pneumonia/infection Flashcards
How many patients are diagnosed with CAP by GP/year?
5-12% of all abx prescribed
How many patients admitted with CAP/year?
22-42%
Mortality of hospitalised CAP?
5.7-14%
Long term mortality at 5 yrs is 35-39%
Mortality of CAP on ITU?
> 30%
Most common pathogens in community/hospital/ITU for CAP?
Community: S pneumoniae, H. influenzae and FLU
Hospital: S. Pneumoniae, Mycoplasma/chlamydiae, flu
ITU: S. Pneumoniae, Legionella, FLU/S. aureus
which orgnism is involved with CAP in bird workers?
C psittaci
which orgnism is involved with CAP in sheep workers and calving season?
Coxiella burnetii
S aureus CAP can cause cavitation which is associated with…?
Panton-Valentine
Leucocidin toxin
Strep CAP is associated with what features?
increasing age, comorbidity,
acute onset, high fever and pleuritic chest pain
Bacteraemia: F, no cough or a non-productive cough,
history of excess alcohol, diabetes mellitus or COPD.
legionella CAP is associated with what features?
M, smokers, young, diarrhoea
coxiella burnetii CAP is associated with what features?
males, dry cough, high fever
Klebsiella CAP is associated with what features?
alcoholic males
strep viridans CAP is associated with what features?
aspiration
acinotobacter CAP is associated with what features?
alcoholics, high mortality
radiographic resolution in elderly?
35%, 60% and 84% at 3, 6
and 12 weeks
what % resolve after 6 weeks of CXR?
73%
when should you repeat the CXR?
persistence of
symptoms or physical signs or who are at higher risk
of underlying malignancy (especially smokers and those aged 50 years)
whether or not they have been admitted to hospital
What is the gold standard to test for mycoplasma?
complement fixation test- although it lacks sens and spec
What treatment do you give a low severity CAP that is an IP?
amox- still tend to be Strep so should be sensitive, clari if allergy
What treatment do you give a moderate severity CAP that is an IP?
need to cover for legionella as they can fit in this bracket so need to include a macrolide/B lactam added to amox
What treatment do you give a high severity CAP that is an IP?
even though gram neg and Staph are rarer causes, they carry high mort.
Why you need broad spectrum B lactams
Is Legionella notifiable?
Yes!!. But reporting the the health protection unit can:
- investigations recent travel and activities within 2 weeks before illness onset (the usual
incubation period is 2–10 days) from the patient or their
relatives to assist epidemiological investigation
What is the other name for PVL CAP? What is the treatment?
necrotising pneumonia
IV linezolid 600 mg bd, IV clindamycin 1.2g qds and IV rifampicin 600mg bd
What are the factors involved with failing to improve?
multilobar involvement
cavitating pneumonia
pleural effusion
liver disease
cancer or neurological disease
aspiration pneumonia
legionella
Gram-neg pneumonia
leucopenia
high disease severity
inappropriate antibiotics
what are the main differences between NICE an BTS CAP guidelines?
CONSIDER testing for legionella in high severity CAP (NICE) test (BTS)
review after 3 days (NICE) 2 days (BTS)
5 days Abx for low severity and 7-10 for others (NICE) not 7days (BTS)
ON THE WHOLE FOLLOW NICE
What organisms are implicated in tropical pulmonary eosinophilia?
Wuchereria bancrofti, brugia malayi
different from loefflers as Hx tends to be more insidious
a 21F has a cough and feels breathless- they have spent the last week in Mississippi kayaking and swimming. A course of amox didn’t help. They have bilateral infiltrates on CXR. Which organism is likely?
blastomycosis
assoicated with outdoor activities near waterways
a 21F army officer has a cough, feels fatigued and breathless- they have spent the last month on desert training. A course of amox didn’t help. They have lobar consolidation on CXR. Which organism is likely?
coccidiomycosis
eosinophilia
southwest desert areas following sand storms, constuction, military exercises and dry periods after rainy season
a 21F has a cough and with joint pain- they have spent the last few weeks in Ohio taking photos of abandoned buildings by the river. A course of amox didn’t help. They have bilateral cavitatory infiltrates on CXR. Which organism is likely?
histoplasmosis
areas around ohio river- associated with bat or rodent droppings
a 21F has had a bone marrow transplant and presents with fever, cough and chest pain. A course of amox didn’t help. They have a cavitatory lesion on CXR. Which organism is likely?
A. histoplasmosis
B Mucormycosis
C Paracoccidiomycosis
D Coccidiomycosis
E Blastomycosis
B Mucormycosis
only in immunocompromised
usually a solitary nodule, or cavitatory lesion. but can be disseminated
a 21F has fevers, weight loss and new hepatospenomegaly- they have spent the last month travelling in south america. A course of amox didn’t help. They have nodular changes on CXR. Which organism is likely?
Paracoccidiomycosis
endemic to SA
What treatment do you give HAP?
early HAP (<5 days)
penicillin with beta lactamase or ceph or quinolone
late HAP (>5 days)
anti-pseud plus flouroquinolone
