PNEUMONIA Flashcards
Define pneumonia
Infection of the lung parenchyma
Define a Community Acquired Pneumonia (CAP).
Either presenting with pneumonia or developing pneumonia within 48 hours of attending hospital.
What is the most common bacterial cause of pneumonia and where is bacteria likely to have come from to cause the lower respiratory tract infection?
Streptococcus pneumoniae is a commensal bacteria found in the upper respiratory tract.
Apart from S. Pneumoniae, what other bacteria commonly cause typical CAP? (Name 3)
Moraxella catarrhalis
Staphylococcus aureus
Haemophillus influenzae
Mycoplasma
What are the most common bacteria that cause atypical CAP? (Name 4) Which is the most common?
Mycoplasma pneumoniae (Most common)
Legionella pneumophilia
Multiple species of Chlamydia
Coxiella burnetti
Name 4 symptoms of typical CAP.
Fever
Rigors
Malaise
Cough
Purulent sputum
Haemoptysis
Pleuritic chest pain
Dyspnoea
What is pleuritic chest pain?
Pain caused by inflammation of the pleura. It is reported as a sharp stabbing pain and is worse upon inspiration and coughing.
Name 4 signs of typical CAP.
Pyrexia
Tachypnea
Tachycardia
Hypotension
Reduced chest movements
Dullness to percussion (often in a single lobe)
Increased vocal fremitus
Bronchial breathing
Coarse crepitations
What might be seen on a chest x-ray with someone who has typical CAP?
Consolidation (most often in a single lobe)
Pleural effusion
What does this chest x-ray show?
Right upper lobe consolidation
Name 4 symptoms of atypical CAP.
Fever
Confusion
Myalgia (pain in groups of muscles)
Non-productive cough
Headache
As well as any of the typical symptoms
What does this chest x-ray show and what might organism might lead to this?
Right hemithorax shadowing, not restricted to a single lobe.
Atypical pneumonia caused by Legionella pneumophila.
What is the CURB 65 score used for?
What is assessed when working out the CURB 65 score? What are the criteria for each part?
C - confusion
U - urea less than 7 mmol/L
R - resp rate of more than 30 breaths per minutes
B - systolic blood pressure of less than 90 mmHg and diastolic blood pressure of less than 60 mmHg
65 - age over 65
What blood tests would be ordered when trying to diagnose a patient with suspected pneumonia?
Full Blood Count
Urea and Electrolytes
C-reactive protein
What would you use to treat someone with CAP of unknown cause who has a CURB 65 score of 2? Can you give the doses of each drug and the route of administration?
Amoxicillin 500mg-1g/8h PO
AND
Clarithromycin 500mg/12h PO OR Doxycycline 200mg loading then 100mg/12h PO
What would you use to treat someone with a typical CAP of unknown cause with a CURB 65 score of 3 or above? Can you give doses for each drug and the route of adminstration?
Co-amoxiclav 1.2g/8h IV
OR Cephalosporin eg Cefuroxime 1.5g/8h IV
AND
Clarythromycin 500 mg/12h IV
A 48 year old farmer is admitted with a fever, headache, myalgia and a non-productive cough. His X-ray is shown below. What is the likely organism responsible for his admission?
Coxiella burnetii causes Q-fever which can progress to an atypical pneumonia.
It is often found in cattle, sheep, goats and other animals.
A 42 year old poultry farmer is brought in with a fever of 38.2, headache, cough and myalgia. He also has blood on his face from an earlier nose bleed. He is breathing at a rate of 32 breaths per minute and his sats are 85%. His X-ray is shown below. What is a possible diagnosis based on his profession and severe symptoms? How should this patient be managed?
This patient may have Avian influenza. The signs that may lead to this diagnosis are the very high fever and the nose bleeds which can be an early feature of “bird flu” but the fact that he deals with birds on a daily basis would be what would make you suspect this in the first place. This patient will need ventilatory support and oxygen in isolation. Antivirals such as Oseltamivir have been shown to reduce mortality.
