pneumonia - Eric Flashcards
what is pneumonia
inflammation of the alveoli and bronchioles
#1 most deadly hospital acquired infection
what are the causes of pneumonia
infection (bacteria, viruses and fungi) or aspiration
what are the common bacterial pathogens of pneumonia
strep pneumoniae #1
H. Influenze B
S. aureus
what are the most common virus pathogens of pneumonia
influenza
RSV
Parainfluenza
adenovirus
COVID
what are the most common fungi pathogens of pneumonia
aspergillosis
histoplasma
coccidiomycosis
blastomycese
candida
what is the most rare type of pneumonia
fungal pneumonia
who is at risk of getting pneumonia
immunocompromised
children
CF
smoking - COPD
sickle cell disease
asthma
underlying lung disease
DM
intubated
who are considered immunocompromised in association with pneumonia
bone marrow transplant, organ transplant, cancer, immunosuppressive drugs, HIV, steroids
why are immunocompromised patients at increased risk of developing pneumonia
neutropenia and impaired granulocyte function which causes infection to happen
what pathogens are immunocompromised patients most likely to get
s. aureus
aspergillus
candida
gram-negative bacilli
what are the classifications of community acquired pneumonia
typical and atypical
what is typical community acquired pneumonia
caused by bacteria leading to alveolar inflammation and exudate
productive cough
lobar consolidation on CXR
S. pneumonia
what are atypical community acquired pneumonia
organisms invade and destroy interstitium of the lungs
lack of alveolar exudate
dry cough
patchy infiltrate on CXR
mycoplasma, chlamydia, viral
what causes typical community acquired pneumonia
aspiration + loss of cough/damage to cilia/impaired immunity / changes in flora
most common pathogen S. pneumonia
what are the symptoms of typical community acquired pneumonia
fever, chills, productive cough, crackles or absent lung sounds, malaise, chest pain
where are S. pneumonia antibodies created
within the spleen
what are the diagnostics for typical community acquired pneumonia
pt is ill appearing
crackles on exam
absent lung sounds
increased in whispered pectoriloquy
egophony e-a
bronchophony - 99
increased tactile fremitus
lobar consolidation
what are out patient treatment options for typical community acquired pneumonia
adult: Azithromycin OR Doxycycline OR levofloxacin
Peds: Amoxicillin 90mg/kg/day BID
what are inpatient treatments for typical community acquired pneumonia
adult: ceftriaxone + azithromycin OR levofloxacin
peds: ampicillin (if fully immunized) or ceftriaxone (if not fully immunized)
what is community acquired Atypical community acquired pneumonia
more common in children
known as bronchopneumonia = patchy infiltrate on CXR
cough is usually dry
crackles on exam
mycoplasma, chlamydia, influenza, adenovirus, RSV, parainfluenza
what is the most common pneumonia in children and young adults
mycoplasma Atypical community acquired pneumonia
what is mycoplasma Atypical community acquired pneumonia
damaged the epithelium allowing bacteria to over grow
fever, headache, dry cough, bullous myringitis (not common)
chlamydia pneumonia presents similarly (college aged, sore throat, koalas, no bullous myringitis)
what is the gram negative bronchopneumonia
legionnaires Atypical community acquired pneumonia
what is legionnaires disease (Atypical community acquired pneumonia)
not transmitted human-human
pathogen grown in water of ventilation systems
onset 2-10 days
what are the symptoms and tests used for legionnaires disease
fever, chills, malaise, dry cough, diarrhea
urine antigen or sputum fluorescent antibody tests
what is the treatment for legionnaires disease
levofloxacin
any delay in abx will increase risk of mortality
what are the common pathogens for hospital acquired pneumonia
pseudomonas, S. aureus, enterobacter, klebsiella, e. coli
what patients are at risk for hospital acquired pneumonia
intubation
tracheotomy
immunocompromised
chronic lung disease
what is the common college age person presenting with coughing with minimal production
mycoplasma or chlamydia
what is the most common ICU pathogen
pseudomonas - highest mortality rate
what is the presentation time for hospital acquired pneumonia
