Pneumonia

Question 1

Define pneumonia

Answer 1

signs and symptoms of LRTI with evidence of radiological infiltration (consolidation on X-Ray)

Question 2

What are the different types of pneumonia?

Answer 2

• Community acquired – acquired outside hospital/healthcare facilities
• Hospital-acquired/nosocomial – acquired >48h after admission to hospital
• Aspiration – results from inhalation of oropharyngeal contents
• Atypical – caused by organisms not detectable on Gram stain or cultured using standard methods

Question 3

What are the causes/ risk factors of the different types of pneumonia?

Answer 3

Community acquired
causes:
• Streptococcus pneumoniae (70%)
• Haemophilus influenza
• Moraxella catarrhalis (COPD)
• Staphylococcus aureus (influenza)
• Coxiella burnetti (Q fever)
• Atypical pneumonia
risk factors:
• Age >65 years
• Smoking
• Alcohol abuse
• COPD

Hospital-acquired/ nosocomial
causes:
• MRSA
• Pseudomonas aeruginosa
• Klebsiella pneumoniae
• Acinetobacter spp.
risk factors:
• Poor infection control/ hand hygiene
• Intubation

Aspiration
causes:
• Anaerobes
risk factors:
• Altered mental status
• Swallowing dysfunction e.g. stroke
• GORD, hiatus hernia
• Intubation/ tracheostomy
• NG tube

Atypical
causes:
• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Legionella pneumophila
risk factors:
• Close communities
• Immunosuppression
• Air conditioning
• Stagnant water
• Travel

Question 4

What are the symptoms of pneumonia?

Answer 4

• Fever
• Rigors
• Sweating
• Malaise
• Cough
• Sputum (rusty red in pneumococcal infection)
• SOB
• Pleuritic chest pain
• Confusion (severe, elderly)
• high BP, low HR

Aspiration
• Frothy/purulent sputum
• Foul-smelling breath

Atypical
• Headache
• Myalgia
• Pharyngitis
• Hoarseness
• Diarrhoea/abdominal pain (Legionella)
• Confusion (Legionella)

Question 5

What are the signs of pneumonia?

Answer 5

• Pyrexia
• Respiratory distress
• Tachypnoea
• Tachycardia
• Hypotension
• Cyanosis
• Reduced chest expansion
• Dullness to percussion
• Increased tactile/vocal fremitus
• Whispering pectoriloquy
• Bronchial breathing
• Coarse crepitations

Question 6

What are the investigations for pneumonia?

Answer 6

• Bloods
o FBC – raised WCC
o U&Es – low Na in Legionella
o LFTs – deranged in Mycoplasma, Legionella
• Blood culture
• Blood film – RBC agglutination in Mycoplasma (cold agglutinin)
• ABG
• Sputum MC&S – acid fast bacilli
• Urine – pneumococcal and Legionella antigens
• CXR – lobar or patchy consolidation, pleural effusion, abscess, cavitations
• Bronchoscopy and lavage

Question 7

What is the management of pneumonia?

Answer 7

CURB-65 score
• Start empirical antibiotics
o 5 days oral amoxicillin (or macrolide)
o 7-10 days oral or IV amoxicillin and macrolide
o 7-10 days IV co-amoxiclav/cefotaxime/cefuroxime
and macrolide
o + metronidazole if aspiration (anaerobes)
• Oxygen
• IV fluids – dehydration, shock
• Analgesia
• CPAP or BiPAP and ITU for respiratory failure
• Surgical drainage of empyema/abscess

Question 8

What are the complications of pneumonia?

Answer 8

• Pleural effusion
• Empyema
• Abscess
• Septic shock
• ARDS
• Acute renal failure

Mycoplasma pneumoniae
• Erythema multiforme
• Myocarditis
• Haemolytic anaemia
• Meningoencephalitis
• Transverse myelitis
• Guillain-Barré syndrome