Pneumonia Flashcards
common causes of lung defense failure
viral infection, smoking, COPD, meds (inhaled steroids)
severe cases of lung defense failure
AIDS, immunosuppressives, malignancy, trach tubes
contast the course of typical and atypical pneumonia
typical: rapid, ill appearing
atypical: indolent, not as ill appearing (“walking”)
sx in typical vs atypical
high fevers, rigors, chest pain, purulent sputum
low grade fever, malaise, headache, dry cough
signs in typical vs atypical pneumonia
typical: consolidation, crackles, high WBC, lobar infiltrates on CXR
a: crackles w/o consolidation, mild-normal WBC, patchy/interstitial infiltrates
bugs in typical vs atypical
typical: S. pneumo, staph aureus, G- bacilli
atypical: mycoplasma, chlamydia, viruses
5 main causes of ambulatory CAP
strep pneumo, mycoplasma, H flu, chlamydia pneumo, viruses
notable difference b/w bus in hospitalized and ICU CAP vs abulatory (more severe illness)
hospitalized: also think about legionella, aspiration
ICU: higher priority on staph aureus, legionella, G- bacilli
define “aspiration” pneumonia
entity where patients at increased risk of aspirating develop pulm infiltrates- possibility of different organisms like anaerobes or G- bacilli
epi of blood cultures
specific but not sensitive (might miss something, but no false positives)
what to think w/ upper lobe cavitary infiltrate
TB- atypical presentation
what factors other than CXR to think atypical causes?
indolent course, non resolution w/ rx
exposure: outdoors (blasto) or desert SW (coccidioides) or TB contacts
list factors that contribute to pneumonia severity
age >60, comorbities, altered mental status, severe vital abnormalities, failure of outpatient therapy, very high or very low WBCs, hypoxemia/acidosis, multilobar involvement
empiric for healthy outpatient
macrolide or doxy
rx for risky outpatient (risk of drug resistance) CAP
FQ or beta lactam + macrolide
