Pneumonia Flashcards
What is pneumonia?
Lower respiratory tract infection
which causes inflammation of the lung tissue and sputum filling the airways and lungs
What is the most common cause of Pneumonia and what are the other causes?
- most common = bacterial
- viral
- fungal - pneumocystis jirovecii
What are the 3 classifications of pneumonia?
CAP
HAP
Aspiration
What are the bacterial causes of pneumonia? (typical)
6
most common
- streptococcus pneumoniae
- haemophilus influenza
less common
- moraxella catarrhalis (immunocompromised or chronic pulmonary disease)
- Pseudomonas aueroginosa (CF or bronchiectasis)
- staphylococcus aureus (CF)
- klebsiella pneumoniae - typically alcoholics
What are the atypical causes of pneumonia ?
How do you contract them?
Legions of psittaci MCQs
- Legionella pneumophila (Legionnaires’ disease) - infected water supplies. causes SIADH leading to hyponatraemia, deranged LFTs. flu like sx, dry cough, recent holiday
- Mycoplasma pneumoniae - milder. associated with erythema multiforme - pink target lesions with pale centres. can cause neurological sx in young people. Mycoplasma serology and agglutination test - +ve
- Chlamydophila pneumoniae - typically presents as school aged child, mild to moderate pneumonia and wheeze
- Coxiella burnetii AKA “Q fever” - causes flu like illness, due to exposure to animals and bodily fluids. typically farmer
- Chlamydia psittaci - caught from infected birds. typically parrot owner
What does atypical pneumonia mean?
cannot be cultured in normal way or detected using gram stain
How do you treat atypical pneumonias ?
cannot tx with penicillin. can use:
- macrolides e.g clarithromycin
- fluoroquinolones e.g levofloxacin
- tetracylcines e.g doxycycline
What causes fungal pneumonia ?
Who is it common in?
How does it present?
How is it treated?
What is given as prophylaxis?
Pneumocystis Jirovecii
common in new HIV or those with low CD4 count
dry cough, exercise induced SOB, night sweats
co-trimazole/septin
those with low CD4 given prophylactic co-trimazole
How does pneumonia present?
symptoms (5)
signs (3)
Symptoms
- cough
- sputum
- SOB
- chest pain, may be pleuritic
- fever
signs
- systemic inflammatory response: fever, tachycardia
- reduced oxygen saturations
- ausculatation: reduced breath sounds, bronchial breathing, crackles, dullness to percussion
How do you assess the severity of pneumonia?
CURB-65 Score in hospital, CRB-65 out
C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65
How should you manage pneumonia based on the CURB-65 score?
what does the CURB-65 score predict?
0 - manage at home
1 - check oxygen sats (if 92%+ manage at home), CXR - bilateral/multilobar shadowing - hospital
2 + - hospital
- predicts mortality
What investigations are done for pneumonia?
- CXR - consolidation
- FBC - raised neutrophils in bacterial infection
- Urea and electrolytes - check for dehydration and Urea for CURB-65
- CRP
- ABG - if oxygen sats low or pre-existing condition e.g COPD
Severe cases:
- sputum culture
- blood culture
- legionalla and pneumococcal urinary antigen test
What is the management of pneumonia?
mild CAP: Amoxicillin (or macrolide) 5 days
moderate to severe CAP: dual abx - macrolide + amoxicillin (in severe beta lactamase stable - co-amox, ceftriaxone, pipercillin with tazobactam)
what are symptoms/signs that prevent discharge?
2 of
- temperature higher than 37.5°C
- respiratory rate 24 breaths per minute or more
- heart rate over 100 beats per minute
- systolic blood pressure 90 mmHg or less
- oxygen saturation under 90% on room air
- abnormal mental status
- inability to eat without assistance.
What is the expected symptom timecourse?
Time Progress
1 week Fever should have resolved
4 weeks Chest pain and sputum production should have substantially reduced
6 weeks Cough and breathlessness
should have substantially
reduced
3 months. Most symptoms should have
resolved but fatigue may still be
present
6 months Most people will feel back to
normal.
