Pneumonia

Question 1

What is pneumonia?

Answer 1

An acute LRTI associated with fever and chest symptoms/signs and CXR abnormalities.
CAP- acquired outside HC setting (likely strep pneumoniae)
HAP- acquired inside HC setting after 48 hrs.

Question 2

What are the types of pneumonia?

Answer 2

Aspiration
Atypical- Cannot be cultured by normal methods (legionella, mycobacterium, chlamydia)
Chlamydophila- C pneumoniae, major cause of pneumonia
CAP/ HAP(more G-ve)
Pneumocystis jiroveci (PCP)- causes disease in immunocompromised patients with CD4<200 cells per microlit etc.
SARS (SARS coronavirus) TRAVEL HISTORY

Question 3

What are the risk factors of pneumonia?

Answer 3

Very young or very old
Overcrowding
Healthcare setting
COPD/ smoking

Question 4

What is the epidemiology of pneumonia?

Answer 4

Incidence = 5-11 per 1000

Mortality about 21% in hospital

Question 5

What are the signs and symptoms of pneumonia?

Answer 5

Fever
Cough
Dyspnoea
Chest pain
Rigors
Anorexia
Purulent sputum 
Haemoptysis
Pleuritic pain
Pyrexia
Cyanosis
Confusion
Tachypnoea
Tachycardia
Hypotension 
Consolidation
Pleural rub

Question 6

What investigations would you do for pneumonia?

Answer 6

ABG
Low oxygen sats

Bloods
Leukocytosis
Normal U/E
Slightly elevated Blood glucose
CRP may be elevated

Sputum

Urine
Antigen for legionella and pneumococcus

CXR
New infiltrates

PCR
Antigens

Bronchoscopy/ bronchoalveolar lavage

Question 7

What does CURB-65 stand for?

Answer 7

CURB-65
Confusion
Urea (<7 mmol/L)
Resp rate (>30 /min)
BP <90 systolic/ 60 diastolic
65 yrs or older

> 3 severe pneumonia, consider ITU

Question 8

What is the management of pneumonia?

Answer 8

Pneumococcal vaccine
Antibiotics (Amoxicillin/ clarithromycin/ doxicillin/ co amoxiclav/ flucox/ rifampicin etc.) levofloxacin
Oxygen
IV fluids
Analgesia (if pleurisy)

6 week follow up- CXR

Question 9

What is the complications of pneumonia?

Answer 9

Pleural (parapneumonic) effusion (drain)
Empyema (drain with radiological guidance)
Lung abscess (antibiotics and drainage)
Resp. failure (oxygen)
Septicaemia (IV AB)
AF (beta blocker or digoxin)
Pericarditis
Myocarditis
Cholestatic jaundice (due to AB)

Repeat CRP and CXR if not progressing

Question 10

What is the prognosis of pneumonia?

Answer 10

Determined by age, general health and setting in which AB was given.
Mortality rate varies by disease but lower in outpatients than inpatients
Readmission rate is 7-12%
There are prognostic biomarkers like ANP, CRP, cortisol etc.