Pneumonia Flashcards
What are the 4 types of pneumonia?
Community-accquired pneumonia (CAP)
Hospital-acquired pneumonia (HAP)
Atypical pneumonia
Aspiration pneumonia
What is the most common cause of pneumonia and empyema?
Strep. pneumoniae
When can HAP occur?
> 48hrs after admission to hospital
Patient with redcurrant jelly sputum and right lower lobe consolidation on CXR.
What is likely cause of pneumonia?
Klebsiella pneumoniae - redcurrant sputum
Right lower lobe - most common site in aspiration pneumonia - (due to more proximal vertical orientation of right bronchi)
Who is most likely to get aspiration pneumonia?
Alcoholics and diabetics
Why may you require broad-spectrum antibiotics in HAP?
Generally caused by gram-negative bacteria and staph. aureus
Pneumonia associated with birds?
Chlamydia psittaci
Pneumonia assoc. with hot tubs, water source with poor ventilation? ?
Legionella
Bacteria assoc. with pneumonia post viral URTI (upper resp tract infection)?
Staph aureus
How may the lung look macroscopically on autopsy?
Red hepatisation - looks like liver due to consolidation
What pneumonia is associated with sheep?
Coxiella burnetti
Clinical features?
Pyrexia Chills Tachypnoea Tachycardia Productive cough Pleuritic chest pain
How may atypical pneumonia (coxiella burnetti, klebsiella, chylamdia psittaci, mycoplasma pneumoniae) present
Atypical symptoms but normal CXR
Pneumonia causes an exudate (high in protein) to be produced but what else is characteristic of it?
Fibrin rich
Pathophysiology of pneumonia?
Infectious organisms reach alveoli -> produce exudate -> fills infected and neighbouring alveolar spaces -> proliferation of NEUTROPHILS
Defintion
Infection of distal air spaces with a NEW infiltration on CXR
What bug can cause minimal chest symptoms but associated with GI symptoms?
Legionella
What criteria is used to estimate MORTALITY with CAP - hence determine inpatient vs. out-patient care
Explain it and what the scoring means
CURB-65
Confusion (<8 on Abbreviated Mental Test Score) Urea (>7mmol/L) Resp rate (>30/min) Blood pressure (<90/<60) =/> 65
LOW RISK 0-1 = out-patient
MOD RISK 2 = in patient
HIGH RISK >3 = consider ICU assessment
CAP manangement (CHECK AGAINST SIGN)
Amoxicillin - most important
Low risk = amoxicillin/doxycycline
Mod risk = oral amoxicillin (clarithromycin if atypical)
High risk = IV co-amoxiclav + clarithromycin
***** HAP management (CHECK AGAINST SIGN)
Co-amoxiclav - most important
Low risk = PO amoxicillin
High severity = IV amoxicillin + gentamicin
THIS CHANGES DEPENDANT ON GUIDELINES - ALWAYS CHECK LOCAL GUIDELINES
What can be found on examination?
Dull percussion - (effusion)
Reduced chest expansion
Crackles on auscultation
Match the following sputum types to bacteria:
Rusty brown
Redcurrant jelly like
Mucoid
Rusty brown - strep. pneumoniae
Redcurrant jelly like - klebsiella
Mucoid - Chlamydia psittaci
Difference between pneumococcus and Strep. pneumoniae
Same thing
Aspiration pneumonia management
PO Amoxicillin + metronidazole
Severe = IV amoxicillin + metronidazole + gentamicin
