Pneumonia/Chest Infections

Question 1

What is procalcitonin and what is it seen more commonly in?

Answer 1

Biomarker.
Released in response to inflammatory stimuli, particularly those of bacterial origin.
It is increased in response to TNF-alpha and IL-6 inflammatory mediators.

Question 2

What is klebsiella pneumoniae?

Answer 2

A gram-negative rod that is part of the normal gut flora.

Question 3

What infections are typically caused by klebsiella pneumoniae?

Answer 3

Aspiration pneumonia

UTIs

Question 4

What are the features of klebsiella pneumoniae?

Answer 4

More common in alcoholics and diabetics
May occur following aspiration
‘Red-currant jelly’ sputum
Often affects upper lobes

Question 5

What is the prognosis of klebsiella pneumoniae?

Answer 5

Commonly causes lung abscesses and formation of empyema

Mortality is 30-50% (Causes severe hospital infections)

Question 6

What is the most common causative organism of pneumonia?

Answer 6

Streptococcus pneumoniae 
(Accounts for 80% of cases)

Associated with high fever, rapid onset and herpes labialis.

Question 7

What is a common causative organism of pneumonia in patients with COPD?

Answer 7

Haemophilus influenza

Question 8

What bacteria often causes a pneumonia following an influenza infection?

Answer 8

Staphylococcus aureus

Question 9

What unusual signs are seen in mycoplasma pneumoniae?

Answer 9

Autoimmune haemolytic anaemia and erythema multiforme

Question 10

What unusual signs are seen in legionella pneumophilia?

Answer 10

Hyponatraemia and lymphopenia

Infected air conditioning units

Question 11

What is a common causative organism of pneumonia in alcoholics?

Answer 11

Klebsiella pneumoniae

Question 12

What is a common causative organism of pneumonia in patients with HIV?

Answer 12

Pneumocystis jiroveci

Question 13

What is the name for non-infective causes of pneumonia?

Answer 13

Idiopathic interstitial pneumonia

complication RA or amiodarone therapy

Question 14

What are the symptoms of pneumonia?

Answer 14

Cough
Sputum
Dyspnoea
Chest pain: may be pleuritic
Fever

Question 15

What are the signs of pneumonia?

Answer 15

Systemic inflammatory response: fever, tachycardia
Reduced oxygen saturations
Auscultation: reduced breath sounds, bronchial breathing

Question 16

What are the investigations of pneumona?

Answer 16

Chest x-ray: consolidation
Bloods: FBC (neutrophilia) U+Es (dehydration), CRP (raised)
ABG: if indicated with low O2 sats

In intermediate or high-risk patients blood and sputum cultures (urinary antigen tests if pneumococcal or legionella)

Question 17

What is the management of pneumonia?

Answer 17

Antibiotics

Supportive care: O2, IV fluids (if required)

Question 18

What scoring system can be used to risk stratify patients with CAP and determine treatment?
What are the components of this risk score?

Answer 18

CURB-65

C - Confusion (AMT)
U - Urea > 7 mmol/L
R - Respiratory rate > 30/min
B - Low blood pressure
65 - Age > 65 years

Question 19

What corresponds to the scores of the CURB-65 scores?

Answer 19

0 - community management
1 - hospital assessment - SpO2 assessment + CXR, (home or hospital treatment, may require admission)
2 + - Hospital admission

(Also corresponds to increased risk of mortality)

Question 20

What is the management (drugs) of low-severity community acquired pneumonia?

Answer 20

Amoxicillin is first-line

allergy. macrolide or tetracycline

Question 21

What is the management (drugs) of moderate and high-severity CAP?

Answer 21

Dual antibiotic therapy with amoxicillin and a macrolide (7-10 days)

Question 22

What is the timeline for pneumonia recovery?

Answer 22

1 week - fever should have resolved
4 weeks - chest pain and sputum production should have reduced
6 weeks - cough and breathlessness should have reduced
3 months - most symptoms resolved, fatigue may persist
6 months - most people back to normal