Pneumonia Flashcards
Pneumonia definition
inflammatory condition of the lung affecting predominately the alveoli
Pathophys of pneumonia
- micro aspiration of organism
- defect in host defense system
- virulence of the organism
What is the number one cause of community acquired pneumonia
bacteria
What is the number one cause of pneumonia in children less than 5
viral
Community acquired pneumonia
non hospitalized patients without extensive health care contact
Health care associated pneumonia
- non hospitalized paitents with extensive healthcare contact
- hospitalized in an acute care setting >48 hours last 90 days
- resides in NH or LTC
- IV therapy, chemotherapy or wound care >30 days
- attend hospital or dialysis clinic >30 days
Hospital acquired pneumonia
-pneumonia acquired while hospitalized after >48 hours
Ventilator acquired pneumonia
48-72 hours after intubation
Aspiration pneumonia
relatively large amount of material from the stomach or mouth entering the lungs
What types of pneumonia affect immunocompromised
fungal, parasites
Typical organisms of community acquired pneumonia (bacterial)
strep pneumoniae (number 1) H. flu
Atypical organisms of community acquired pneumonia
M. pneumoniae (number 2)
C. pneumoniae
Viral causes of pneumonia
- influenza
- RSV
- adenovirus
- rhinovirus
- parainfluenza
- coronavirus
- SARS
Symptoms of pneumonia
- fever
- cough
- chills
- pleuritic pain
- hemoptysis
Physical exam findings of pneumonia
- rales/crackles
- decreased/asymmetric breath sounds
- expiratory wheezes
- hypoxemia
- tachycardia
- hypotension
Most important diagnostics for pneumonia
- clinical evaluation
- chest xray
Sputum color with S. pneumonia
rust color
Sputum with atpicals
scant or watery
Sputum with kiebsiella
hemoptysis or currant jelly
PE findings with legionella pneumonia
- abdominal pain
- diarrhea
- confusion
- high fever
- recent travel
Gold standard for pneumonia diagnosis
chest xray
Criteria for getting a chest xray
1 or more of the following vital signs
- temp >100 - HR >100 - RR >20
2 or more of the following clinical findings
- decreased breath sounds - crackles - absence of asthma
Lobar findings are common with what?
step pneumoniae
Interstitial and prebronchial pattern is common with what?
viral pneumonia, PCP
Necrotizing pneumonia is common with what
- aspiration pneumonia
- strep pneumoniae
- GAS
- S. aures
Caseating granulomas occur with what
TB
When to do a sputum induction with pneumonia
- admitting to the ICU
- antibiotic failure
- cavitary lesions on xray
- active ETOH abuse
- severe COPD/lung disease
- immunocompromised
When to do blood cultures with pneumonia
- admission to ICU
- leukopenia
- ETOH abuse
- chronic severe liver disease
- cavitary lesions
- pleural effusion
- asplenia
- positive pneumococcal UAT
UAT will show what organisms
S. pneumoniae
Legionella
Multiplex PCR shows what organisms
- M. pneumoniae
- C. pneumoniae
- B. pertussis
- many different viruses
Serology shows what organisms
- C. pneumoniae
- M. pneumoniae
- legionella
What diagnostics to do for outpatients with suspected pneumonia
- clinical diagnosis
- CXR
- only do organism testing if it will change treatment
What diagnostic to do for inpatients with suspected pneumonia
- CXR
- CBC with diff, BMP or CMP
- ? CRP, sed rate, lactic acid
Diagnostics for ICU patients with suspected pneumonia
- CXR
- blood cultures
- UAT
- sputum
- CBC with diff, BMP or CMP, lactic acid
- ? CRP or sed rate
Treatment for outpatients with no comorbidities or abx treatment in the last three months
macrolide (clarythro or erythro) x5 days
OR
doxy x5 days
Outpatient treatment for patients with comorbidities, use of abx in the last three months or in regions with high DRP
fluroquinolone (moxi, levo) x5 days
OR
beta lactam (amox, augmentin, cefpo,cefur)
plus macrolide(clarythro or erythro)/doxy
Inpatient non ICU treatment
fluroquiniolone (moxi, levo) IV +/- gluccocorticoid
OR
anti-pneumococcal beta lactam (ceftriaxone, unasyn) IV
plus macrolide/doxy IV +/- gluccocorticoid
What does the Pneumonia Severity Index measure
mortality risk at 30 days
Curb score criteria
Confusion Urea >19 mg.dL Respiratory rate >30 BP <90 Age >65
Scoring of CURB score
0-1= outpatient 3= admission >3= ICU admission
What does the SMART-COP score measure
predicts which patients require intensive care and need of intensive respiratory or vasopressor support
SMART- COP criteria
Systolic BP Multilobar Albumin level RR Tachycardia Confusion Oxygen level arterial Ph
HAP/VAP early onset organisms
- strep pneumoniae
- H flu
- MSSA
- gram negative bacilli
Treatment for early onset HAP/VAP
Ceftriaxone PO
or
Levo IV/PO
or
Unasyn IV and Augmentin POLate onset HAP/VAP organisms
- pseudomonas
- acinetobacter
- MRSA
Treatment for late onset HAP/VAP
Cefepime IV or Ceftazadime or Meropenem IV or Zosyn IV or Levo IV
PLUS
Vanco IV or linesolid PO
Risk factors for multi-drug resistant pathogens
- abx therapy in last 90 days
- hospitalization >5 days
- high rate of abx resistance in hospital or area
- presence of risk factors for HCAP
Risk factors for aspiration pneumonia
- altered LOC
- dysphagia
- neurological disorders
- mechanical disruption
Opportunistic pneumonia
- tuberculosis
- mycobacterium avium complec
- PCP
- cryptococcus
- cytomegalovirus
- influenza
- Kaposi sarcoma
- toxoplasmosis
Risk factors for PCP pneumonia
- advanced immunosuppression
- previous PCP
- oral thrush
- recurrent pnuemonia
- high plasma RNA
Symptoms of PCP pneumonia
- graudal onset
- fever
- non productive cough
- dyspnea
- fatigue
- weight loss
Mild PCP pneumonia treatment
TMP-SMX
Moderate PCP pneumonia treatment
TMP-SMX PLUS adjunctive corticosteriods (prednisone)
Severe PCP pneumonia treatment
TMP-SMX IV plus methylpred IV
When to give PCP prophylaxis
- CD4 <200
- oral candidiasis
- CD4 count <14%
What to give for PCP prophylaxis
TMP-SMX
