Pneumonia and Bronchitis Flashcards
What are risk factors/aetiology for pneumonia?
Immunosuppressed
Smoking
Chronic lung disease: COPD
>Age
Associated conditions: Diabetes, alcoholism
What organisms can cause pneumonia?
Streptococci Pneumoniae
Staphylococcus aureus
Haemophilus Influenzae
Legionella: Younger patients, poorly maintained air conditioning systems
Mycoplasma Pneumoniae
Chlamydia Psittaci
Coxiella Burnetii
Klebsiella pneumoniae
Describe the presentation of pneumonia
Cough with purulent green sputum
Reduced chest expansion
Pleuritic chest pain (sharp chest pain worse on inspiration)
Myalgia
Stony dull percussion
Crepitations on auscultation/coarse crackles
Fever
Tachycardia
Tachypnoea
Bronchial breathing
- Harsh breath sounds equal on inspiration and expiration caused by consolidation of lung tissue
Pleural rub
>Vocal resonance
What investigations are used in pneumonia diagnosis?
CXR
Sputum Culture and gram stain
FBC
- >WCC
>CRP
U&E for urea
ABG
- Hypoxia
Urinary Legionella antigen
What is the CURB-65 classification?
Determines risk of mortality of pneumonia
C: Confusion
U: Urea>7 mmoles/l
R: RR>30/min
B: <90/60mmHg
>65
What does a CURB-65 score of 0 suggest?
Low risk of death, no need for admission
What does a CURB-65 score of 1-2 suggest?
Increased risk, should be admitted
What does a CURB-65 score of >3 suggest?
Urgent hospital admission, consider intensive care assessment
What is the management of pneumonia?
Non-severe
- 5 days of treatment
- Amoxicillin
Severe
- 7 days of treatment
- Amoxicillin + Clarithromycin
- Co-Amoxiclav
Supportive
- IV fluids
- Oxygen
What are the possible complications of pneumonia?
Sepsis
Lung abscess
Respiratory failure
Empyema
Death
Bronchiectasis
Exudate pleural effusion
What investigation is used to monitor response to treatment in pneumonia?
CRP
What area of the lung is aspiration pneumonia most common in?
Right lower lobe
What organism is associated with pneumonia in diabetics and alcoholics?
Klebsiella Pneumoniae
Associated with red currant sputum
What organism is associated with pneumonia in bird owners?
Chlamydia Psittaci
What organism is associated with younger patients and a target rash?
Mycoplasma pneumoniae
What organism causes fungal pneumonia in severely immunocompromised patients/HIV?
Pneumocystis jiroveci
What organism is associated with. pneumonia post influenza infection?
Staph aureus
What organism is associated with pneumonia in patients exposed to infected water supplies and poor air ventilation?
Legionella pneumophila
Also causes hyponatraemia
What organism is associated with pneumonia in farmers/exposure to animals?
Coxiella burnetii
What is important to remember about CRP when monitoring pneumonia?
Shows a lag in decreasing compared to WCC in treatment of acute bacterial infection
Give risk factors for aspiration pneumonia
Poor dental hygiene
Swallowing difficulties
Prolonged hospitalization or surgical procedures
Impaired consciousness
Impaired mucociliary clearance
Intubation
What are the classes of pneumonia?
Community aquired
Hospital aquired, developed more tha 48 hours after hospital admission
Aspiration
What is the difference between CURB-65 outside and inside hospital?
Outside hospital does not count urea
Describe the prognosis of pneumonia at 1 week?
Fever should have resolved
Describe the prognosis of pneumonia at 4 weeks
Chest pain and sputum culture should have substantially reduced
Describe the prognosis of pneumonia at 6 weeks
Cough and breathlessness should have substantially resolved
Describe the prognosis of pneumonia at 3 months
Most symptoms should have resolved but fatigue may be present
What is the prognosis of pneumonia at 6 months?
Most patients should be back to normal
How is pneumocystis jiroveci pneumonia managed?
Co-trimoxazole and steroids
What is acute bronchitis?
Self limiting chest infection caused by inflammation of the trachea and major bronchi and therefore associated with oedematous large airways and the production of sputum
What is the prognosis of bronchitis?
The disease course usually resolves before 3 weeks, however 25% of patients will still have a cough beyond this time
What organisms cause bronchitis?
Viral
How does bronchitis present?
Cough that may or may not be productive
Sore throat
Rhinorrhoea
Wheeze, no other focal chest signs
Low grade fever
How is bronchitis managed?
Analgesia
Good fluid intake
Consider antibiotic therapy if patients:
- Are systemically very unwell
- Have pre-existing co-morbidities
- Have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)
- Doxycycline or amoxicillin for children/pregnant women
What antibiotic is used in aspiration pneumonia?
Metronidazole
What is gold standard in diagnosing pneumocystitis pneumonia?
Bronchoalveolar lavage
