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
rx for inpatient non-ICU CAP
FQ or beta lactam + macrolide (same as risky outpatient)
rx for inpatient ICU CAP
beta lactam + azithromycin (macrolide) or
beta lactam + FQ
how long do fever/fatigue/ CXR abnormalities take to clear w/ rx?
fever- around 3 days
fatigue (and dyspnea, cough)- 7-14 days
CXR- can take weeks, if progresses w/i 48 hrs poor px
what to do w/ pts who dont respond or deteriorate
think about wrong dx, wrong rx, host failure
more dx procedures like bronchoscopy
look for complications like empyema, MI
highest pts w/ HAP mortality
intubated pts
pathogenesis of HAP
colonization of pharynz w/ pathogenic bacteria, micro aspiration
HAP dx
based on fever, high WBCs, new/worse infiltrates, new secretions
not just on new culture result
common HAP pathogens
G- bacilli ( pseudomonas, enterbacter, E coli, klebsiella, acinetobacter) MRSA, anaerobes
*focus on MRSA and pseudomonas
more likely to be polymicrobial
bug risk w/ neutropenia
bacteria, aspergillus, candida
bug risk w/ splenectomy
encapsulated organisms (strep pneumo)
bug risk w/ low T cells or fn
fungi, mycobacteria, viruses (CMV, EBV), bacteria
bug risk at CD4<200
PJP
most likely dx in symptomatic HIV pt w/ abnormal CXR
bacterial pneumonia (strep pneumo and H flu still most common)
presentation of AIDS/ PJP
dyspnea, dry cough, fever (insidious onset)
diffuse infiltrates, hypoxemia
dx of PJP
visualization on DFA/silver stain from sputum or BAL
rx of PJP
bactrim, IV pentamidine, corticosteroids w/ pO2 <70 or high Aa gradient
Mtb w/ higher or lower CD4 count
w/ higher- normal presentation (upper lobe, cavitary)
w/ lower- atypical presentation: lower zone infiltrates, mediastinal adenopathy, dissemination
