Pneumonia Flashcards
What is pneumonia?
Infection involving the distal airspace’s, usually with inflammatory exudates (localised oedema).
What causes consolidation?
Fluid filled spaces
Classification
By clinical setting, organism and morphology.
Clinical setting
Community, hospital, aspiration, legionella.
Organisms
Mycoplasma pneumonia, strep pneumoia, klebsiella pneumonia.
Mycoplasma pneumonia
Community acquired pneumonia
Morphology
Lobar pneumonia & bronchopneumonia
Lobar pneumonia
Confluent consolidation involving complete lung lobe
Causative organism of lobar pneumonia
Most often streptococcus but also with klebsiella & legionella.
Clinical setting of lobar pneumonia
Usually community acquired
Affected individuals of lobar pneumonia
Healthy young adults
Pathology of Lobar Pneumonia
Classical acute inflammatory response => exudation of fibrin rich fluid, neutrophil infiltration, macrophage infiltration => resolution.
Immune response in Lobar Pneumonia
Antibodies lead to opsonisation & phagocytosis of bacteria.
Bronchiopneumonia
Infection starting in the airways that spreads to adjacent alveolar lung.
Affected individuals of Brochopneumonia
Patients with pre-existing disease.
Causative organisms of bronchopneumonia
Streptococcus, haemophilia influenza, staphylococcus, anaerobes, coliforms.
Why is mycoplasma pneumonia resistant to B-lactam antibiotics?
They have no cell wall.
Symptoms
Malaise, anorexia, sweats, arthralgia, myalgia, headache, confusion, cough & haemoptysis, pleurisy, dyspnoea, preceding URTI, abdominal pain, diarrhoea.
Signs
Fever, rigors, herpes labilus, tachypnoea, crackles, pleural rub, cyanosis, hypotension, diminished expansion, dull percussion.
Investigations
CXR, FBC, Blood glucose, ABG, oximetry, liver function, CURB65, sputum, pleural fluid aspirate
CXR
Lobar or multilobar infiltrates, cavitation, pleural effusion
CURB65
- Confusion
- Urea > 7
- RR > 30
- BP: Systolic < 90, Diastolic < 61.
- Age > 65.
Complications
Resp failure, hypotension, pleural effusion etc.
General treatments
Oxygen, fluids, bed rest, no smoking.
Antibiotics for mild, moderate and severe acquired
Mild-Moderate (0-2 CURB65): amoxicillin.
Severe (3-5 CURB65): IV Co-amoxiclav + clarithoromycin or levofloxacin. Step down to doxycycline.
Antibiotics for hospital or aspiration acquired
IV amoxicillin, metronidazole & gentamicin.
Antibiotics for legionella pneumonia
Levofloxacin
Prevention of pneumonia
Influenza and pneumococcal vaccines.
