Pneumonia Flashcards
Definition of general pneumonia
Inflammation of the substance of the lungs, usually caused by bacteria but also viruses and fungi, which results in abnormalities on the CXR + fever and signs in the chest
Epidemiology of general pneumonia
5-11/1000
Increase in young and old
Mortality around 21% in hospital
Types of pneumonia
Community
Hospital
Immunocompromised
Aspiration
CAP epidemiology
Occurs across all ages but more common in extremes of age
Most common causative agent is S. Pneumonia
1-3/1000
25% cases require admission
M=F
Clinical features of CAP
Cough - initially non productive Breathlessness due to alveoli being filled with puss and debris Fever Generally unwell Pleuritic chest pain Abnormal auscultation inc increased fremitus, asymemetric breath sounds and pleural rub Dullness to percussion Cyanosis
Characteristic colour of sputum in pneumococcal infection
Brown
What is the CURB65 score?
Tool used to measure severity of pneumonia
C - Confusion present U - Urea level > 7mmol/L R - RR > 30 B - BP <90/<60 65 - Age
Investigative methods in pneumonia
CXR
FBC showing a leukocytosis
Sputum tests
What are the blood tests you would order to diagnose pneumonia?
WBC - leucocytosis ESR - may be normal CRP = >100mg/L indicated likely pneumonia FBC - leucosytosis U+E - usually normal ABG - Assess saturations LFT
How is CAP managed?
O2 (if sats are low)
IV fluids ( if hypotensive)
Abx - loading dose within 4 hours of presentation
- PO once temp is controlled
- Seek micro help if unresponsive
Thromboprophylaxis if admitted for >12hrs
Analgesia for pain control
Management of CAP in a previously healthy, non MDR pt
Macrolide or tetracycline therapy
Macrolides: azithromycin, clarithromycin, erythromycin all 500mg LD
Tetracyline: Doxycycline
Treatment of severe CAP
IV co-amoxiclav*^ + macrolide (clarithromycin)
*Co-amoxiclav can be replaced with ampicillin or amoxicillin if not severe
^It’s a broad spectrum penicillin
When is flucloxacillin added to treatment?
If staph is suspected
Which drug is added to treatment if MRSA is present?
Vancomycin
Definition of HAP
New onset of cough with purulent sputum along with a compatible CXR demonstrating consolidation in patients who are beyond 2 days of their initial admission to hospital
Definition of Aspiration pneumonia
Defined as acute aspiration of gastric contents into the lungs which can produce an extremely severe and sometimes fatal illness
Treatment of HAP
Broad spectrum abx which covers gram -ve organisms which are resistant to abx used in CAP:
CEPHALOSPORINS or
CARBAPENEMS or
ANTIPSEUDOMONAL PENICILLIN
Treatment of Aspiration pneumonia
Cephalosporin IV + metronidazole IV
Features of immunocompromised pneumonia
Commonest opportunistic pathogen - pneumocystitis
Presents w/ rapid desaturation on exertion and increased temp + dry cough + breathlessness
Treatment of immunocompromised pneumonia
Aminoglycoside IV + antipseudomonal penicillin IV
Complications of pneumonia
SLAP HER
Sepsis Lung Abscess AF Pericarditis Hypotension Empyema Resp failure T1
CAP key risk factors
Smoking COPD Age >65 Poor oral hygiene Alcohol abuse Immunosuppressed Resident in a healthcare setting
DDx CAP
Acute bronchitis - no breathlessness and there would be no consolidation on the CXR
Asthma exacerbation - Signs of bronchospasm + no consolidation on CXR
Bronchiectasis exacerbation - Increasing cough, worsening dyspnoea + no consolidation on CXR
TB - long history with aspect of travel + cavitation on CXR w/ enlarged lymph nodes
Lung Cancer - red flag symptoms in history + multiple consolidation + pleural effusion
RFs for HAP
Extremes of age Hospitalised Increased aspiration risk Invasive procedures in the hospital setting Immunocompromised
Presentation of HAP
Cough - initially non productive
Breathlessness due to alveoli being filled with puss and debris
Fever
Generally unwell
Pleuritic chest pain
Abnormal auscultation inc increased fremitus, asymemetric breath sounds and pleural rub
Dullness to percussion
RFs for Aspiration pneumonia
Swallow ability Being old Mental status GI disease Invasive procedure i.e. NG tube
Causative agents of pneumonia in previously fit adults (6)
Pneumococcus Mycoplasma H. influenzae Viruses Staphylococcus Legionella
Causative agents of pneumonia in elderly patients with previous resp, illness?
Pneumococcus H. influenzae Staphylococcus Klebsiella Gram -ve organisms
If a pt does not respond to standard abx treatment, which conditions should be investigated further?
TB
Mycoplasma
Legionella
Carcinoma
Causative agents in HAP
- P. aurigenosa
- Gram negative enterobacillae
- S. aureus
Which microorganism commonly causes exacerbations in patient with COPD?
H. Influenzae
Which pneumonia microorganism causes skin changes (Stevens-Johnson syndrome or erythema multiforme)?
Mycoplasma
Which microorganism is usually only seen in patient with CF or bronchiectasis causing pneumonia?
Pseudomonas
Which pneumonia microorganism commonly causes pneumonia in immunocompromised patients (HIV)?
Pneumocystitis
What types of pneumonia microorganism causes a cavitating abscess?
Klebsiella
Staphylococcal
