pneumonia Flashcards
what is pneumonia?
inflammation of alveoli or interstitium of lung cause my microorganism (bacteria, viral, fungal)
how is pneumonia classified and what are the 4 types we went over?
by source of infection major groups: - CAP: community acquired -HAP: hospital acquired minor groups: -HIV associated (immunocompromised) -Flu associated MRSA pneumonia
how long must you have been at the hospital for it to be classified as HAP?
48 hrs after admission
3 risk factors for CAP
extremes of age, alcoholism (KLEB CL), other medical conditions (i.e. DM)
3 types of CAP
bacterial (worse symptoms, 85% of cases) viral (milder symptoms) fungal (only in immunocompromised people)
3 typical bacterial organisms that cause CAP. Typical makes up ___% of CAP
Strep Pneumo, H flu, M catarrhalis; 85%
which bacterial organisms for CAP are penicillin sensitive and penicillin resistant
Strep pneumo- some sensitive and resistant
H flu- some sensitive and some resistant to ampicillin (txt w/ Beta Lactamase inhib)
M cattarrhalis- all strains resistant
3 atypical bacterial organisms that cause CAP
legionella, mycoplasma, C pnemoniae
-usually less acute symptoms w/ less productive cough
rare bacterial pathogens that cause CAP and what are they assosciated with?
klebsiella (w/ alcoholism)
staph aureus (w/ flu)
* recent reports of recent fatal CA-MRSA pneumonia
inoculation of pneumonia means?
microaspiration (oral secretion with bacteria travels down the throat to the lungs)
clinical presentation of pneumoniae, how are these different if its viral?
symptoms come on rapidly, early onset COUGH (if productive it is purulent), PLEURISY (localized chest pain w/ breathing), maybe SOB and dec. pulse ox
*viral: same symptoms but more mild
respiratory rate w/ pneumonia
commonly increased
Lung PE for pneumonae
- bronchial breath sounds in periphery (consolidation, fluid filled causes transmitted sounds to travel)
- dull to percussion (effusion)
- crackles (pus in alveoli)
Dx for simple pneumonia (no hospital admission)
chest x ray (gold standard) : guidelines recommend seeing consolidation (pus in airways- alveoli)
***INFILTRATES NOT PNEUMO
txt for pneumoniae: abx?
tripack > Zpack
azithromycin: 1 pill/day for 3 days
if Dx with CAP and considering hospitalization, what two further tests will you run?
deep cough sputum culture before giving abx and gram stain
additional tests for CAP and hospitalizing… to evaluate severity.. (3)
1) . pulse ox (if not as sick), ABG (if very sick)
2) . procalcitonin to evaluate severity (elevated w/ sepsis)
3) . pneumonia severity index
6 signs that pt should be admitted with CAP
neutropenia, multilobar infection, 50+yo and other med. problems, altered mental status, low BP
if CAP and hospitalized, what drugs (in general) are you giving?
IV Abx, multi-drug therapy
non ICU: floxacin or macrolide (mycin) AND b lactam
ICU: b lactam AND mycin or floxacin
4 requirements to give oral abx and discharge
able to take PO, WBC decreasing, afebrile, improving cough and SOB
when txt considered failed?
if not better in 72 hours: this might mean you gave the wrong drug, the bug was resistant or there are other complications (i.e. empyema)
what is empyema?
complication of pneumonia: collection of pus in pleural cavity (abx cant reach these) (might need thoracentesis and drainage)
symptoms get better before _____ gets better
chest xray (for longterm followup); can take 4-8 weeks to return to normal
klebsiella pneumoniae has what as a risk factor?
alcoholism
“walking pneumonia” usually refers to what?
viral pneumonia (more mild symptoms, no consolidation just crackles, few or no infiltrates)
mortality for HAP; which pt population usually gets this?
high: 20-50%; most often vent pts
HAP is usually from what source?
bacterial, multiple drug resistant pathogens
clinical presentation for HAP
change in CLINICAL STATUS: those in hospital should be improving NOT declining
important Dx test for HAP
sputum culture
blood cultures (helpful if positive)
*but dx is often unclear
w/ HAP, there is a risk with _____
treating empirically- overtreating
start with broad spectrum then narrow based on culture results (involve ID)
when did we see flu assosciated pnumonaie and who did it effect?
young healthy people
2008: very severe mortality from flu–>MRSA–>pneumonia
2014: –> strep pneumoniae
index of suspicion of post-flu pneumonia is elevated by…
Hx of skin infection, recent flu, multilobar disease, lack of txt response, no flu vaccine
SARS and MERS cause by what virus?
mutated coronavirus - very high mortality
what is the most common opportunistic infection in HIV?
pneumocystitis jiroveci
low CD4 counts mean what?
low immune system (HIV pts have this)
many AIDs pts receive prophylactic azithromycin if CD4 count is under 100 to avoid what kind of pneumonia?
mycobacterium (fungal)
most common types of fungal pneumonia? (3)
If healthy person, self limited *histoplasmosis- midwest from bird droppings
occidiomycosis- southwest
old people have less or more pulmonary symptoms of infection
less- dont mount immune response as well. Be wary of old people whose vitals are bad- this means the infection must be really bad
-confusion, falling down
major clinical presentation in elderly with pneumonia**
tachypnea
what is BOOP?
bronchial obliterans organizing pneumoniae : bilateral bronchial and alveolar fibrous plugging PLUS alveolitis
–> looks like pneumonia but isnt infectious
etiology of BOOP
immune hypersensitivity and resulting fibrosis
txt for BOOP
steroids - but hard to taper off b/c signs recur once you start lowering
**NOT ABX
CAP outpatient ABX therapy: previously healthy person vs someone with ABX therapy in the past 3 months
healthy- azithromycin or doxy
previous ABX use- floxacin OR mycin plus b lactam (cillin)
symptoms and treatment of klebsiella
s/s: high fever, chills, productive cough with CURRANT JELLY SPUTUM
tx: inpatient, broad spectrum IV ABX
two most common ATYPICAL CAP organisms?
M pneumo and C pneumo
symptoms for atypical CAP (compared to typical bugs)
low grade fever, nonproductive cough, negative culture, self limiting in young healthy adults
how long do you typically treat CAP vs HAP for?
CAP- 5 days of ABX
HAP- 7 days ABX
**longer if comorbidities present
