Pneumonia Flashcards
What is pneumonia?
Acute respiratory tract illness
How is impaired gas exchange caused in pneumonia?
Organism reach lungs
Immune activation and infiltration (systemic response)
Fluid and cellular build up in alveoli leads to impaired gas exchange
What are the organisms that commonly cause community-acquired pneumonia?
S. pneumoniae H. influenza Maxialla Catarrhlais Mycoplasma pneumonia Chlamydia Psittaci Pneumococcal pneumonia
Which organisms cause hospital-acquired pneumonia?
48-72 hours after being admitted
E. coli Staph aureus Anaerobes Klebsiella spp Psedomonas spp
What are special case pneumonia?
Legionella
Aspiration-Klebsiella
Penumocystis pneumonia
Aspergillus (fungi)
What is the most common causative organism of pneumonia and how is it treated?
Streptococcus Pneumoniae
Amoxicillin
Mycoplasma pneumonia is found in _________. Why is mycoplasma resistant to penicillins? Which antibiotic do you give instead?
Children and adults
Resistant to beta-lactams because it has no peptidoglycan cell wall
Give erythromycin/doxycycline
What are common features of aspiration pneumonia?
Inhalation of foreign material into the lungs - food, drink, vomit (interference with normal gag reflex) Alcohol(ism BUZZ), Brain injury, drugs Anaerobes Klebsiella Red-jelly sputum (BUZZ)
PCP (Pneumocystis penumonia) is linked to which patients?
Immunosuppressed
HIV/AIDS
Cancer patients
How do you treat PCP?
Trimethoprim / Sulfamethoxazole
Where is Legionella Pneumonia found and how is it transmitted?
Found in fresh water
Air conditioning
Confusion and diarrhoea in a returning traveller (not person-person)
Compost
How is Legionella pneumonia treated?
Clarithromycin
Erythromycin
Quinolones e.g. Levofloxacin
What are risk factors for HAP?
Invasive ventilation
Impaired mucociliary escalator
Sedation
Immunosuppresion
Which pneumonia is often found in nursery workers?
H. influenza
Coxiella burnetti (aka Q-fever) is typically transmitted from?
Sheep
Cattle
Farms
What are clinical features of Coxiella Burnetti?
Culture negative endocarditis
Pyrexia
What are clinical features of Klebsiella pneumonia?
Cavitating
Common inpatients with alcoholism , diabetes, chronic lung disease
How and why is Klebsiella treated?
Resistant to beta lactase
Treat with carbapenems
Whatare symptoms and signs of Pneumonia?
Malaise Anorexia Sweats Rigors Myalgia Arthralgia Headache Confusion Cough Pleurisy haemoptyis Breathlessness Preceding URTI Abdo pain Diarrhoea Crackles heard on asucultation Pleural rub (possible) cyanosis Hypotension
How is severity assessed?
CURB-65 score
How is the CURB-65 score calculated?
Confusion Urea >7 mmol/L Respiratory Rate >30 Blood pressure <90 sys or >61 diastolic 65 years or older
What are other severity markers of pneumonia besides CURB-65?
Temperature <35 or >40 Cynaosis PaO2 < 8kPa WCC <4 or >30 Multi-lobar involvement
What are investigations for pneumonia?
Blood culture Serology Arterial gases FBC Urea Liver function CXR
What type of pneumonia is a high fever, rapid onset and herpes labialis typically linked to?
Strep pneumonia
What type of pneumonia commonly occurs in COPD patients?
H. influenza
Which type of pneumonia commonly follows influenza infection?
Staph aureus
What is an atypical pneumonia which often present with a dry cough and atypical chest sign/x-ray findings. Autoimmune haemolytic anaemia and erythema multiform may be seen.
Mycoplasma pneumoniae
Atypical pneumonia. Hyponatraemia and lymphopenia common.
Legionella
Which type of pneumonia is commonly seen in alcoholics??
Klebsiella
Which type of pneumonia is typically seen in patients with HIV?
Pneumocystis jiroveci
How does Pneumocystis jiroveci present?
dry cough
Exercise-induced desaturations
Absence of chest signs
How do you treat Aspergillus pneumonia?
Amphotericin B
Voriconazole
Surgery
