pneumonia Flashcards
what is it
inflammation of the substances of the lungs
what is it caused by
bacteria
viruses
fungi
symptoms
- acute illness
- cough
- purulent sputum
- breathlessness
- fever
what does the lung look like
consolidation
where is community acquired pneumonia contracted
in the community in a person who has no underlying immunosuppression or malignancy
where is hospital acquired pneumonia contracted
in nursing home or hospital
where does bronchopneumonia affect
bronchi and bronchioles
how is infection spread
by respiratory droplets
risk factors
- age
- HIV
- diabetes
- kidney disease
- malnutrition
- cystic fibrosis
- bronchiectasis
- COPD
- smoking
- alcohol
- IV drug use
symptoms
- cough (can be productive)
- haemoptysis
- breathless
- coarse crackles
- bronchial breath sounds
- fever
- chest pain, pleuritic
what is sputum like in pneumococcal pneumonia
rust-coloured
why does patient get breathless
alveoli become filled with pus and debris
why can coarse crackles be heard
due to consolidation of the lung
what does swinging fever indicate
empyema
why is chest pain present
due to inflammation of the pleura
extrapulmonary features of community acquired pneumonia
- myalgia
- myocarditis/pericarditis
- headache
- abdominal pain
- diarrhoea
- skin rashes
what causes myocarditis and pericarditis
mycoplasma pneumonia
what causes headaches
legionella pneumonia
what is a feature of legionella pneumonia
hepatitis
why can be reactivated by pneumococcal pneumonia
labial herpes simplex
symptoms often in elderly
- confusion
- recurrent falls
- generally un well
what is most common cause of pneumonia
streptococcus pneumonia
what should be excluded
- tuberculosis
- lung cancer
etc
what should mild infections be treated with
antibiotic:
- amoxicillin
- clarithromycin (penicillin allergic)
how is severity assessed
CURB 65
CURB 65 stand for
C: confusion U: urea >7mmol/L R: resp rate >30 B: BP systolic <90 65: age > 65
1 point for each of above
what should all patients get when admitted to hospital
chest X-ray
blood test
microbiological test
how can causative organism be identified
sputum culture and gram stain
what is strep pneumonia
gram positive diplococci
what is staph aureus
gram positive cluster (like bunch of grapes)
is legionella seen on gram stain
no
what should be offered to all patients with pneumonia
HIV test
general management
- oxygen
- intravenous fluids
- antibiotics
- thromboprophylaxis
- physiotherapy
- analgesia
why is oxygen given
to maintain saturations between 94-98%
what antibiotic does staph aureus need
flucloxacillin
what is a side effect of cephalosporin
diarrhoea
what is used to treat pleuritic pain
analgesia such as paracetamol or NSAIDs
preventative measures
- stop smoking
- vaccine against influenza
is consolidation always pneumonia
NO
think upper lobe can be tuberculosis
sputum in streptococcus pneumonia
rust coloured
symptoms of streptococcus pneumonia
- cough
- rusty sputum
- high fever
- pleuritic chest pain
symptoms of mycoplasma pneumonia
- headache
- malaise
- myalgia
- anaemia
- hepatitis
how is legionella pneumonia acquired
inhaling water mist containing bacteria
just back from holiday?
who is legionella more common in
- smokers
- male
complication of staph aureus
recent influenza
who is H.influenza more common in
- cystic fibrosis
- bronchiectasis
- COPD
what is chlamydia psittaci acquired from
birds
who is more likely to get coxiella burnetti
young men
symptoms of coxiella burnetti
- dry cough
- high fever
what is coxiella burnetti a recognised cause of
endocarditis
who is more likely to get klebsiella pneumonia
- men
- alcohol excess
- poor dental hygiene
- diabetes
complications of pneumonia
- respiratory failure
- sepsis
- pleural effusion
- empyema
- lung abscess
what kind of empyema does pneumonia cause transudative or exudative
exudative
what are early indications of empyema
- ongoing fever
- rising inflammatory markers
all despite antibiotic therapy
what should be done to diagnose empyema
thoracocentesis
what should aspiration been done under
ultrasound guidance
what should be done to treat empyema
- urgently drained to prevent further complication
what organisms can cause lung abscess
- klebsiella pneumonia
- staphylococcus pneumonia
- mycobacterium tuberculosis
- H. influenza
what is essential to diagnose lung abscess
CT
bronchoscopy
what is hospital acquired pneumonia defined as
- new onset cough
- purulent sputum
- CXR showing consolidation
what are causative organisms of HAP
- pseudomonas aureginosa
- e.coli
- k. pneumonia
- staph aureus
- enterobacter
where is most usual site for aspirated material to end
right middle lobe
where is pneumocystis jiroveci found
in air
what is first line treatment for pneumocystis jiroveci
co-trimoxazole
what kind of consolidation
patchy consolidation
is bronchopneumonia bilateral
yes
what is lobar pneumonia mostly due to
strep pneumonia
who gets klebsiella pneumonia
- elderly
- diabetics
- alcoholics
sputum in strep pneumonia
rusty coloured
how is legionella pneumonia spread
via water droplets
what is alveoli like in pneumocystis jirovecii
filled with pink exudate
types of fungi
- candida
- aspergillus
