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PSBIM: Infectious Disease > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Most common mode of entry of microbial pathogens into the alveolar level

A

Aspiration from oropharynx

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2
Q

Stages/evolution of pneumonia and what are seen during those stages

A
  1. Edema/congestion: Proteinaceous exudates, a lot of bacteria
  2. Red hepatization: Erythrocytes, occasional bacteria
  3. Gray hepatization: Neutrophils, fibrin deposits, no more erythrocytes and bacteria
  4. Resolution: Macrophages, clearing of debris
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3
Q

Patterns of CAP, HAP, VAP

A

CAP: Bronchopneumonia
HAP: Lobar pneumonia
VAP: Respiratory bronchiolitis

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4
Q

A serious consequence of pneumonia caused by S. aureus

A

Necrotizing pneumonia

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5
Q

Possible CAP pathogen if with exposure to sheep, goats and parturient cats

A

Coxiella burnetti

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6
Q

Possible CAP pathogen if with exposure to rabbits

A

Francisella tularensis

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7
Q

Possible CAP pathogen if with exposure to birds

A

Chlamydophila psittaci, Histoplasma capsulatum

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8
Q

Possible CAP pathogen if with exposure to bats

A

Histoplasma capsulatum

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9
Q

Possible CAP pathogen if stayed in a hotel or on cruise ship in previous 2 weeks

A

Legionella spp.

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10
Q

Possible CAP pathogen if with structural lung disease

A

Pseudomonas aeruginosa, Burkholderia cepacia, Staphylococcus aureus

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11
Q

Possible CAP pathogen if with decreased level of consciousness, dementia, stroke

A

Anaerobes, gram negative enteric bacteria

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12
Q

Possible CAP pathogen if with lung abscess

A

MRSA, anaerobes, fungi, atypical mycobacteria, Mycbacterium tuberculosis

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13
Q

Possible CAP pathogen if travelled to Ohio or St. Lawrence river valleys

A

Histoplasma capsulatum

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14
Q

Possible CAP pathogen if travelled to Southwestern US

A

Hantavirus, Coccidioides spp.

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15
Q

Possible CAP pathogen if travelled to Southeast Asia

A

Burkholderia pseudomallei, avian influenza virus

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16
Q

Possible CAP pathogen if with pneumatoceles

A

Staphylococcus aureus

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17
Q

What is an adequate sputum specimen for culture

A

PMN >25, squamous epithelial cells < 10 per lpf

18
Q

Most frequently isolated pathogen in blood cultures of patients with CAP

A

Streptococcus pneumoniae

19
Q

Indications for doing blood culture in CAP

A

Neutropenia, asplenia, complement deficiencies, chronic liver disease, severe CAP

20
Q

Standard of diagnosis for respiratory viral infection

A

PCR of nasopharyngeal swabs

21
Q

Components of CURB-65 and significance of score

A

Confusion, urea nitrogen >7mmol/l, RR >/= 30, BP = 90/60, age >/= 65

Score = 0: can be treated as outpatient
Score = 2: must be admitted
Score = 3: must be admitted at the ICU
22
Q

Most important risk factor for antibiotic-resistant pneumococcal infection

A

Use of antibiotic within the previous 3 months

23
Q

Sensitivity classification of pneumococcal strains

A

Susceptible: MIC = 2
Intermediate: MIC > 2-4
Resistant: MIC > 8

24
Q

Definition of MDR strains

A

Resistant to >/= 3 drugs of antimicrobials with different MOA

25
Q

Mechanism of resistance of MRSA

A

mecA gene - encodes for resistance to all beta lactam drugs

Type II or III for HA-MRSA
Type IV for CA-MRSA

26
Q

Enterobacter spp. are inherently resistant to what and how to treat it

A

Resistant to cephaolsporins

Treat with fluoroquinolones or carbapenems

27
Q

Diagnosis, potential pathogens, and treatment for CAP-LR

A

Diagnosis:

  1. Stable VS: RR<30, HR<125, BP>90/60, temp >36 or <40
  2. No altered mental state of acute onset
  3. No suspected aspiration
  4. No or stable comorbid
  5. CXR findings: localized infiltrates, no pleural effusion

Potential pathogens: S. pneumoniae, H. influenzae, M. pneumoniae, M. catarrhalis, C. pneumoniae, enteric gram negative bacilli (among those with comorbids)

Treatment:

  1. No comorbids: PO Amoxicillin 1g TID or PO extended macrolide
  2. Stable comorbids: (PO BLIC or PO 2nd gen cephalosporin) +/- PO extended macrolide
28
Q

