Pneumonia Flashcards
What is pneumonia?
Infection of the lung tissue causing inflammation and exudation (oedema)
What are the symptoms of pneumonia?
Shortness of breath Purulent cough Haemoptysis Pleuritic chest pain Malaise Rigors (spiking change in temperature) Myalgia Confusion
What are the signs of pneumonia?
Fever Tachypnoea Tachycardia Hypoxia Hypotension Crackles Bronchial breath sounds (harsh breath sounds on insp and exp) Dullness to percussion Pleural rub Cyanosis
What investigations are done for pneumonia?
CXR Sputum culture Viral PCR Blood culture Serology ABGs FBC CRP U&Es LFTs Legionella and pneumococcal urinary antigens
What is the assessment criteria for pneumonia?
CURB65
What is the most common cause of pneumonia?
Streptococcus pneumoniae
What is a common cause pneumonia in COPD patients?
Haemophilus influenzae
What is a common cause of pneumonia in PWIDs, the young or elderly, or often following influenza?
Staphylococcus aureus
Which atypical pneumonia organism is associated with birds?
Chlamydophila psittaci
Which atypical pneumonia organism is associated with sheep and goats, and farming?
Coxiella burnetti
Which atypical pneumonia organism is associated with water tanks/ air con and holiday to Spain?
Legionella pneumophilia
Which atypical pneumonia organism is associated with alcoholism and aspiration pneumonia?
Klebsiella/mixed anaerobbes
Which atypical pneumonia organism is associated with the immunocompromised?
Pneumocystis jiroveci
Which atypical pneumonia organism causes erythema multiforme (target lesions) and neurological symptoms in a young patient?
Mycoplasma pneumoniae
How does strep pneumonia appear on gram staining?
Gram positive (purple) cocci in strips
How does haemophilia influenzae appear on gram staining?
Gram negative (pink) coccobacilli
How does staph aureus appear on gram staining?
Gram positive coccus, ‘grape-like’ clusters
What is community acquired pneumonia?
Pneumonia acquired outside hospital or healthcare facilities
What is the pathology of pneumonia?
- Organism reaches the lungs
- Immune activation and infiltration of neutrophils, macrophages
- Fluid and cellular build up in alveoli
- Impaired gas exchange
What are risk factors for community acquired pneumonia?
Increasing age Immunocompromised/suppressed patients Smoking COPD Alcohol abuse Drugs that reduce stomach acid production - H2 antagonist, antacids
In what way can atypical pathogens present differently to other pathogens?
Can present sub-acutely with gradual onset of symptoms
When should you suspect community acquired pneumonia?
In patients with symptoms and signs of a lower respiratory tract infection, and when there is new radiographic consolidation for which there is no other explanation
What are some differentials for pneumonia?
Acute bronchitis Congestive heart failure Bronchiectasis exacerbation TB Lung cancer Pulmonary embolism Pneumothorax
How does the assessment criteria for pneumonia assess severity?
Confusion Urea >7 Resp rate >30 BP <90 systolic or <60 diastolic 65+ One point for each of the above that they exhibit 0 points is low risk 1-2 is moderate 3+ is high risk
What is the treatment for mild/moderate community acquired pneumonia?
Oral amoxicillin/doxycycline 5 days
What is the treatment for severe community acquired pneumonia?
Co-amoxiclav + doxycycline
If penicillin allergic then levofloxacin only
If high risk of atypical organism: co-amoxiclav + clarithromycin
What are the supportive measures used for pneumonia?
Oxygen if <94%
IV fluids
Bed rest
Who are pneumonia vaccines given to?
Over 65 year olds Patients with chronic chest or cardiac disease Patients with diabetes Immunocompromised Health care workers
What are some complications of pneumonia?
Septic shock ARDS C diff associated colitis (pseudomembranous) Heart failure Pleural effusion Empyema Lung abscess
What is hospital acquired pneumonia?
An acute lower respiratory tract infection that is acquired after at least 48 hours of admission to hospital
What is early onset hospital acquired pneumonia often caused by?
Strep pneumoniae
What are risk factors for hospital acquired pneumonia?
ICU
Major surgery
Patients who have been in hospital a long time
Endotracheal intubation with mechanical ventilation
Sedation
Immunosuppression
Head of the bead at <30 degree angle
What is the treatment for non-severe hospital acquired pnuemonia?
Amoxicillin/doxycycline PO 5 days
What is the treatment for severe hospital acquired pneumonia?
IV Amoxicillin + gentamicin
If penicillin allergic then co-trimoxazole + gentamicin
What are the most common organisms causing community acquired pneumonia?
Strep pneumoniae
Atypicals
Haemophilus influenza
Staph aureus
What are the atypical bacteria causing pneumonia?
Legionella pneumophilia Mycoplasma Chlamydia pneumonia Coxiella burnetti Chlamydia psittaci
What fungus can cause pneumonia?
Pneumocystis jiroveci
How does pneumocystis jiroveci (pneumocystis pneumonia) present?
Subtly with dry cough without sputum, shortness of breath on exertion and night sweats
How is pneumocystis pneumonia treated?
Co-trimoxazole
What are the most common organisms causing hospital acquired pneumonia?
E. coli
Klebsiella
Pseudomonas aeruginosa
What is lobar pneumonia?
Consolidation involving a complete lobe
What is bronchopneumonia?
Infection starting int he airways and spreading to adjacent alveolar lung
What is the onset of pneumonia?
Subacute - days
What is the treatment for non-severe aspiration pneumonia?
Amoxicillin/doxycycline + metronidazole PO 5 days
What is the treatment for severe aspiration pneumonia?
IV amoxicillin/clarithromycin + metronidazole + gentamicin
What is the treatment for atypical pneumonia?
If it’s not legionella - doxycycline
If it’s legionella - clarithromycin/erythromycin or levofloxine
