Pneumonia Flashcards
Define Pneumonia?
Infection of distal lung parenchyma
What are the different ways Pneumonia can be categoried?
Community-acquired Hospital-acquired/nosocomial Aspiration Pneumonia Pneumonia in the immunocompromised Typical Atypical (Mycoplasma, Chlamydia, Legionella)
What is the aetiology of Community-Acquired Pneumonia?
Streptococcus pneumoniae (70%) Haemophilus influenzae Moraxella catarrhalis (occurs in COPD patients) Chlamydia pneumonia Chlamydia psittaci (causes psittacosis) Mycoplasma pneumonia Legionella (can occur anywhere with air conditioning) Staphylococus aureus Coxiella burnetii (causes Q fever) TB
What is the aetiology of Hospital-Acquired Pneumonia?
Gram-negative enterobacteria (Pseudomonas, Klebsiella)
Anaerobes (due to aspiration pneumonia)
What are the risk factors for Pneumonia?
Age Smoking Alcohol Pre-existing lung disease (e.g. COPD) Immunodeficiency Contact with patients with pneumonia
What is the epidemiology of Pneumonia?
5-11/1000
Community-acquired pneumonia is responsible for > 60,000 deaths per year in the UK
What are the presenting symptoms of Pneumonia?
Fever Rigors Sweating Malaise Cough Sputum Breathlessness Pleuritic Chest Pain Confusion (in severe cases or in the elderly)
What are the Atypical Pneumonia symptoms?
Headache
Myalgia
Diarrhoea/abdominal pain
Dry cough
What are the signs of Pneumonia on physical examination?
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) leads to clubbing
What investigations do we do for Pneumonia?
Bloods CXR Sputum/Pleural fluid Urine Atypical Viral Serology Bronchoscopy and Bronchoalveolar Lavage
What bloods do we do for Pneumonia and what might we see?
FBC- Raised WCC U&Es LFT Blood cultures ABG (assess pulmonary function) Blood film - Mycoplasma causes red cell agglutination
What do we see on a CXR for Pneumonia?
Lobar or patchy shadowing
Pleural effusion
Klebsiella often affects upper lobes
May detect complications (e.g. lung abscess)
Why do we check sputum/ pleural fluid for Pneumonia?
MC&S
What do we look for in the Urine for Pneumonia?
Pneumococcus and Legionella antigens
When do we do Bronchoscopy and Bronchoalveolar Lavage for Pneumonia?
If pneumocystis carinii pneumonia is suspected, or if pnenomia fails to resolve
How do we assess the severity of Pneumonia?
British Thoracic Society Guidelines
What is the first line of treatment for Pneumonia?
Start empiral antibiotics
What is the order of antibiotics we give for Pneumonia?
Oral Amoxicillin (0 markers)
Oral or IV Amoxicillin + Erythromycin (1 marker)
IV cefuroxine/Cefotaxime/Co-amoxiclav + Erythromycin (> 1 marker)
Add metronidazole if required
Switch to appropriate antibiotic based on sensitivity
When do we add Metronidazole for Pneumonia?
If there is:
Aspiration
Lung Abscess
Empyema
What is the Supportive treatment for Pneumonia?
Oxygen
IV fluids
CPAP, BiPAP or ITU care for resp failure
Surgical drainage may be needed for lung abscesses and empyemea
Wha is the Discharge planning for Pneumonia?
If TWO OR MORE features of clinical instability are present there is a high risk of re-admission and mortality
Consider other causes if Pneumonia isn’t resolving
What are some examples of the features of clinical instability in Pneumonia?
High temperature Tachycardia Tachypnoea Hypotension Low oxygen sats
What is the prevention of Pneumonia?
Pneumococcal vaccine
Haemophilus Influenzae type B vaccine
These are only usually given to high risk groups (e.g. elderly, splenectomy)
What are the possible complications of Pneumonia?
Pleural effusion Empyema Localised suppuration (e.g. abscess) Septic shock ARDS Acute renal failure Extra complications of Mycoplasma pneumonia
What are the symptoms of Abscesses that might also be present as a complication of Pneumonia?
Swinging fever
Persistent Pneumonia
Copious/foul-smelling sputum
What are some of the extra complications of Mycoplasma Pneumonia?
Erythema multiforme Myocarditis Haemolytic anaemia Meninogoencephalitis Transverse myelitis Guillain-Barre syndrome
What is the prognosis for patients with Pneumonia?
Most resolve within treatment within 1-3 weeks
Severe pneumonia has a high mortality
What is used to assess the severity of Pneumonia with regards to prognosis?
CURB-65 score
What is the CURB-65 score?
Confusion < 8 AMTS Urea > 7 mmol/L Respiratory rate > 30/min BP: systolic < 90 mm Hg or diastolic < 60 mm Hg Age > 65 yrs
