Pneumonia Flashcards
What is pneumonia?
Inflammation o the lung with consolidation or interstitial lung infiltrates
What are some common types of pneumonia?
Community acquired
Hospital acquired
Aspiration
Pneumocystic jirovecii pneumonia PJP
What are some risk factors for community acquired pneumonia?
>65yo Comorbidities e.g. COPD Smoking Contact with children Residence in residential home
What is the most common cause of community acquired pneumonia?
strep. pneumoniae
What are some common causes of community acquired pneumonia?
Strep. pneumoniae H. influenzae= most common with COPD Influenza virus Staph aureus Moraxella catarrhalis Mycoplasma pneumoniae= atypical
What can mycoplasma pneumoniae cause?
Autoimmune haemolytic anaemia
Erythema multiforme
What is hospital acquired pneumonia?
If been in hospital 48 hours before deve;loping symptoms
What are risk factors for hospital acquired pneumonia?
> 65yo
Intubation
Poor infection control measures
What are common causes of hospital acquired pneumonia?
Strep pneumoniae Pseudomonas aeroginosa= most dangerous E. coli Influenza virus Klebsiella pneumniae= classically in alcoholics
What is the pathophysiology of aspiration pneumonia?
Aspiration –> pneumonitis –> damage to lung parenchyma –> secondary bacterial infection
Where is aspiration pneumonia normally seen?
Right basal pneumonia
What is the presentation of pneumonia?
Cough with increasing sputum production Dyspnoea Pleuritic chest pain Fever, arthralgia, myalgia Dullness to percussion Asymmetric reduced breath sounds Bronchial breathing
What investigations are done for pneumonia?
FBC, U&Es, CRP, glucose Blood culture Sputum culture CXR ABG if unwell
What is seen on CXR with pneumonia?
Consolidation
What is the scoring system for pneumonia?
CURB65
What are the features used in CURB65?
Confusion Urea >7 RR >25 BP <60 diastolic >65 yo
What scores of CURB65 indicate what?
0-1= outpatient 2-3= inpatient 3-5= inpatient, consider ITU/HDU
What is the management of pneumonia?
Antibiotics and supportive management
What antibiotics are used for pneumonia?
Outpatient= Oral amoxicillin or clairythromycin Inpatient= IV amoxicillin and clairythromycin OR IV levofloxacin
What indicates failure to improve in pneumonia?
Want CRP to half in 3 days
What could be the causes of failure to improve in pneumonia?
Wrong diagnosis
Wrong antibiotics
Difficult/resistant pathogen
Complication e.g. abscess, empyema
What are some complications of pneumonia?
Sepsis ARDS C. diff Heart failure Pleural effusion Lung abscess Empyema
When are lung abscesses esp common?
Staph aureus and klebsiella
What is empyema?
Pus in pleural cavity
What is the investigation and management of empyema?
Pleural aspiration/tap= bacteria and protein, pus
Chest drain
What is PJP?
Fungal infection
Most common opportunist infection in AIDS
Who is PJP seen in?
Severely immunocompromised e.g. AIDS
Bone marrow/organ transplant
Chronic immunosuppression
What are the features of PJP?
Dyspnoea Dry cough fever Few chest signs Rare= hepatosplenomegaly, lymphadenopathy
What investigations are done for PJP?
FBC, U&Es, CRP, check CD4
CXR
Sputum and bronchoalveolar lavage stain
Exercise induced desaturation
What is the management of PJP?
Co-trimoxazole
Severe= + steroids
When is PJP prophylaxis given?
HIV and CD4 <200
What is a common complication of PJP?
Pneumothorax
