidation)
dullness to percussion (pulmonary effusion)
What confirms dx of pneumonia and should be done in all patients suspicious of pneumonia?
CHEST X RAY (WILL SEE INFILTRATES)
but absence of infiltrate does not rule out pneumonia
bilateral “ground glass” infiltrate
pneumocystis jiroveci often seen in AIDS patients
apical consolidation on xray
TB
Where is pneumonia caused by aspiration of GI contents seen?
RLL because of branching bronchial tree
Other testing indicated in pneumonia
CBC, chem panel, blood/sputum culture (low sensitivity)
What test can confirm legionella
urine antigen testing
How to tell if patient with pneumonia can be managed inpatient vs outpatient
use a prediction scoring system!
CURB-65 (CAP)
pneumonia severity index (PSI/PORT score)
low risk = classes 1, 2 can be treated outpatient
high risk = classes 3-5 inpatient
Risky lab findings in pneumonia
low pH, low sodium, low Hct, low o2 sat, high glucose, high BUN, pleural effusion on xray
empiric treatment of CAP in healthy persons for outpatient
macrolide (clarithro/azithromycin) or doxy
Treatment for patient with comorbidities like DM or heart/lung disease
flurouinolones (levofloxacin, moxifloxacin) or combo of b-lactam (high dose amox, augmentin) plus macrolide
When should patient being treated outpatient return for follow up?
3-4 days, since no clinical improvement in 5-7 days can indicate bronchogenic carcinoma which can present with typical pneumonia
how to treat pseudomonas pneumonia
pipercilin tazobactam (ZOSYN) plus fluroquinolone
how to treat MRSA pneumonia
vanc
How long does treatment usually last in CAP vs heatlh care acquired
depends on severity of symptoms
CAP 5-10 days (or 3 days afebrile)
HAP - two-3 weeks
complications of pneumonia
bacteremia, parapneumonic pleural effusion, empyema, (may need to do thoracentesis of too much fluid)
Who should get pneumococcal vaccine?
everyone over 65, adults with chronic cardiopulm diseases, cigarette smokers, immunocompromised
use 23 polysaccharide vaccine in adults 65 an dolder in addition to 13-valent conjugate vaccine.
What other vaccine can you get to reduce risk of pneumonia
influenza! (prevents secondary pneumonia)