presentation 48 hours after admission
what is the treatment for hospital acquired pneumonia
no consensus on best abx treatment
cefepime
zosyn (pip+ tazo)
meropenem
levofloxacin
aspiration pneumonia - clindamycin OR metronidazole + ceftriaxone
what is the leading cause of death for people with HIV worldwide
Pulmonary tuberculosis (TB)
aka HIV associated Pneumonia
What is one of the first diseases seen in the AIDs pandemic
P, jirovecii (PJP)
fungal infection found in the soil
what is the presentation of PJP
creates foamy exudates and cysts in lung
cough, fever, weight loss
CD4+ count < 200
what is the treatment for PJP
treat first with prednisone and them TMP-SMX (Bactrim)
daily bactrim prophylaxis for CD4+ count < 200
what is the presentation of TB
fever, night sweats and weight loss
if a patient is hospitalized with HIV associated pneumonia what should they be treated with
Ceftriaxone and azithromycin
what are sickle cell disease patients at risk for
S. penumonia due to poor spleen function from infarcts
what is the vaccine for S. pneumonia
PCV 20 - all patients
what patients are prone to pneumonia due to damaged ciliary bodies and thickened mucous
CF patients
what is the most common pathogen associated with CF pneumonia
Pseudomonas aeruginosa
how is CF pneumonia treated
aggressively inpatient with tobramycin + Pip-tazo
PCV 20
current studies recommended against prophylactic antibiotics
what can pre-dispose to bacterial infections
viral infection pneumonia
what is the treatment of viral pneumonia
antibiotics still - treated just the same
what is fungal pneumonia
most infected pts are symptomatic but can turn fatal
HIV infxn and suppressed immunity make people more prone to fungal toxins
there are no fungal toxins - hypersensitivity reactions
what is the presentation of fungal pneumonia
granulomas similar to TB on x-ray
what are the phases of fungal pneumonia
- acute
- chronic pulmonary disease
- disseminated infection
what is the presentation of acute fungal pneumonia
mild- flu like illness with fever
what is the presentation of chronic pulmonary disease fungal pneumonia
creation of cavitary lesions
cough, fever and night sweats
very similar to TB
what is the presentation of disseminated fungal pneumonia
hepatosplenomegaly
pancytopenia, elevated Alk Phos, elevated LDH
multi-organ failure, septic shock, death
what is the fungus found in bird and bat droppings
Histoplasma capsulatum
how quickly can disseminated histoplasmosis be fatal
within 6 weeks
how do you confirm histoplasmosis
urine assay
what is the treatment of hisotplasmosis
itraconazole
if patient is immunocompromised - itraconazole is used as lifelong prophylaxis
what is the Valley Fever - Southwest U.S
coccidiomycosis
caused by coccidioides immitis
what is the presentation of coccidiomycosis
fever, fatigue, cough, SOB and night sweats
symptoms onset is 1-3 weeks and can last several months
how is coccidiomycosis diagnosed
skin test
<10% of cases become severe with long term effects
how is coccidiomycosis treated
usually self limiting, but can treat with 3-6 months of Diflucan
what is Cryptococcus found in
bird droppings and effects immunocompromised patients
how do you treat cyrptococcus
fluconazole x 10 weeks
can start with amphotericin B x 2 weeks
what are the ways to prevent pneumonia
PCV 20 and influenza vaccines
what is the key feature about mycoplasma
children/young adults, dry cough, bullous myringitis
what is the key feature about P jirovecii
HIV-related, slow onset, hypoxia worse than CXR findings
what is the key feature about legionella
poor ventiltation, hyponatremia, diarrhea
what is the key feature about chlyamdia
sore throat, dry cough, college age, koala
what is the key feature about s. pneumonia
most common, sickle cell, rust colored sputum
what is the key feature about klebsiella
currant jelly colored, alchol abuse
what is the key feature about h flu
COPD
what is the key feature about pseudomoas
ICU -related (worse prognosis), CF
what is the key feature about RSV
Children <1
what is the key feature about Parainflenza
children <2
what is the key feature about histoplasma
Bats, caving diving
what is the key feature about coccidiomycosis
southwest US