Diagnosis, potential pathogens, and treatment for CAP-MR

A

Diagnosis:

  1. Unstable VS: RR>/=30, HR>/=125, BP=90/60, temp =36 or >/=40
  2. With altered mental state of acute onset
  3. With suspected aspiration
  4. Unstable/decompensated comorbids: uncontrolled DM, active malignancies, neurologic disease in evolution, CHF class II-IV, unstable CAD, ESRD on HD, uncompensated COPD, decompensated liver disease
  5. CXR findings: multilobar infiltrates, with pleural effusion

Potential pathogens: S. pneumoniae, H. influenzae, M. pneumoniae, M. catarrhalis, C. pneumoniae, enteric gram negative bacilli, Legionella, anaerobes

Treatment:

  1. (IV non-antipseudomonal BLIC/2nd-3rd gen cephalosporin) + (PO extended macrolide or PO respiratory fluoroquinolone)
  2. Suspected aspiration pneumonia: + IV clindamycin if did not use ampicillin sulbactam for BLIC or moxifloxacin for fluoroquinolone
29
Q

Diagnosis, potential pathogens, and treatment for CAP-HR

A

Diagnosis: CAP-MR + any of the ff

  1. Severe sepsis
  2. Septic shock
  3. Need for mechanical ventilation

Potential pathogens: S. pneumoniae, H. influenzae, M. pneumoniae, M. catarrhalis, C. pneumoniae, enteric gram negative bacilli, Legionella, anaerobes, S. aureus, P. aeruginosa

Treatment:

  1. No risk for P. aeruginosa: IV non-antipseudomonal BLIC + (IV extended macrolide or IV respiratory fluoroquinolone)
  2. With risk for P. aeruginosa: [(IV antipseudomonal BLIC/cephalosporin/carbapenem) + IV extended macrolide + IV aminoglycoside] OR [(IV antipseudomonal BLIC/cephalosporin/carbapenem) + (IV ciprofloxacin or high dose IV levofloxacin)]
  3. With risk for MRSA: + (IV vancomycin or IV linezolid or IV clindamycin)
30
Q

Indication to repeat CXR after initiating treatment

A

No improvement after 72 hours

31
Q

Duration of treatment

A
  1. Most bacterial pneumonia except those in #2: 5-7 days; 3-5 days if azalides for S. pneumoniae
  2. Enteric gram neg, S. aureus, P. aeruginosa
    a. MSSA: 7-14 days if nonbacteremic, 21 days if bacteremic
    b. MRSA: 7-21 days if nonbacteremic, 28 days if bacteremic
    c. P. aeruginosa: 14-21 days if nonbacteremic, 28 days if bacteremic
  3. Mycoplasma, Chlamydophila: 10-14 days
  4. Legionella: 14-21 days; 10 days if azalides
32
Q

Criteria for hospital discharge

A
  1. Temp 36-37.5
  2. HR < 100
  3. RR 16-24
  4. SBP >90
  5. sO2 >90
  6. Functioning GI tract - on PO meds
33
Q

Repeat CXR post discharge

A

4-6 weeks after discharge to establish new baseline and rule out malignancy (not prior to discharge if clinically improving)

34
Q

Main risk factors for P. aeruginosa infection

A
  1. Structural lung disease
  2. Recent antibiotic use
  3. Glucocorticoids
35
Q

Diagnostic threshold for quantitative ET aspirate of more proximal samples

A

10^6 cfu/ml

36
Q

Diagnostic threshold for protected specimen brush method of more distal samples

A

10^3 cfu/ml

37
Q

Major risk factor for infection with MRSA and ESBL-positive strains

A

Use of beta lactam drugs (cephalosporins)

38
Q

Empiric treatment for HCAP

A
  1. Without risk factors for MDR pathogens: SINGLE AGENT - ceftriaxone or IV fluoroquinolones or IV ampicillin/sulbactam or ertapenem
  2. With risk factors for MDR pathogens: 3 AGENTS - IV antipseudomonal BLIC/cephalosporin/carbapenem + (IV aminoglycoside or IV fluoroquinolone) + (IV linezolid or IV vancomycin)
39
Q

Major difference of CAP and VAP

A

Lower incidence of atypical pathogens in VAP (exception is Legionella)

40
Q

Most sensitive component of CPIS

A

Improvement in oxygenation

41
Q

Major difference of HAP and VAP

A

Higher frequency of non-MDR pathogens and anaerobes in HAP

PSBIM: Infectious Disease (9 decks)

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