pneumonia Flashcards by Mai Wells

common organisms in CAP (5)

S. pneumo, H. Flu, S. aureus, M. Cat, Klebsiella

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atypical organisms in CAP (4)

legionella, mycoplasma, chlamydia, viruses

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viral organisms in CAP (4)

influenza, parainfluenza, RSV, adenovirus

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CAP symptoms

1-10 day hx of increasing cough, PURULENT sputum, fever, rigors, pleuritic CP, dyspnea

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1-10 day hx of increasing cough, PURULENT sputum, fever, rigors, pleuritic CP, dyspnea

CAP symptoms

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PE in CAP

altered breath sound, dullness to percussion(if an effusion), increased tactile fremitus, egophony, bronchial breath sounds(consolidation);

inspiratory rales/crackles

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altered breath sound, dullness to percussion(if an effusion), increased tactile fremitus, egophony, bronchial breath sounds(consolidation);

inspiratory rales/crackles

PE in CAP

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Tests to order for CAP

sputum culture, CXR, gram stain

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procalcitonin indicates what

increased in bacterial infections

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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

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most common organism in atypical CAP

mycoplasma.

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atypical CAP symptoms

usually asymptomatic: LOW fever with mild pulm sx, non prod cough, may have crackes/rales

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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

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labs in atypical CAP

WBC nml or slightly elevated

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CXR in atypical CAP

diffuse, patchy interstitial or reticulonodular infiltrates

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tx for atypical CAP

mycoplasma: macrolide or doxy
legionella: macrolide or FQ(no cipro)
chylamydia: same I think

* tetracycline (chlamydia)

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2nd most common cause of hospital acquired infections

noscomial pneumonia (UTI most common)

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mortality rate of noscomial pneumonia

20-50%

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CURB 65

2 points for admission
confusion, uremia(>30), resp rate >30, BP low(90/60), age >65

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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

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most common organism in bacterial pneumonia in HIV pts

streptococcus

haemophillus, pseudomonas, mycobacterium

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sx in HIV pneumonia; duration

DOE, non prod cough, impaired oxygenation, fever, tachypnea, wt loss, fatigue. the sx will present for weeks

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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

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DOE, non prod cough, impaired oxygenation, fever, tachypnea, wt loss, fatigue. the sx will present for weeks

sx in HIV pneumonia; duration

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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

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.