Pneumonia Flashcards
Criteria for Community-acquired pneumonia
Acute pulmonary infxn in a pt who is not hospitalized or residing in a long-term care facility 14 or more days before presentation
Criteria for hospital-acquired pneumonia
New infxn occurring 48 or more hours after hospital admission
Ventilator-acquired pneumonia
New infxn occurring 48 or more hours after starting mechanical ventilation
Healthcare-associated pneumonia
- 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
Most common general causes for PNA
Bacteria, viruses, fungi
PNA is the most common trigger for what worsening condition?
Sepsis
Who are the pts most at risk for PNA
*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])
What is pneumonia
An infection of the alveoli (the gas-exchange portion of the lung)
All risk factors for PNA
*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
What tend to be the causes of intense inflammatory response vs a less intense inflammatory response
Bacterial pneumonia usually results in an intense inflammatory response. Atypical organisms often trigger less intense inflammatory responses.
What are the atypical causes of PNA
mycoplasma, chlamydia, legionella
Most common causes of PNA in order from most common to least common
- Pneumococcus (Streptococcus pneumoniae)
- Viruses
- Mycoplasma (bacteria), Chlamydia (bacteria), and Legionella (gram-neg bacteria)
Common sx of PNA (most common to least common)
Cough, fatigue, fever, dyspnea, sputum production, pleuritic chest pain
What is coryza
nasal congestion and discharge
Some of the atypical agents are associated with which sx?
HA or GI illness
Streptococcus pneumoniae: Sx, sputum, CXR
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
Staphylococcus aureus: Sx, sputum, CXR
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
Klebsiella pneumoniae: Sx, sputum, CXR
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
Pseudomonas aeruginosa: Sx, sputum, CXR
Sx: Recently hospitalized, debilitated, or immunocompromised patient with fever, dyspnea, cough
Sputum: Gram-negative coccobacilli
CXR: Patchy infiltrate with frequent abscess formation
Haemophilus influenzae: Sx, sputum, CXR
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
Legionella pneumophila: Sx, sputum, CXR
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
Moraxella catarrhalis: Sx, sputum, CXR
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
Chlamydophila pneumoniae: Sx, sputum, CXR
Sx: Gradual onset, fever, dry cough, wheezing, occasionally sinus symptoms
Sputum: Few neutrophils, organisms not visible
CXR: Patchy subsegmental infiltrates
Mycoplasma penumoniae: Sx, sputum, CXR
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
Anaerobic organisms: Sx, sputum, CXR
Sx: Gradual onset, putrid sputum, especially in alcoholics
Sputum: Purulent; multiple neutrophils and mixed organisms
CXR: Consolidation of dependent portion of lung; abscess formation
Who are at highest risk for pneumococcal pneumonia?
Elderly, children <2 yo, minorities, children who attend day care, immunocompromised (splenectomy, transplant, HIV, sickle cell dz)
What lab values could you see in pneumonia?
Leudocytosis, elevation of serum bilirubin or LFTs, decreased albumin, hyponatremia
