Pneumonia and Lung abscess - DONE

Question 1

Pneumonia def:

Answer 1

is an infection of the pulmonary parenchyma

Question 2

What is the classification of pneumonia?

Answer 2

1. Community-acquired pneumonia (CAP)
2. Health care-associated pneumonia (HCAP).
   Hospital-acquired pneumonia (HAP)
   Ventilator-associated pneumonia (VAP)

Question 3

CAP

Answer 3

Community-acquired pneumonia

Question 4

HCAP

Answer 4

Health care-associated pneumonia

Question 5

HAP

Answer 5

Hospital-acquired pneumonia

Question 6

VAP

Answer 6

Ventilator-associated pneumonia

Question 7

What results in fever in pneumonia?

Answer 7

The release of inflammatory mediators, such as interleukin-1 and tumor necrosis factor, results in fever.

Question 8

What stimulate the release of neutrophils and attracts them to the lung?

Answer 8

Chemokines, such as interleukin-8 and granulocyte colony-stimulating factor, stimulate the release of neutrophils and their attraction to the lung, producing both peripheral leukocytosis and increased purulent secretions

Question 9

What does the capillary leak results in?

Community-acquired pneumonia

Answer 9

The capillary leak results in a radiographic infiltrate and rales detectable on ascultation, and hypoxemia results from alveolar filling

Question 10

What causes respiratory alkalosis?

Community-acquired pneumonia

Answer 10

Increased respiratory drive in the systemic inflammatory response syndrome leads to respiratory alkalosis

Question 11

Classic pneumonia evolves through a series of pathologic changes:

Answer 11

1. Edema
2. Red hepatization (the presence of erythrocytes in the cellular intraalveolar exudate)
3. Gray hepatization (no new erythrocytes, those already present are lysed and degraded)
4. Resolution

Question 12

What is Red hepatization?

Answer 12

the presence of erythrocytes in the cellular intraalveolar exudate

Question 13

What is Gray hepatization?

Answer 13

no new erythrocytes, those already present are lysed and degraded

Question 14

TYPICAL community-acquired pneumonia:

Answer 14

• Streptococcus pneumoniae (the most common)
• Haemophilus influenzae
• Staphylococcus aureus
• Klebsiella pneumoniae
• Pseudomonas aeruginosa

Question 15

What is the most common TYPICAL community-acquired pneumonia?

Answer 15

Streptococcus pneumoniae

Question 16

ATYPICAL community-acquired pneumonia:

Answer 16

• Mycoplasma pneumoniae
• Chlamydophila pneumoniae
• Legionella species influenza viruses, adenoviruses, human metapneumovirus respiratory syncytial viruses

Question 17

What is the etiology of community-acquired pneumonia?

Answer 17

• Anaerobes
• The combination of unproductive pathway (patients with alcohol or drug overdose or a seizure disorder) and significant gingivitis constitutes the major risk factor

Question 18

Anaerobic pneumonias are often complicated by…….

Answer 18

abscess formation and by significant empyemas or parapneumonic effusions

Question 19

What are the clinical manifestation of community acquired pneumonia?

Answer 19

• Tachycardia
• Chills and/or sweats
• Cough (maybe either nonproductive or productive of mucoid, purulent, or blood-tinged sputum)
• Dyspnoea
• Pleuritic chest pain

LESS COMMON

• Gastrointestinal symptoms (nausea, vomiting, diarrhea)
• Fatique, headache, myalgias, arthralgias

Question 20

community-acquired pneumonia - diagnosis:

Answer 20

• Careful history
• Chest radiography
• Urinary antigen tests (detect pneumococcal and Legionella antigen in urine)

Question 21

Potential etiologic agents of VAP include……

Answer 21

both MDR (multidrug-resistant) and non-MDR bacterial pathogens

*The non-MDR group is nearly identical to the pathogens found in severe CAP (Community acquired pneumonia)

Question 22

What are the clinical manifestation of ventilatory associated pneumonia?

Answer 22

• Fever
• Leukocytosis
• Increase in respiratory secretions
• Pulmonary consolidation on physical examination
• New or changing radiographic infiltrate
• Tachypnea
• Tachycardia
• Worsening oxygenation
• Increased minute ventilation

Question 23

Ventilator-associated pneumonia (VAP) - diagnosis:

Answer 23

Ventilator-associated pneumonia is usually suspected when the individual develops a new or progressive infiltrate on chest radiograph, leukocytosis, and purulent tracheobronchial secretions.

Question 24

Ventilator-associated pneumonia (VAP) - microbiologic diagnosis:

Answer 24

• Blood and pleural fluid cultures.
• Non-quantitative or semiquantitative airway sampling
• Quantitative cultures of airway specimens

Question 25

When should VAP be concidered?

Answer 25

VAP should be considered with a CPIS score of >6, or alternatively, with a new pulmonary infiltrate and at least two of the following: fever, leukocytosis, and purulent secretions.

Question 26

Lung abscess:

Answer 26

• Lung abscess represents necrosis and cavitation of the lung following microbial infection
• Lung abscess can be single or multiple but usually are marked by a single dominant cavity > 2 cm in diameter

Question 27

Primary lung abscess:

Answer 27

• ~80% of cases
• usually arise from aspiration, are often caused principally by anaerobic bacteria, and occur in the absence of an underlying pulmonary or systemic condition

Question 28

Secondary lung abscess:

Answer 28

• arise in the setting of an underlying condition, such as a postobstructive process (e.g. HIV infection or another immunocompromising condition)

Question 29

Lung abscess - epidemiology:

Answer 29

• In addition, patients with esophageal dismotility or esophageal lesions (structures or tumors) and those with gastric distention and/or gastroesophageal reflux, especially those who spend substantial time in the recumbent position, are at risk for aspiration.
• It is widely thought that colonization of the gingival crevices by anaerobic bacteria or microaerophilic streptococci (especially in patients with gingivitis and periodontal disease), combined with a risk of aspiration, is important in the development of lung abscesses

Question 30

What are the primary location of primary lung abscess?

Answer 30

• posterior upper lobes

- superior lower lobes

Question 31

Which lung is mainly affected by primary lung abscess?

Answer 31

The right lung is affected more more commonly than the left (because the right mainstem bronchus is less angulated)

Question 32

The microbiology of primary lung abscess is….

Answer 32

often polymicrobial

• primarily including anaerobic organisms
• as well as aerophilic streptococci

Question 33

What is the location of secondary lung abscess?

Answer 33

The location of the abscess may vary with the underlying cause

Question 34

The microbiology of secondary lung abscess is….

Answer 34

The microbiology can encompass quite a broad spectrum, with infection by Pseudomonas aeruginosa and other gram-negative rods most common

Question 35

What are the primary symptoms of lung abscess?

Answer 35

• cough (77%)
• sputum (65%)
• fever and chills (40%)

Question 36

What are the imaging diagnosis of lung abscess?

Answer 36

• chest X-ray

- CT

Question 37

What is the treatment for primary lung abscesses:

Answer 37

• Clindamycin or IV-administeredℬ-lactam/ℬ-lactamase combination
  
  • Treatment duration may range from 3-4 weeks to as long as 14 weeks

Question 38

What is the treatment for secondary lung abscesses:

Answer 38

• antibiotic coverage should be directed at the identified pathogen, and prolonged course (until resolution of the abscess is documented) is often required.
• Treatment regiments and courses vary widely, depending on the immune state of the host and the identified pathogen.