Pneumonia Flashcards
CAP
acute, patient was not hospitalized or in long term care facility within the last 14 days or more before presentation
Typical , Atypical
HCAP
in hospital for 2 or more days within last 90 days
HAP
patient with infection occurring 48 or more hours after hospital admission
hospitalized for something different like HA or MI or stroke
VAP
patient with infection occurring 48 or more hours after endotracheal intubation
they are intubated or on a ventilator
Pediatric pneumonia
CAP
CAP typical pathogens
- Strep pneumo
- Haemophilus influenzae
- M. cat
CAP atypical pathogens
- Mycoplasma pneumonia
- Chlamydia
- Legionella
CAP - outpatient organisms and tx
Strep pneumo
Mycoplasma pneumonia
previously healthy then give them MACROLIDE (axithromycin, clarithromycin) OR DOXYCYCLINE
if other comorbids give fluoroquinolones ( levofloxacin, moxifloxacin), azithromycin + augmentin, cefuroxime
follow up 1 week
CAP - hospitalized - organisms and tx
S. pneumo
M. pneumo
fluoroquinolones ( levofloxacin, moxifloxacin)
consider macrolide + ceftriaxone
CAP hospitalized ICU bed organisms and tx
s. pneumo
staph
legionella
fluoroquinolones ( levofloxacin, moxifloxacin) + beta lactam -(ampicillin,ceftriaxone)
consider: fluoroquinolones (levofloxacin, moxifloxacin) + clindai
HCAP - organisms and tx
s. pneumo
h. flu
potentially drug resistant
OUTPATIENT: fluoroquinolones ( levofloxacin, moxifloxacin)
consider: macrolide + augmentin
HAP - organisms
s. pneumo
h. flu
staph
pseudomonas
ADMISSION:
EARLY/LOW RISK - fluoroquinolones ( levofloxacin, moxifloxacin)
consider ceftriaxone or Unasyn
LATE/HIGH RISK - cefepime pr pipercillin-tazobactam, levofloxacin + vancomycin (MRSA coverage)
VAP - organisms and tx
s. pneumo
h. flue
staph
pseudomonas
acinetobacter
stenotrophomonas maltophilia
< tx is same as high risk/late HAP>
Aspiration pneumonia and tx
anaerobes - fusobacterium, bacteroides
clindamycin - best for mixed flora in the mouth
consider: augmentin and Imipenem - carbapentum
Neonate - just born (pediatric pneumonia) - organism and tx
Group B strep
listeria
2/3 women have it (try and treat mom before baby comes out)
amoxicillin or ceftriaxone
1-3 month (pediatric pneumonia) - organisms and tx
Chlamydia
s. pneumo
amoxicillin or ceftriaxone
3m-5y (pediatric pneumonia) - organisms and tx
s. pneumo
mycoplasma (atypical starts to creep up)
amoxicillin or ceftriaxone
but macrolide for mycoplasma
5-18 years (pediatric pneumonia) - organisms and tx
mycoplasma
s.pneumo
macrolides
CAP Typical H & P
fever
cough
dyspnea
chest pain pleuritic
CAP Atypical H & P
GRADUAL and insidious onset
low fever
slowly worsening cough
diarrhea
CAP Typical - Physical
tachypnea
crackles
dull percussion
increased TF
CAP Atypical - Physical
pharyngeal injection
cervical adenopahty
normal lung finding at first - remember slow onset
non toxic appearance
s. pneumo suptum color & CXR?
rust color & lobar infiltrate, patchy
when do we usually get staph? staph on CXR?
just after a viral illness
multi lobar infiltrates
Kiebsiella pneumoniae sputum color and symptoms?
brown currant jelly & and symptoms seen in alcoholics or nursing home patients
pseudomonas
recently hospitalized , debilitated or immunocompromised and usually forms abscess
H. flu causes symptoms in______ & ____.
elderly and COPD
Legionella symptoms
diarrhea, vomiting and nausea
M. pneumo symptoms and CXR?
upper and lower respiratory tract symptoms & and CXR shows interstitial infiltrates - RETICULONODULAR PATTERN
Bacterial Pneumonia Diagnostic studies?
CXR
Sputum Gram stain - help direct tx.
Blood cultures
maybe: ABG
Typical CXR?
consolidation , one lobe, concentrated
Atypical CXR?
diffuse , cloudy
CURB 65 ( admit them or not)
confusion BUN > 19 Resp. rate > 30 BP < 90/60 > or equal to 65
Viral pneumonia pathogens and tx
influenza A and B RSV adenovirus parainfluenza virus rhinovirus
tx: mostly supportive but…. :
influenza - Zanamivir or Oseltamivir (Amantadine / Rimantadine)
CMV - Ganciclovir
RSV - Ribavirin
Viral pneumonia H & P?
sudden onset fever
arthralgia
sore throat
rhinorrhea
Viral pneumonia diagnostic studies?
Rapid antigen detection kits
CXR
Viral pneumonia CXR findings?
diffuse infiltrates
similar to atypical cloudy
Fungal pneumonia pathogens
Coccidioidomycosis
Cryptococcosis (pigeon shit)
Histoplasmosis (bird shit, CD$ <50)
Pneumocystosis jiroveci (CD4<200) - classic of AIDS and bactrum - TMP-SMX - for prophylactic treatment
immunicompromise and workers or farmers
Fungal pneumonia risk factor geographic locations?
Histoplasmosis - Mississippi, ohio
Coccidiomycosis - SW US and NW mexico
Is fungal pneumonia cough productive or not?
usually nonproductive
Fungal specific test for Coccidiomycosis?
IgG and IgM
Fungal specific test for cryptococcosis?
india ink
Fungal specific test for histoplasmosis?
urine antigen
fungal pneumonia CXR finding?
Patchy infiltrate
military - little dots
consolidation or cavitation
CT or MRI for hemorrhagic lesions
when do you use fiberoptic bronchoscopy?
obtain bronchial lavage specimens from staining and culture techniques
histoplasmosis prognosis?
80 % mortality if untreated but 25% if treated
Fungal pneumonia complications?
hematogenous dissemination - especially in immunocompromised
Fungal pneumonia tx?
pneumocystis - TMP-SMX for empiric and preventative (CD4 <200)
alternatives: Dapsone, Pentamidine, Atovaquone
Tx for uncomplicated fungal pneumonia ?
oral antifungals: fluconazole, itraconazole) for months
Tx for complicated fungal pneumonia ? ( disseminating or meningeal)
IV antifungals : Amphotericin B
HIV related pneumonia pathogens?
pneumocystosis jiroveci
HIV related pneumonia Hx?
exertion dyspnea
nonproductive cough
pleuritic chest pain
anorexia and weight loss
findings are disproportionate to image results - lungs may sound normal but the Pulse OX is low
HIV related pneumonia tx?
treat underlying type of pneumonia
treat HIV with highly active antiretroviral therapy ( HAART)
