Pneumonia

Question 1

Criteria for Community-acquired pneumonia

Answer 1

Acute pulmonary infxn in a pt who is not hospitalized or residing in a long-term care facility 14 or more days before presentation

Question 2

Criteria for hospital-acquired pneumonia

Answer 2

New infxn occurring 48 or more hours after hospital admission

Question 3

Ventilator-acquired pneumonia

Answer 3

New infxn occurring 48 or more hours after starting mechanical ventilation

Question 4

Healthcare-associated pneumonia

Answer 4

• Pts hospitalized for 2 or more days w/in the past 90 days.
• Nursing home/long-term care residents
• Pt receiving home IV antibiotic therapy
• Dialysis pts
• Pts receiving chronic wound care
• Pts receiving chemotherapy
• Immunocompromised pts

Question 5

Most common general causes for PNA

Answer 5

Bacteria, viruses, fungi

Question 6

PNA is the most common trigger for what worsening condition?

Answer 6

Sepsis

Question 7

Who are the pts most at risk for PNA

Answer 7

*Predisposition to aspiration
(swallowing d/o, stroke, NG-tube, intubation, seizure/syncope)
*Impaired mucociliary clearance
*Risk of bacteremia
(indwelling vascular devices, intrathoracic devices [e.g. chest tube])

Question 8

What is pneumonia

Answer 8

An infection of the alveoli (the gas-exchange portion of the lung)

Question 9

All risk factors for PNA

Answer 9

*Aspiration risk
(swallow d/o, stroke, NG-tube, intubation, seizure/syncope)
*Bacteremia risk
(Indwelling vascular devices, intrathoracic devies [e.g., chest tube])
*Debilitation
(Alcoholism, extremes of age, neoplasia, immunosuppression)
*Chronic dz
(DM, renal failure, liver failure, valvular heart dz, CHF)
*Pulmonary d/o
(COPD, chest wall d/o, skeletal muscle disorder, bronchial obstruction)
*Bronchoscopy
*Viral lung infxns

Question 10

What tend to be the causes of intense inflammatory response vs a less intense inflammatory response

Answer 10

Bacterial pneumonia usually results in an intense inflammatory response. Atypical organisms often trigger less intense inflammatory responses.

Question 11

What are the atypical causes of PNA

Answer 11

mycoplasma, chlamydia, legionella

Question 12

Most common causes of PNA in order from most common to least common

Answer 12

1. Pneumococcus (Streptococcus pneumoniae)
2. Viruses
3. Mycoplasma (bacteria), Chlamydia (bacteria), and Legionella (gram-neg bacteria)

Question 13

Common sx of PNA (most common to least common)

Answer 13

Cough, fatigue, fever, dyspnea, sputum production, pleuritic chest pain

Question 14

What is coryza

Answer 14

nasal congestion and discharge

Question 15

Some of the atypical agents are associated with which sx?

Answer 15

HA or GI illness

Question 16

Streptococcus pneumoniae: Sx, sputum, CXR

Answer 16

Sx: Sudden onset, fever, rigors, pleuritic chest pain, productive cough, dyspnea

Sputum: Rust-colored; gram-positive encapsulated diplococci

CXR: Lobar infiltrate, occasionally patchy, occasional pleural effusion

Question 17

Staphylococcus aureus: Sx, sputum, CXR

Answer 17

Sx: Gradual onset of productive cough, fever, dyspnea, especially just after viral illness

Sputum: Purulent; gram-positive cocci in clusters

CXR: Patchy, multi lobar infiltrate; empyema, lung abscesses

Question 18

Klebsiella pneumoniae: Sx, sputum, CXR

Answer 18

Sx: Sudden onset, rigors, dyspnea, chest pain, bloody sputum; especially in alcoholics or nursing home patients

Sputum: Brown “currant jelly”; thick, short, plump, gram-negative, encapsulated, paired coccobacilli

CXR: Upper lobe infiltrate, bulging fissure sign, abscess formation

Question 19

Pseudomonas aeruginosa: Sx, sputum, CXR

Answer 19

Sx: Recently hospitalized, debilitated, or immunocompromised patient with fever, dyspnea, cough

Sputum: Gram-negative coccobacilli

CXR: Patchy infiltrate with frequent abscess formation

Question 20

Haemophilus influenzae: Sx, sputum, CXR

Answer 20

Sx: Gradual onset, fever, dyspnea, pleuritic chest pain; especially in elderly and COPD patients

Sputum: Short, tiny, gram-negative en capsulated coccobacilli

CXR: Patchy, frequently basilar infiltrate, occasional pleural effusion

Question 21

Legionella pneumophila: Sx, sputum, CXR

Answer 21

Sx: Fever, chills, HA, malaise, dry cough, dyspnea, anorexia, diarrhea, nausea, vomiting

Sputum: Few neutrophils and no predominant bacterial species

CXR: Multiple patchy nofsegmented infiltrates, progresses to consolidation, occasional cavitation and pleural effusion

Question 22

Moraxella catarrhalis: Sx, sputum, CXR

Answer 22

Sx: Indolent course of cough, fever, sputum, and chest pain; more common in COPD pts

Sputum: Gram-negative diplococci found in sputum

CXR: Diffuse infiltrates

Question 23

Chlamydophila pneumoniae: Sx, sputum, CXR

Answer 23

Sx: Gradual onset, fever, dry cough, wheezing, occasionally sinus symptoms

Sputum: Few neutrophils, organisms not visible

CXR: Patchy subsegmental infiltrates

Question 24

Mycoplasma penumoniae: Sx, sputum, CXR

Answer 24

Sx: Upper and lower respiratory tract symptoms, nonproductive cough, HA, malaise, fever

Sputum: Few neutrophils, organisms not visible

CXR: Interstitial infiltrates, (reticulonodular pattern), patchy densities, occasional consolidation

Question 25

Anaerobic organisms: Sx, sputum, CXR

Answer 25

Sx: Gradual onset, putrid sputum, especially in alcoholics

Sputum: Purulent; multiple neutrophils and mixed organisms

CXR: Consolidation of dependent portion of lung; abscess formation

Question 26

Who are at highest risk for pneumococcal pneumonia?

Answer 26

Elderly, children <2 yo, minorities, children who attend day care, immunocompromised (splenectomy, transplant, HIV, sickle cell dz)

Question 27

What lab values could you see in pneumonia?

Answer 27

Leudocytosis, elevation of serum bilirubin or LFTs, decreased albumin, hyponatremia