Pneumonia Flashcards
What is the definition of pneumonia?
Common lower respiratory tract infection causing inflammation of lung tissue
- associated with fever, chest signs and symptoms and chest X-Ray abnormalities
What are the most common organisms causing community acquired pneumonia?
Step pneumoniae
H.Influenzae
Moraxella cattarrhalis
Atypicals - legionella, S.aureus and M.pneumoniae
What are the most common organisms causing hospital acquired pneumonia?
Enterobacteria (gram negative)
S.aureus
Less common - pseudomonas, klebsiella and clostridia
What is hospital acquired pneumonia defined as?
Pneumonia diagnosed greater than 48 hours after hospital admission
What are the most common precipitating causes of pneumonia?
Aspiration - stroke, myaesthenia gravis, bulbar palsies and decreased consciousnesses
Immunocompromised patients - S.pneumoniae, H.influenza, S.aureus and M.pnuemoniae
S.pneumoniae often follows a viral infection
Cigarettes/alcohol
Bronchiectasis
What are the clinical features of pneumonia?
Fever, pyrexia Rigors Confusion Tachypnoea Malaise Anorexia Cyanosis Dyspnoea Tachycardia Cough (purulent) Hypotension Haemoptysis Pleuritic pain Vomiting Headache Pleural rub Signs of consolidation - dull percussion, decreased expansion, increased fremitis and vocal resonance - bronchial breathing
What investigations would you perform for pneumonia?
Oxygen sats - ABG if <92% of very severe Blood pressure Blood tests - FBC (WCCs, ESR, anaemia suggests an abscess) - U&Es, LFTs and CRP Chest X-Ray - consilidation with air bronchograms Cultures - sputum, urine (legionella) and blood if septic/HAI CURB65
What are the points on the CURB65 score?
Confusion Urea >7mmol/l Respiratory rate >30 Blood pressure <90 systolic and/or <60 diastolic 65 - age over 65 years
Describe the management of pneumonia?
Oxygen IV fluids - to prevent dehydration and shock Analgesia VTE prophylaxis Antibiotics (depending on CURB65 score) Pneumococcal vaccine
What antibiotics are given for pneumonia?
CURB 0-1
- S.pneumoniae or H.influenza
- oral amoxicillin 500mg or clarithromycin 500mg
- doxycycline 200mg - 100mg if penicillin allergy
CURB 2
- M.pnuemoniae, S.pnuemoniae or H.influenza
- oral amoxicillin 500mg or clarithromycin 500mg (doxycycline 200mg - 100mg)
- use amoxicillin or clarithromycin if IV required
CURB 3+
- M.pnuemoniae, S.pnuemoniae or H.influenza
- IV co-amoxiclav 1.2g (cephalosporin IV) and IV clarithromycin 500mg
- add flucloxacillin if staph suspected and vancomycin if MRSA suspected
What antibiotics are given for atypical causes of pneumonia?
Legionella - fluroquinolone
Clamydophilia - tetracycline
Pneumocystis jiroveci - co-trimoxazole
What are some of the common complications of pneumonia?
Respiratory failure - type 1 common Hypotension - due to dehydration and sepsis causing vasodilation Atrial fibrillation - resolves with the pneumonia Pleural effusion Empyema Septicaemia Peri/myocarditis Jaundice Lung abscess
What are some causes of a lung abscess?
Pneumonia Aspiration Bronchial obstruction Pulmonary infarction Septic emboli Suphrenic/hepatic abscess
What are the clinical features of a lung abscess?
Swinging fever Cough (purulent) Foul smelling sputum Pleuritic chest pain Heamoptysis Malaise Weight loss Finger clubbing Anaemia Crepitations
What investigation should be done for a lung abscess?
Blood tests
- FBC, ESR and CRP
Blood and sputum culture
Chest X-Ray - shows a walled cavity
