PNEUMONIA Flashcards
What is HAP defined as?
Hospital acquired pneumonia - develops within 48 hours of admission to hospital OR within 1 month following discharge from hospital.
What is a lower respiratory tract infection?
Acute illness present for 21 days or less with cough +; fever, sputum, SoB, wheeze or chest discomfort/pain
What is antibiotic therapy for low severity CAP?
5 day course of oral amoxicillin
What is antibiotic therapy for moderate severity CAP?
7 to 10 days of dual antibiotic therapy with a penicillin + macrolide = co-amoxiclav + clarithromycin
What is co-amoxiclav?
Amoxicillin (a penicillin) + clauvanic acid (beta lactamase inhbitor)
Name a macrolide? and how do they work?
Clarithromycin, Azithromycin, Erythromycin. Macrolides work by binding to ribosomes and inhibit protein synthesis thereby inhibiting bacterial growth.
Who should be given antibiotics?
- If > 80 y/o/ give if; have at least one of; >65 y/o/ have at least 2 of; DM1, DM2, hx HF, hospitalisation in last year, being treated with oral corticosteroids
- patients with significant heart, lung, liver, renal or neuromuscular disease
- patients on immunosuppressant drugs
What are the 7 findings of which if a patient has 2 or more of would constitute not discharging from hospital following pneumonia treatment?
1) Temperature > 37.5
2) RR >/= 24 bpm
3) HR > 100 bpm
4) SBP = 90 mmHg
5) O2 sats < 90% on air
6) Abnormal mental status
7) Inability to eat or drink without assistance
What is Legionairre’s disease?
It is a type of atypical pneumonia
How can Legionairre’s disease occur?
By breathing in water vapours infested with L. Pneumophilia. (this bacteria is often found in water supplies of buildings of cooling towers).
Name a fungal pneumonia which can occur in those with impaired immune system such as; HIV virus or on immunosuppresent drugs
Pneumocystis jiroveci pneumonia caused by fungus pneumocystis jiroveci.
Which antibiotic is usually always just given orally despite severity of pneumonia due to lack of difference in efficacy and bioavailability between IV and oral route?
Clarithromycin (a macrolide)
which bacteria causes the rust coloured sputum in pneumonia infections?
Pneumococcal pneumonia.
What are the 3 most common bacteria causing CAP?
Streptococcus pneumoniae, Haemophilus Influenza, Moraxella catarrhalis
What are the atypical bacteria causing CAP?
Mycoplasma pneumoniae, Legionella pneumophila
Most common bacteria to cause HAP?
Staphylococcus aureus
What can the fungus Aspergillus fumigatus cause?
1) Chronic cough + haemoptysis 2) Pneumonia
What does the urine antigen test look for?
Pneumococcal antigen and Legionella antigen
What test can be done to rule out fungal infection?
Beta-D-glucan
What is HBsAg and what does it indicate?
Hepatitis B surface antigen AND indicates pt. is infectious.
What is anti-HBs and what does its level indicate?
Hepatitis B surface antibody AND indicates recovery and immunity from Hepatitis B virus infection and successful vaccination against Hepatitis B.
What is anti-HBc and what does it indicate?
Hepatitis B core antibody AND it appears at the onset of symptoms in acute Hepatitis B and persists for life (therefore indicates previous or ongoing infection).
What is IgM anti-HBc and what does it indicate?
IgM antibody to Hepatitis B core antigen AND positivity indicates recent infection (<6 months).
What is the pathophysiology of Pneumonia?
- neutrophil infiltration
- inflammatory exudate in the intersitium leading to thickening of alveolar septa
- alveolar oedema
- alveolar haemorrhage
- loss of alveolar spaces
