Pneumonia Flashcards
Community acquired pneumonia is (CAP)?
defined as pneumonia occurring before hospitalization or within 48 hrs of hospital admission.
What is the most common cause of CAP ?
streptococcus pneumoniae.
Neither the enviromental resevoir of streptococcus pneumoniae nor its method of acquisition is known.
Common pathogen in CAP with association of COPD ?
H. influenzae.
Common pathogen in CAP with association of Recent viral infection?
S. aureus.
Common pathogen in CAP with association of Alcoholism or diabetes ?
K. pneumoniae.
Common pathogen in CAP with association of poor dentition or aspiration ?
Anaerobes.
Common pathogen in CAP with association of Young, healthy patients ?
Mycoplasma pneumoniae.
Common pathogen in CAP with association of Hoarseness ?
Chlamydophila pneumoniae.
Common pathogen in CAP with association of Contaminated water sources, air conditioning, ventilation systems ?
Legionella
Common pathogen in CAP with association of Birds ?
Chlamydia psittaci
Common pathogen in CAP with association of animals at the time of giving birth, veterinarians, farmers ?
Coxiella bumetii
Presentation of pneumonia ?
- Fever & cough.
- Severe infection is associated with Dyspnea.
- Dullness to percussion is found if there is an effusion.
- Severe infections are distinguished by abnormalities of vital signs (tachycardia, hypotension, tachypnea) or mental status.
- Chills or “rigors” are a sign of bacteremia.
What are the main ways to distinguish pneumonia from bronchitis ?
- Dyspnea.
- High fever.
- Abnormal chest x-ray.
Which organism is associated with this presentation, Hemoptysis from necrotizing diseases “currant jelly” sputum?
Klebsiella pneumonia.
Which organism is associated with this presentation, Foul-smelling sputum “rotten eggs” ?
Anaerobes.
Which organism is associated with this presentation. Dry cough, rarely severe and bullous myringitis?
Mycoplasma pneumoniae.
Which organism is associated with this presentation. GI symptoms (abd pain, diarrhea) or CNS symtoms such as headache and cunfusion?
Legionella
Which organism is associated with this presentation, AIDS with <200 CD4 cells ?
Pneumocystis
Infections often with a “dry” or nonproductiove cough ?
- Mycoplasma.
- Viruses.
- Coxiella.
- Pneumocystis.
- Chlamydia.
Coz these preferentially involve the interstitial space and more often leave the air spaces of the alveoli empty. thats why there is less sputum production.
Diagnosis of pneumonia ?
- Best initial test is chest X-ray. (can’t determine a specific etiology)
- Sputum gram stain and Sputum culture are the best ways to determine a specific microbial etiology.
- Many organisms won’t be visible on GS or not culturable “atypical pneumonia” like mycoplasma, chlamydophila, legionella, coxiella and viruses.
- Leukocytosis is often present, but is a nonspecific marker of infection.
Chest x-ray: bilateral interstitial infiltrates are seen with ?
- Mycoplasma.
- Viruses.
- Coxiella.
- Pneumocystis.
- Chlamydia.
same organisms as dry cough.
Tests done in severe disease with unclear etiology, or those not responding to treatment ?
- Thoracentesis: Analysis of a pleural effusion.
- Empyema: look for LDH (lactate dehydrogenase) above 60% of serum level and protein above 50% of serum level.
- Bronchoscopy.
what is the initial approach in treatment of pneumonia?
- Determining the severity of the disease in order to determine the location in which to place the patient.
- Its the severity of the disease, not the aetiology that drives initial therapy.
What score do we have to assess mortality ofCAP to help determine inpatient vs outpatient treatment ?
CRUB65
- Confusion.
- BUN >19 mg/dl (>7 mmol/L).
- Respiratory rate >30.
- BP (systolic <90) or (diastolic <60)
- Age >65.
- 0-1 = outpatient.
- 2-5 = inpatient.
Outpatient treatment in CAP ?
- Healthy, mo antibiotics in past 3 months and mild symptoms:
MACRLIDE (azithromycin or clarithrimycin) or DOXYCYCLINE. - Comorbidities or antibiotics in the past 3 months: Respiratory FLUOROQUINOLONE (levofloxacin or moxifloxacin).
Inpatient treatment in CAP ?
- Respiratory FLUOROQUINOLONE (levofloxacin or moxifloxacin).
or - CEFTRIAXONE & AZITHROMYCIN.
Hospital acquired pneumonia is ?
Defined as a pneumonia developing more than 48 hrs after admission or after hospitalisation in the last 90 days.
- These patients have a higher incidence of gram-negative bacilli such as E.coli or pseudomonas .
Treatment of HAP ?
- Antipseudomonal Cephalosporins: cefepime or ceftazidime.
or - Antipseudomonal penicillin: piperacillin/tazobactam.
or - Carbapenems: imipenem, meropenem or doripenem.
treatment of ventilator-assocaited pneumonia?
Combine 3 different drugs:
1. Antipseudomonal beta-lactam: (cephalopsporins, penicillins,carbapenem).
PLUS
2. second antipseudomonal agent: (aminoglycosides, fluoroquinolone)
PLUS
3. Methicillin-resistant antistaphylococcal agent: (Vancomycin or linezolid)
