Pneumonia/Chest Infections Flashcards
What is procalcitonin and what is it seen more commonly in?
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.
What is klebsiella pneumoniae?
A gram-negative rod that is part of the normal gut flora.
What infections are typically caused by klebsiella pneumoniae?
Aspiration pneumonia
UTIs
What are the features of klebsiella pneumoniae?
More common in alcoholics and diabetics
May occur following aspiration
‘Red-currant jelly’ sputum
Often affects upper lobes
What is the prognosis of klebsiella pneumoniae?
Commonly causes lung abscesses and formation of empyema
Mortality is 30-50% (Causes severe hospital infections)
What is the most common causative organism of pneumonia?
Streptococcus pneumoniae (Accounts for 80% of cases)
Associated with high fever, rapid onset and herpes labialis.
What is a common causative organism of pneumonia in patients with COPD?
Haemophilus influenza
What bacteria often causes a pneumonia following an influenza infection?
Staphylococcus aureus
What unusual signs are seen in mycoplasma pneumoniae?
Autoimmune haemolytic anaemia and erythema multiforme
What unusual signs are seen in legionella pneumophilia?
Hyponatraemia and lymphopenia
Infected air conditioning units
What is a common causative organism of pneumonia in alcoholics?
Klebsiella pneumoniae
What is a common causative organism of pneumonia in patients with HIV?
Pneumocystis jiroveci
What is the name for non-infective causes of pneumonia?
Idiopathic interstitial pneumonia
complication RA or amiodarone therapy
What are the symptoms of pneumonia?
Cough Sputum Dyspnoea Chest pain: may be pleuritic Fever
What are the signs of pneumonia?
Systemic inflammatory response: fever, tachycardia
Reduced oxygen saturations
Auscultation: reduced breath sounds, bronchial breathing
What are the investigations of pneumona?
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)
What is the management of pneumonia?
Antibiotics
Supportive care: O2, IV fluids (if required)
What scoring system can be used to risk stratify patients with CAP and determine treatment?
What are the components of this risk score?
CURB-65
C - Confusion (AMT) U - Urea > 7 mmol/L R - Respiratory rate > 30/min B - Low blood pressure 65 - Age > 65 years
What corresponds to the scores of the CURB-65 scores?
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)
What is the management (drugs) of low-severity community acquired pneumonia?
Amoxicillin is first-line
allergy. macrolide or tetracycline
What is the management (drugs) of moderate and high-severity CAP?
Dual antibiotic therapy with amoxicillin and a macrolide (7-10 days)
What is the timeline for pneumonia recovery?
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
