Pneumonia

Question 1

Causes of common pneumonia

Answer 1

Strep pneumoniae- accounts for 80%. Vaccine for pneumococcus available for the vulnerable.
Haemophilus influenzae- seen in COPD patients.
Staph aureus- seen following influenza infection, seen in ITU patients.

Question 2

Causes of atypical pneumonia

Answer 2

Mycoplasma pneumonia- see autoimmune haemolytic anaemia.
Legionella- from infected air conditioning units
Klebsiella- seen in alcoholics and diabetics. “Red current jelly” sputum.
Pneumocystis- seen in HIV with CD4 < 200. Typically normal CXR but declining oxygen saturations on exertion.
Chlamydia.

Question 3

Symptoms

Answer 3

Cough +/- sputum
Dyspnoea
Pleuritic chest pain
Fever, rigors, malaise
Haemoptysis
Cyanosis
Confusion
Signs: tachycardia, hypotension, high respiratory rate, consolidation in lungs, reduced breath sounds, low sats

Question 4

Tests

Answer 4

Temperature, BP, HR
Bloods: FBC, U+Es, LFTs, CRP, culture
CXR
Sputum culture
Urine dip

Question 5

Scoring system

Answer 5

CURB65:
Confusion
Urea > 7
RR > 30
BP < 90 systolic or 60 diastolic
Age > 65

1- at home treatment
2- hospital treatment
> 3- severe, mortality 15-40%. Consider ITU referral.

Question 6

Management of CAP

Answer 6

Mild- doxycycline / amoxicillin if pregnant / clarithromycin
Moderate/severe- amoxicillin + clarithromycin / doxycycline If pregnant give amoxicillin plus erythromycin.
Add in flucloxacillin if staphlococci is suspected.

Question 7

Management of HAP

Answer 7

C-amoxiclav / cefuroxime + tazocin

+ vancomycin if MRSA suspected

Question 8

Management of atypical pneumonia

Answer 8

Mycoplasma- erythromycin
Legionella- ciprofloxacin and clarithromycin / erythromycin
Chlamydia- tetracycline
Pneumocystis- co-trimoxazole