Pneumonia Flashcards
Risk Factors for pneumonia
Smoking Chronic lung disease Chronic heart disease Alcohol excess Immunosuppresion Swallowing impairment
Classification of Pneumonia
Community acquired pneumonia (CAP)
Hospital acquired pneumonia (HAP) after >48 hours
Aspiration pneumonia
Pneumonia in the immunocompromised
Clinical Features of pneumonia
SOB
Cough
Sputum production
Pleuritic Chest Pain
On examination of Pneumonia
Pyrexial Tachycardic Tachypnoeic Reduced lung expansion Dull Percussion Coarse crackles on auscultation Increased tactile fremitus
Common Organisms in CAP
Streptococcus Pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Common organisms in HAP
Staphylococcus aureus
Gram - enterobacteria
Pseudomonas
Klebsiella
Common Organisms in Aspiration
Anaerobes
Gram - enterobacteria
Staphylococcus aureus
Common Organisms in immunocompromised Pneumonia
CAP organisms HAP organisms CMV, VZV Mycobacteria Aspergillus
Legionella Pneumophila
Gram negative
Found in cooling towers and air conditioning
Flu like symptoms- dry cough and SOB
Diarrhoea, vomiting, hepatitis, hyponatraemia
Severe pneumonia with high mortality
What is in an atypical pneumonia screen?
Urinary legionella screen
Cold agglutinins (present in mycoplasma)
Mycoplasma, Chlamydia serology
Pneumococcal antigenq
CURB-65 Score:
Confusion- abbreviated mental test score <8 Urea- >7mmol/L Respiratory Rate- >30 breaths/min Blood pressure- systolic <90mmHg 65- >65 years of age
How to manage a CURB 65 score of 0
Treatment at home with oral antibiotics
How to manage a CURB 65 score of 1
Consider hospital admission
How to manage a CURB 65 score of 2
Consider IV antibiotics
How to manage a CURB 65 score of 3
Consider ICU admission
Pneumocystis Jirovecii
Opportunistic infection in HIV patients, CD4<200
Progression SOB, non-productive cough
Desat on exertion
Complications of pneumonia
Septic Shock
ARDS- needs supportive care, low pressure ventilation, ECMO
Parapneumonic effusion and empyema- Intercostal drain
Cavitation and abscess- resection
MI
Antibiotics for CAP-Low severity
Amoxicillin- 7 days
Doxycyclin or clarithromysin- alternatives
Antibiotics for CAP-Low severity
Suspected atypical pathogen
Amoxicillin- add:
Clarithromycin or azithromycin or erythromycin
Antibiotics for CAP-Low severity
Staphylococci suspected
Amoxicillin- add:
Flucloxacillin
14-21 days
Antibiotics for CAP-moderate severity
Amoxicillin + clarithromycin OR
Doxycyclin alone
7 days
Antibiotics for CAP-moderate severity
MRSA suspected
Amoxicillin + clarithromycin OR
Doxycyclin alone and ADD
vancomycin
14-21 days
Antibiotics for CAP-high severity
Benzylpenicillin sodium + clarithromycin OR
benzylpenicillin sodium + doxycycline
Antibiotics for CAP-high severity
MRSA suspected
Benzylpenicillin sodium + clarithromycin OR
benzylpenicillin sodium + doxycycline
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