Pneumonia basics Flashcards
what is pneumonia
an acute infection causing inflammation in the lungs
which organisms cause CAP?
- mainly caused by strep pneumonia (70%)
- haemophilus influenzae (5%)
- staph. aureus (4%)
- Influenza A
what patients may present with a staph aureus infection?
IV drug users with boggy swelling near groin
what are the atypical causes of CAP?
- mycoplasma
- legionella
- chlamydophila pneumoniae/psittaci
- coxiella brunetti
what are the risk factors for CAP?
age : below 16 or over 65
co-morbidities: HIV infection, diabetes mellitus, chronic kidney disease, malnutrition, recent viral respiratory infection
Other respiratory conditions
lifestyle: cigarette smoking, excess alcohol, IV drug use
Iatrogenic: immunosuppressant therapy
which respiratory conditions are a risk factor for CAP?
CF, bronchiectasis, COPD, obstructing lesion (endoluminal cancer, inhaled foreign body)
which organisms cause HAP?
- 60% gram negative : e.coli, klebsiella spp., pseudomonas spp
- CAP organisms
- staph aureus
- anaerobes
which organisms are involved in immunocompromised pneumonia ?
pneumocystis jirovecii pneumonia (PCP)
this is one of the most frequent and severe opportunistic infection in people with weakened immune systems (like AIDs)
how is PCP acquired ?
inhalation of fungus
what are the symptoms of pneumonia ?
- malaise
- chest pain
- fever
- rigors
- myalgia
- arthralgia
- headache
- confusion
- cough
- pleurisy
- haemoptysis
- dyspnoea
- preceding URTi
- sputum
- abdo pain
- anorexia
- diarrhoea
what causes chest pain in pneumonia?
it is pleuritic in nature and results from inflammation of the pleura
a pleural rub may be heard early on in the illness
what does a swinging fever indicate?
an empyema
what organisms commonly causes a headache and coldsores?
legionella
why do people get dyspnoea?
the alveoli become filled with pus and debris, impairing gas exchange
what are the signs of pneumonia
- fever
- cyanosis
- confusion
- herpes labialis
- tachypnoea
- crackles
- rub
- hypotension
- reduces chest expansion - if very bad
- dull percussion note
- increased resonance
- skin rash
why are coarse crackles heard?
due to consolidation of the parenchyma
what may be heard over areas of consolidated lung?
coarse crackles and bronchial breath
increased vocal fremitus and dull percussion
which organism may cause rust coloured sputum?
strep pneumoniae
what causes a rub?
inflammation of the pleura
what causes cold sores?
when the immune system is shocked - you can get a recurrence of the herpes virus
this is not uncommon in people who have penumococcal pneumonia
which skin rashes are found in mycoplasma penumonia
erythema nodosum,
erythema multiforme
what are signs of severe pneumonia
CXR: more than one lobe involved PaO2 20 x10 ^9/L ) blood culture - positive other co-morbidities absence of fever in the elderly
