Pneumonia Flashcards
Pneumonia classifications
- Anatomical
- Setting
Anatomical
- Lobar
- Broncho-pneumonia
- Diffuse
Setting
- Community acquired: Primary or secondary to underlying diseases
- Hospital acquired/ Nosocomial: Occurs >48 hrs after hospital admission
- Ventilator associated
Community acquired pneumonia
- Commonest causes
- S. pneumoniae
- H. influenzae
- Mycoplasma pneumoniae.
Others: S. aureus, Legionella, Chlamydia.
Broncho-pneumonia
Secondary infection in someone unwell/ immobile.
- Centred on airways in dependent parts of the lung.
Microbiology
- S. aureus
- E coli
- Pseudomonas.
Diffuse pneumonia
Primary infection in those with impaired host defences.
- I.e in HIV or cytotoxic chemo patients.
- Neither lobar or broncho-centric
- Non specific radiology
Pneumonia complications
General
- Respiratory failure
- Sepsis
Local
- Pleural effusion
- Lung abscess
- Empyema
Pneumonia epidemiology
- Age
- Mortality
Age
- Affects very young and very old
Mortality
- Highest in those admitted to ITU (>50%)
- HAP= 5-10%
- CAP= very rare.
Empyema
- Definition
- Microbiology
- Dx
- Indications for drainage
Collection of pus in pleural cavity.
- considered if patient is not responding to treatment
Microbiology
- Pneumococcus mainly
- Others: S aureus, Strep milleri
Differential
- Pleural TB
Drainage indications
- Visible purulent effusion
- Radiologically loculated
- Positive microbial culture from effusion
- Pleural pH <7.2
CURB 65
Screening tool used to assess pneumonia severity
C- Confusion U- urea >7 R- Resp rate >30 B- Blood pressure <95, D<60 65- age >65
CAP management
- Rest + fluids
- Analgesia
- Antibiotics
CAP management
- Rest + fluids
- Analgesia
- Antibiotics
- Amoxicillin or clarithromycin
HAP antibiotics
- Gram- bacilli, pseudomonas, anaerobes
Aminoglycoside IV (gentamicin) + cephalosporin
Severe HAP antibiotics
- Co-amoxiclav + macrolide
- 3rd gen cephalosporin.
- Cefuroxime/ ceftriaxone
Lobar pneumonia
Infection and inflammation primarily affecting a lobe.
Causative agents
- Strep pneumoniae is most common
Others
- Haemophilus influenzae - Moraxella catarrhalis.
CAP moderate antibiotics treatment
- Strep. pneumoniae
- H. influenzae
- M. pneumoniae
Amoxicillin + clarithromycin/ doxycycline
CAP severe antibiotics treatment
- Pneumococcal, influenzae
- Staph
- MRSA
Co-amoxiclav/ cephalosporin
AND
Clarithromycin
Staph
- Add flucloxacillin/ + rifampicin
- MRSA= vancomycin
Atypical pneumonia treatment
- Legionella
- Pneumocystis
Legionella
- Fluroquinolone + clarithromycin/ rifampicin
Pneumocystis
- Co-trimoxazole
Klebsiella pneumonia
- Population mostly affected
- Features
- Treatment
Population
- Elderly
- Diabetics
- Alcoholics
Features
- Cavitating, upper lobes
Treatment
- Cefotaxime
Mycoplasma pneumoniae pneumonia
- Presentation
- Features
- Treatment
Presentation
- Flu-like symptoms
- Drug cough
Features
- X-ray: reticular nodular shadowing/ patchy consolidation, lower lobe
Treatment
- Clarithromycin/ doxycycline/ fluroquinolone
Legionella pneumonia
- Presentation
- Features
- Treatment
Bacteria colonises water tanks <60 degrees.
Presents
- Flu-like symptoms
- Dry cough, dyspnoea
- Extra-pulmonary symtoms
- Bloods: hypoNa+, LFs,
- May have haematuria
Features
- CXR= bi-basal consolidation
Treatment
- Fluroquinolone/ clarithromycin
