Pneumonia Flashcards
1
Q
Define
A
Acute lower respiratory tract illness associated inflammation of the alveoli
- Inflammation may be caused by bacteria, viruses or fungi
- Air sacs fill with fluid or pus, alveolar walls thickened by oedema
Classification
- Community acquired (CAP)
- Hospital acquired (nosocomial) - >48hrs after admission
- Usually G-ve enterobacilla or Staph Aureus
- Also aspiration - pts with stroke, myasthenia, bulbar palsies,
- ↓consciousness, oesophageal disease, poor dental hygiene Immunocompromised pts
- Typical vs. atypical pneumonias
(Atypical: mycoplasma, chlamydia, legionella)
2
Q
Cause
A
- Commonest cause of community acquired: Spread by droplet inhalation
- Strep pneumonia (70%)
- Haemophilus influenzae
- Mycoplasma pneumonia
- Hospital acquired: G–ve enterobacteria (pseudomonas, Klebsiella) or anaerobes om aspiration pneumonia
3
Q
Risk factors
A
- Age
- Smoking
- Alcohol
- Pre-existing lung disease
- Immunodeficiency
- Contact with pneumonia
4
Q
Epidemiology
A
5-11/1000
Community-acquired pneumonia is responsible for > 60,000 deaths per year in the UK
5
Q
Symptoms
A
- Fevers
- sweating
- SOB
- pleuritic CP
- rigors
- malaise
- anorexia
- dyspnoea
- cough
- purulent sputum
- haemoptysis
Confusion in severe cases/elderly/legionella
Atypical pneumonia - headache, myalgia, diarrhoea/abdomen pain
6
Q
Signs
A
- Pyrexia
- Respiratory distress
- Tachypnoea
- Tachycardia
- Hypotension
- Cyanosis
- Decreased chest expansion
- Dull to percuss over affected area
- Increased tactile vocal fremitus over affected area
- Bronchial breathing over affected area
- Coarse crepitations on affected side
- Chronic suppurative lung disease (empyema, abscess) –> clubbing
7
Q
Investigations
A
- Bloods
- FBC - raised WCC
- U&Es
- LFT
- Blood cultures
- ABG (assess pulmonary function)
- Blood film - Mycoplasma causes red cell agglutination
- CXR
- Lobar or patchy shadowing
- Pleural effusion
- NOTE: Klebsiella often affects upper lobes
- May detect complications (e.g. lung abscess)
- Sputum/Pleural Fluid - Microscopy culture and sensitivity
- Urine - Pneumococcus and Legionella antigens
- Atypical Viral Serology
- Bronchoscopy and Bronchoalveolar Lavage - if Pneumocystis carinii pneumonia is suspected, or if pneumonia fails to resolve
8
Q
Management
A
Low severity: oral amoxicillin
- Moderate: amoxicillin and macrolide (erythromycin, oral
or IV)
- High: co-amoxiclav and macrolide (erythromycin)
- Add metronidazole if aspiration/abscess/empyema
Then switch to appropriate antibiotic as per sensitivity
Supportive treatment
- Oxygen
- IV fluids
- CPAP, BiPAP or ITU care for respiratory failure
- Surgical drainage may be needed for lung abscesses and empyema
Consider other causes if pneumonia is not resolving
Prevention
- Pneumococcal vaccine
- Haemophilus influenzae type B vaccine
- These are only usually given to high risk groups (e.g. elderly, splenectomy)
9
Q
Complications
A
- Pleural effusion
- Empyema
- Localised suppuration (e.g. abscess)
- Symptoms of abscesses:
- Swinging fever
- Persistent pneumonia
- Copious/foul-smelling sputum
- Septic shock
- ARDS
- Acute renal failure
10
Q
Prognosis
A
Most resolve within treatment within 1-3 weeks
Severe pneumonia has a high mortality
