Pneumonia Flashcards
Define pneumonia
Infection of distal lung parenchyma. Predominantly infection of the alveoli, causing them to become filled with pus/fluid
It can be categorised in many ways:
Community-acquired
Hospital-acquired/nosocomial
Aspiration pneumonia
Pneumonia in the immunocompromised (Secondary endogenous)
Typical
Atypical (Mycoplasma, Chlamydia, Legionella)
What are the causative agents for community and hospital acquired pneumonias?
Community-Acquired Streptococcus pneumoniae (70%) Haemophilus influenzae Moraxella catarrhalis (occurs in COPD patients) Chlamydia pneumonia Chlamydia psittaci (causes psittacosis) Mycoplasma pneumonia Legionella (can occur anywhere with air conditioning) Staphylococcus aureus Coxiella burnetii (causes Q fever) TB
Hospital-Acquired
Gram-negative enterobacteria (Pseudomonas, Klebsiella)
Anaerobes (due to aspiration pneumonia)
What are the risk factors for Pneumonia?
Age Smoking Alcohol Aspiration Pre-existing lung disease (e.g. COPD) Immunodeficiency Contact with patients with pneumonia
Summarise the epidemiology of pneumonia
5-11/1000
Community-acquired pneumonia is responsible for > 60,000 deaths per year in the UK
Recognise the presenting symptoms of pneumonia
Fever Rigors Sweating Malaise Cough Sputum Breathlessness Pleuritic chest pain Confusion (in severe cases or in the elderly)
Atypical Pneumonia Symptoms: Headache Myalgia Diarrhoea/abdominal pain DRY cough
Recognise the signs of pneumonia on physical examination
Pyrexia Respiratory distress Tachypnoea Tachycardia Hypotension Cyanosis Decreased chest expansion Dull to percuss over affected area Increased tactile vocal fremitus over affected area Bronchial breathing over affected area Coarse crepitations on affected side Chronic suppurative lung disease (empyema, abscess) --> clubbing
Identify appropriate investigations for pneumonia
FBC - raised WCC U&Es LFT Blood Cultures ABG (assess pulmonary function) Blood film - Mycoplasma causes red cell agglutination
CXR
Lobar or patchy shadowing
Pleural effusion
(NOTE: Klebsiella often affects upper lobes)
May detect complications (e.g. lung abscess)
Sputum/Pleural Fluid - MC&S
Urine - Pneumococcus and Legionella antigens
Atypical Viral Serology
Bronchoscopy and Bronchoalveolar Lavage - if Pneumocystis carinii pneumonia is suspected, or if pneumonia fails to resolve
Generate a management plan for pneumonia
Assess severity using the British Thoracic Society Guidelines
Start empirical antibiotics
Oral Amoxicillin (0 markers)
Oral or IV Amoxicillin + Erythromycin (1 marker)
IV Cefuroxime/Cefotaxime/Co-amoxiclav + Erythromycin (> 1 marker)
Add metronidazole if: Aspiration Lung abscess Empyema Switch to appropriate antibiotic based on sensitivity
What is the supportive therapy for pneumonia?
Supportive treatment
Oxygen
IV fluids
CPAP, BiPAP or ITU care for respiratory failure
Surgical drainage may be needed for lung abscesses and empyema
Discharge planning
If TWO OR MORE
features of clinical instability are present (e.g. high temperature, tachycardia, tachypnoea, hypotension, low oxygen sats) there is a high risk of re-admission and mortality
Consider other causes if pneumonia is not resolving
Prevention Pneumococcal vaccine Haemophilus influenzae type B vaccine These are only usually given to high risk groups (e.g. elderly, splenectomy)
Identify the possible complications of pneumonia
Pleural effusion Empyema Septic shock ARDS Acute renal failure Localised suppuration (e.g. abscess)
Symptoms of abscesses:
Swinging fever
Persistent pneumonia
Copious/foul smelling sputum
Extra complications of Mycoplasma pneumonia: Erythema multiforme Myocarditis Haemolytic anaemia Meningoencephalitis Transverse myelitis Guillain- Barre syndrome
Summarise the prognosis for patients with pneumonia
Most resolve within treatment within 1-3 weeks
Severe pneumonia has a high mortality
The CURB-65score is used to assess the severity of pneumonia:
Confusion < 8 AMTS
Urea > 7 mmol/L
Respiratory rate > 30/min
Blood pressure: systolic < 90 mm Hg or diastolic < 60 mm Hg
Age >65yr
