Pneumonia and flu Flashcards
- Definition and Features of Pneumonia (PNA)
A disease of the lungs that is characterized by inflammation of the parenchyma of the lung (alveolar wall) and accumulation of abnormal alveolar filling with fluid of lung tissue. Most commonly caused by infection
Describe lung protective defenses
Lower airways usually remain organism-free due to pulmonary host defense mechanisms: Innate (Nonspecific) and Acquired (Specific).
Lower airways usually remain organism-free due to pulmonary host defense mechanisms: Innate (Nonspecific) and Acquired (Specific).
- Pneumonia Pathogenesis
Pneumonia is caused by: Inhalation of infectious particles, Inhalation of oropharngeal or gastric contents, Hematogenous spread, Infection from adjacent or contiguous structures, Direct inoculation or Reactivation. Pneumonia occurs when hosts ability to fight pathogens is compromised
Pneumonia is caused by: Inhalation of infectious particles, Inhalation of oropharngeal or gastric contents, Hematogenous spread, Infection from adjacent or contiguous structures, Direct inoculation or Reactivation. Pneumonia occurs when hosts ability to fight pathogens is compromised
Clinical presentation of pneumonia
fever, chills, pleuritic chest pain, dyspnea and cough that can be productive of sputum (bacterial infections) or with minimal sputum (atypical vs viral).
pneumonia physical exam
Fever, tachypnea, tachycardia, hypoxia, cyanosis. Lungs have crackles, rhonchi, bronchial breath sounds, egophony, dullness to percussion
Basic Tests for all patients with suspected pneumonia pneumonia
CXR, CBC, CMP (complete metabolic profile), blood gas or pulse oximetry
CXR results in pneumonia
NOT sufficient to pneumonia, but helps. Lobar consolidation, interstitial infiltrates and cavitation
What can fill alveoli?
mnemonic: poor funny boy cant piss for crap: Pus, fluid, blood, cells/cancer, protein, fat, calcium
CXR pattern and possible pathogens
Focal/ large pleural effusion: bacteria. Cavitary: bacterial abscess, fungi, acid-fast bacilli. Miliary: acid-fast bacilli, fungi. Rapid progression/ multifocal: Legionella spp, pneumococcus, staphylococcus. Interstitial: viruses, pneumocystis, mycoplasma, chlamydia. Mediastinal widening without infiltrate: inhalation anthrax
- Pneumonia Classifications or Types
Community Acquired Pneumonia (CAP), Hospital (Nosocomial) Acquired Pneumonia (HAP), Ventilator Associated Pneumonia (VAP), Healthcare-Associated Pneumonia (HCAP)
Community acquired pneumonia description
Begins Outside the Hospital . Diagnosed < 48 Hrs after Hospital Admission . Patient is not a resident in a long-term facility for > 14 days or more before the onset of symptoms
Most common causes of CAP
Bacteria: strep pneumonia, H. Influenza, M. Catarrhalis, Staph aureus, Group A strep. Less common: legionella, Mycoplasma, chlamydia
CAP treatment
Outpatient: Macrolide or Doxycyline (60 rs or comorbid dsease). Inpatient ICU: Beta-lactam + Macrolide, Beta-lactam + Respiratory Fluoroquinolone. Inpatient non-ICU: Respiratory Fluoroquinolone , Beta-lactam + Macrolide
Definitions of HAP, VAP and HCAP
HAP: PNA>48hrs after hospital admission. VAP: PNA > 48 - 72 Hrs after Endotracheal Tube Intubation. HCAP: PNA in a non-hospitalized patient with extensive healthcare contact (hospitalization within 90 days of infection, long term care facility,
HAP: PNA>48hrs after hospital admission. VAP: PNA > 48 - 72 Hrs after Endotracheal Tube Intubation. HCAP: PNA in a non-hospitalized patient with extensive healthcare contact (hospitalization within 90 days of infection, long term care facility,
What is unique about HAP, VAP and HCAP organisms
•Infections are Frequently Polymicrobial in Origin and tend to be multi-drug resistant. Organisms that colonize oropharynx enter lower respiratory tract by micro/macro aspiration
HAP, VAP and HCAP common pathogens
gram negative (SPACE): Serratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacter or Escherichia coli. Gram positive: Methicillin-Resistant Staphylococcus Aureus - MRSA
HAP, VAP and HCAP treatment
For drug resistant strains: Antipseudomonal Agent: Cephalosporin or Carbopene.
Plus 1 of the Following: Anti-pseudomonal Fluoroquinolone or Anti-Gram Negative Aminoglycoside. Plus 1 Anti-MRSA Medication: Linezolid or Vancomycin
- Differential diagnosis of PNA
Airway diseases: Organizing pneumonia, Allergic Bronchopulmonary Aspergillosus (ABPA), Bronchiectasis
, Bronchopulmonary sequestration, Bronchocentric granulomatosis. Vascular disease: eosinophilic lung disease, fat emboli, vasculitis, vascular tumors. Parenchymal diseases: drug rxn, granulomatous lung disease, pulmonary edema, neoplasm, ARDS, idiopathic interstitial pneumonia.
- Basics of PNA Treatment
Determine severity of disease (pneumonia severity index), do further testing if severely ill or immunocompromised, or inpatient/ deteriorating
Pneumonia severity index and mortality
class 1- 0.1% mortality. Class II: 0.6%. Class III: 2.8%. Class IV: 8.2%. Class V: 29.2%
Which pneumonia severity classes require admission?
class IV and V
Further testing for severely ill or immunocompromised with suspected pneumoni
Sputum gram stain/culture, blood culutre, urinary Ag testing
Further inpatient testing
HIV serology, mycoplasma serology, chlamydia serology, fungal serology, test for TB, gram stains.
Further testing for deteriorating patient despite therapy for pneumonia
Bronchoscopy, biopsy, bacterial serology, fungal serology, evaluate for CHF, pulm embolism, neoplasm, CT disease
