pneumonia Flashcards
common organisms in CAP (5)
S. pneumo, H. Flu, S. aureus, M. Cat, Klebsiella
atypical organisms in CAP (4)
legionella, mycoplasma, chlamydia, viruses
viral organisms in CAP (4)
influenza, parainfluenza, RSV, adenovirus
CAP symptoms
1-10 day hx of increasing cough, PURULENT sputum, fever, rigors, pleuritic CP, dyspnea
1-10 day hx of increasing cough, PURULENT sputum, fever, rigors, pleuritic CP, dyspnea
CAP symptoms
PE in CAP
altered breath sound, dullness to percussion(if an effusion), increased tactile fremitus, egophony, bronchial breath sounds(consolidation);
inspiratory rales/crackles
altered breath sound, dullness to percussion(if an effusion), increased tactile fremitus, egophony, bronchial breath sounds(consolidation);
inspiratory rales/crackles
PE in CAP
Tests to order for CAP
sputum culture, CXR, gram stain
procalcitonin indicates what
increased in bacterial infections
tx for CAP outpt and inpt
OUTPT: * 1st choice: macrolide or doxycycline
* comorbid condition or recent antibiotic use: FQ
* Inpatient: cover for s.pneumo and legionella with FQ or combo Beta lactam plus macrolide
most common organism in atypical CAP
mycoplasma.
atypical CAP symptoms
usually asymptomatic: LOW fever with mild pulm sx, non prod cough, may have crackes/rales
legionella CAP symtoms
HIGH fever, DRY cough, dyspnea, other systemic sx (chr cardiac or resp d/s, hyponatremia, nonbloody diarrhea), increased LFT, poss neuro sx
labs in atypical CAP
WBC nml or slightly elevated
CXR in atypical CAP
diffuse, patchy interstitial or reticulonodular infiltrates
tx for atypical CAP
mycoplasma: macrolide or doxy
legionella: macrolide or FQ(no cipro)
chylamydia: same I think
* tetracycline (chlamydia)
2nd most common cause of hospital acquired infections
noscomial pneumonia (UTI most common)
mortality rate of noscomial pneumonia
20-50%
CURB 65
2 points for admission
confusion, uremia(>30), resp rate >30, BP low(90/60), age >65
most common organism in ICU and tx
pseudomonas or MRSA.
tx is anti pseudomonal B lactam plus anti pseudomonal AG or FQ
MRSA: add vanco
most common organism in bacterial pneumonia in HIV pts
streptococcus
haemophillus, pseudomonas, mycobacterium
sx in HIV pneumonia; duration
DOE, non prod cough, impaired oxygenation, fever, tachypnea, wt loss, fatigue. the sx will present for weeks
tests to order for HIV pneumonia
-CXR(diffuse bil interstitial infiltrates; may be nml),
-low CD4 nml, increased LDH(>200), increased beta D glucan
- bronchalveolar lavage speciman or induced sputum: direct fluorescent antibody staining of sample to see both trophic and cyst forms
trophic: wright giemsa stain
cysts: methamine silver and toluidine blue stains
if induced sputum is neg: bronchoscopy should be performed
DOE, non prod cough, impaired oxygenation, fever, tachypnea, wt loss, fatigue. the sx will present for weeks
sx in HIV pneumonia; duration
CXR in pneumocystis jiroveci
*ground glass appearance
bilateral diffuse interstitial infiltrates
-may be nml
tx for PCP pneumonia
HIV+
severe
sulfa allergy
bactrim high dose for 21 days. maybe do prednisone in pts with moderate to severe hypoxemia
if HIV+, add Prednisone if hypoxic(PaO2 <70, A-a gradiant >35
severe: IV Pentamidine
sulfa allergy: dapsone-trimethoprim, clinda-Primaquine, Atovaquone, IV Pentamidine
common organisms for neonates (3)
gr b strep, e coli, listeria
common organisms age 6 wks to 18 years (5)
s. pneumo, viruses, mycoplasma, chlamydia, s aureus
common organisms age 18-40 years (4)
s. pneumo, viruses, mycoplasma, chlamydia
common organisms age 40-65 years (5)
s. pneumo, viruses, mycoplasma, H flu, anaerobes
common organisms age over 65 years (6)
s. pneumo, viruses, gm neg rods, anaerobes, h flu, s aureus
*ground glass appearance
bilateral diffuse interstitial infiltrates
no effusion
CXR in pneumocystis jiroveci
bullous myringitis
mycoplasma
mycoplasma manifestation and what population
cxr
bullous myringitis, low fever, dry cough, cold agglutinins
young and healthy
reticulonodular pattern
strep pneumo manifestation
rust colored sputum, single rigor
rust colored sputum, single rigor
strep pneumo manifestation
klebsiella manifestations
current jelly sputum, think chr illness or alcoholism
current jelly sputum
klebsiella
organism in alcohol abuse
klebsiella
organisms in COPD
H pneumo, m cat, h flu, s pneumo
organism in CF
pseudomonas
organisms in young adults/college
mycoplasma, chlamydia
organism in air conditioners
legionella
organisms in post splenectomy
encapsulated organisms, s pneumo, h pneumo
organism in leukemia, lymphoma
fungus
organism in kid under 1 year
RSV
organism in kid under 2 years
parainfluenza
organism in post viral pts
staph, s pneumo, h flu
manisfestation of longer prodrome, sore throat, hoarseness
chlamydia
manisfestation of slower onset, immunocompromised, increased lactate dehydrogenase, more hypoxic than xray, interstitial infiltrates
PCP pneumonia
PCP pneumonia G6PD def- tx
mild: atovaquone in sulfa tolerant pts
moderate: in sulfa tolerant pts: atovaquone, desensitize bactrim or switch to IV Pentamidine.
avoid dapsone or primaquine
PCP prophylaxis in HIV
CD4<200, bactrim
histoplasmosis shape
transmission
r/f
s/s (include dissemination)
dimorphic oval yeast (no encapsulated)
soil with bird and bat droppings. MIssissippi, ohio, caves, excavators
immunocompromised states, esp AIDS <150
usually asymptomatic. pneumonia: fever, dry cough, myalgias.
dissemination: if immunocompromised, hepatosplenogmegaly, fever, mouth ulcers, bloody diarrhea, adrenal insufficiency. can mimic TB
histoplasmosis
dx and tx
labs: increased alk phos, LDH, pancytopenia
CXR: pulm infiltrates, hilar, or medialstinial lymphadenopathy
antigen testing via sputum (PCR) or urine highly specific; cultures most specific test.
no tx if asymptomatic.
mild to mod: intraconazole 1st line
severe: amphotericin B.
aspiration pneumonia: what organism
s/s
r/f
smell
tx
hosp acquired tx
anaerobes, think peridontal ds
reduced consciousness, protracted vomiting
most common in right lower lobe.
foul rotten egg smell
ampicillin-sulbactram parenteral 1st line or augmentin po
alternative: flagyl plus amox or pen g
imipenem, meropenus, pipercillan-tazobactam
b lactam allergy
do FQ +/- clinda. Aztreonam, aminoglycoside
b lactams
ceftriaxone
cefotaxime, ampicillin/sulbactam, ertapenem
anti-pseudomonal beta lactams
pipercillin/tazobactam, ceftazidime, cefepime.
imipenem, meropenem
aminoglycosides
gentamicin, amikacin, tobramycin
hosp acquired, suspect MRSA
suspect legionella
mrsa: vanco or linezolid
legionella: levofloxacin or azithromycin
mycoplasma complications
SJS, TEN, EM, cold autoimmune hemolytic anemia IgM
klebsiella sputum, CXR, gm stain
purple currant jelly sputum
cavitary lesions hallmark or lobar consolidations
gm neg rods
gm neg rod
gm pos diplococci
gm pos cocci in clusters
klebsiella and h flu
st. pneumo
st aureus
legionella
s/s
dx
tx
fevers, chills, dyspnea, dry cough, cp, myalgias, malaise
extrapulm: GI non bloody diarrhea, n/v
*hyponatrium and increased LFT, neuro sx
nucleic acid detection: PCR preferred, urine antigen
macrolides and FQ (no cipro)
Percussion, fremitus, breath sounds
pneumonia
dullness
increased
bronchial, egophony
Percussion, fremitus, breath sounds
pleural effusion
dullness
decreased
decreased
Percussion, fremitus, breath sounds
pneumothorax
hyper resonance
decreased
decreased
pneumococcal vaccine PCV 13 administration
pts 6 weeks through 5 years, part of a 4 dose immunization series (given at 2,4,6,12,15 months of age)
pneumococcal polysaccharide vaccine (PPSV 23)
indication
what if pt had vac prior to 65
age 65 and older, young pts with increased risk for developing complications from pneumoccocal infection
if given within 10 years, should be revaccinated following first dose 10 years following that
if both vaccines recommended
if pt has no prior vacc with either vaccine, pt should receive a single dose of PCV13 followed 8 wks later by PPSV23.
if pt received PPSV23 in the past, single dose of PCV 13 should be given 1 yr after PPSV23
contraindications to vaccines
severe allergic to component of diptheria toxoid containing vaccine
PG ok.
