Pneumonia Flashcards
What is Pneumonia
Acute LRTI with fever, chest signs and xray abnormalities
Pneumonia classifications
Community acquired
Hospital acquired
Aspiration
Immunocompromised
Pneumonia organisms CAP
Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Atypically mycoplasma pneumoniae, staph aureus, legionella and chlamydia
Viruses for up to 15%
Pneumonia organisms hospital acquired
Gram -ve enterobacteria
Staph aureus
Less commonly pseudomonas, klebsiella, bacteroides, clostridia
Pneumonia organisms aspiration
Oropharyngeal anaerobes
Pneumonia organisms immunocomp
Strep pneumoniae M. pneumoniae Staph aureus H. influenzae M. catarrhalis P. jirovecii
Pneumonia signs + symptoms
Fever (unless old)/ Confusion (sometimes only sign in elderly) Cough ± haemoptysis Purulent sputum Consolidation signs Tachypnoea/ tachycardia/ hypotension
Pneumonia tests
O2 sats, ABG if <92% or severe pneumonia
CXR shows lobar infiltrates, cavitation, pleural effusion
Sputum/ pleural fluid culture
BAL if on ITU/ immunocompromised
Urine for legionella/ pneumococcal antigen
Pneumonia severity assessment
CURB 65
Confusion (AMTS ≤8)
Urea >7
Resp rate ≥30
BP <90 systolic/60 diastolic
Age ≥65
Pneumonia severity score guidance
0-1 - PO antibiotic/home treatment (Mild)
2 - Hospital therapy (Moderate)
≥3 - Severe pneumonia, consider ITU (Severe)
Pneumonia general management
Antibiotics according to sensitivities, PO if CURB <3 + not vomiting, IV if ≥3
Keep O2 >8 and sats >94
IV fluids + VTE prophylaxis
Analgesia if pleurisy
Follow up at 6 wks ± CXR
Pneumococcal pneumonia treatment
Amoxicillin
Benzylpenicillin
Cephalosporin
Staphylococcal pneumonia treatment
Flucloxacillin ± rifampicin
Vancomycin for MRSA
Klebsiella pneumonia occurs in
Diabetics
Elderly
Alcoholics
Klebsiella pneumonia treatment
Cefotaxime
Imipenem
Pseudomonas treatment
Ceftazidime Ciprofloxacin + Gentamicin Meropenem Pip-taz Vancomycin
Mycoplasma pneumoniae presentation
Flu-like symptoms followed by dry cough
Mycoplasma pneumoniae complications
Erythema multiforme
Stevens-Johnson syndrome
Guillain Barré
Mycoplasma pneumoniae treatment
Clarithromycin 500mg/12h
Legionella pneumonia treatment
Ciprofloxacin for 2-3 wks
Clarithromycin
Chlamydophila pneumonia treatment
Doxycycline
Clarithromycin
Chlamydophila psittaci history
Acquired from infected birds (often parrots)
Pneumocystis pneumonia treatment
High dose co-trimoxazole IVI for 2-3 wks
Steroids if severe hypoxaemia
Prophylaxis if CD4<200 or after 1st attack
Viral causes of pneumonia
Avian influenza
SARS
MERS
