Pneumonia Flashcards
What are the typical pathogens of CAP
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
seen on gram stain
can be inhibited or killed using beta-lactam antibiotics
What are the atypical pathogens of CAP
Mycoplasma pneumonia, Chlamydophila pneumonia, Legionella species, and respiratory viruses
cannot be visualized on gram stain and require special culture methods
are not killed or inhibited by penicillins or other beta-lactam antibiotics
Definition of healthcare associated pneumonia
occurs in patients that have had significant exposure or contact with the healthcare system. This includes patients residing in nursing homes, patients that have been recently hospitalized, or those that receive dialysis, IV medications, or home wound care.
Criteria:
hospitalization for ≥2 days in the preceding 90 days
residence in a nursing home/facility
in the past 30 days:
attendance at a hospital or hemodialysis clinic
home or clinic IV therapy (antibiotics and chemotherapy)
home wound care
Common pathogens of HCAP
Pseudomonas aerugunosa, Escherichia coli Klebsiella pneumonia, Acinebacter, and Staphylococcus aureus.
Symptoms of pneumonia
fever, chills, productive cough, pleuritic pain, chest pain, and shortness of breath or malaise.
Classic pneumonia findings
Typical pneumonia:
- Streptococcus pneumonia – bloody or rust colored sputum
- Haemophilus influenzae – fever, muscle pain, fatigue
Atypical Pneumonias:
- Mycoplasma pneumonia – “walking pneumonia;” upper respiratory symptoms, gradually worsening over weeks or even months
- Chlamydiophila pneumonia – pharyngitis, laryngitis and sinusitis, associated with outbreaks in close-contact settings (dorms, prisons)
- Legionella – respiratory and gastrointestinal symptoms
Aspiration pneumonia potential pathogens
Enterobacteriaceae, Pseudomonas aerguinosa and Staphylococcus aureus.
Treat with gram negative coverage:
cephalosporins, fluoroquinolones and piperacillin are recommended for treatment
Immunocompromised patient considerations
Treatment for PCP is trimethoprim-sulfamethoxazole (TMP-SMX). Tuberculosis is another important consideration in immunocompromised patients as well as patients with a history of prior tuberculosis infection, night sweats, weight loss, or exposure from shelters, prisons, or recent travel to endemic areas.
PCP in HIV patients with low CD4 count
CXR pneumonia factors that predict
Best initial test
temperature >37.8 0C, tachycardia >100bpm, absence of asthma, rales, and locally decreased breath sounds on auscultation. Pulmonary infiltrates on chest x-ray may confirm the clinical diagnosis.
What CXR findings do you find with certain pathogens?
Lobar consolidation is typical of Streptococcus pneumoniae or Klebsiella pneumoniae while multi-lobar infiltrates are more consistent with Staphylococcus aureus and Pseudomonas aeruginosa.
Atypical infections such as Mycoplasma pneumonia, Chlamydophila, and Legionella may reveal patchy infiltrates on radiography.
What is the gold standard test for diagnosis?
The gold standard for the identification of pneumonia is Computer Tomography of the chest
What about an EKG?
An EKG should be ordered on patients with pneumonia, especially those with tachycardia.
Should you make someone induce sputum?
Sputum induction for gram stain and culture should not be routinely performed in the emergency department, as it poses an infection risk to both providers and other patients and is unlikely to change ED management.
