Pneumonia Flashcards
Pneumonia
This patient has been acutely unwell for 3 days, with shortness of breath and a productive cough.
Please examine his chest.
Clinical signs of Pneumonia
- Tachypnoea, O2 mask, sputum pot (rusty sputum associated with pneumococcus)
- Reduced expansion
- Dull percussion note
- Focal coarse crackles, increased vocal resonance and bronchial breathing
- Ask for the temperature chart
- If dull percussion note with absent tactile vocal fremitus, think parapneumonic effusion/ empyema
Investigation
- CXR: consolidation (air bronchogram), abscess and effusion
- Bloods: WCC, CRP, urea, atypical serology (on admission and at day 10) and immunoglobulins
- Blood (25% positive) and sputum cultures
-
Urine:
⚬⚬ Legionella antigen (in severe cases)
⚬⚬ Pneumococcal antigen
⚬⚬ Haemoglobinuria (mycoplasma causes cold agglutinins → haemolysis)
Community acquired pneumonia (CAP)
* Common organisms:
⚬⚬ Streptococcus pneumoniae 50%
⚬⚬ Mycoplasma pneumoniae 6%
⚬⚬ Haemophilus influenzae (especially if COPD)
⚬⚬ Chlamydia pneumoniae.
Community acquired pneumonia (CAP)
* Antibiotics:
⚬⚬ 1st line: penicillin or cephalosporin + macrolide
Special considerations in pneumonia
* Immunosuppressed:
* Aspiration
* Post‐influenza:
-
Immunosuppressed:
⚬⚬ Fungal Rx Amphotericin
⚬⚬ Multi‐resistant mycobacteria
⚬⚬ Pneumocystis carinii Rx Cotrimoxazole/Pentamidine
⚬⚬ CMV Rx Ganciclovir -
Aspiration (commonly posterior segment of right lower lobe):
⚬⚬ Anaerobes Rx + Metronidazole -
Post‐influenza:
⚬⚬ Staph. aureus Rx + Flucloxacillin
Severity score for pneumonia:
CURB‐65 (2/5 is severe) * Confusion * Urea >7 * Respiratory rate >30 * BP systolic <90 mm Hg or diastolic <60 mm Hg * Age >65
Severe CAP should receive high‐dose IV antibiotics initially plus level 2 care (HDU/ITU)
Prevention of pneumonia
Pneumovax II® to high‐risk groups, e.g. chronic disease (especially nephrotic and asplenic patients) and the elderly
Complications of pneumonia
- Lung abscess (Staph. aureus, Klebsiella, anaerobes)
- Para‐pneumonic effusion/empyema
- Haemoptysis
- Septic shock and multi‐organ failure