pneumonia (LTRI) Flashcards
define pneumonia
an infection of the lung tissue causing inflammation with presence of sputum, inflammatory cells, and fluid filling the airways and alveoli.
what are the 5 classifications of pneumonia?
Community Acquired Pneumonia
Hospital Acquired Pneumonia
Atypical Pneumonia
Aspiration Pneumonia
Recurrent Pneumonia
which parts can pneumonia involve?
Lobar pneumonia
(involves a whole lobe or sometimes two lobes)
Bronchopneumonia
(multifocal, involves both lungs, usually in the lower zones)
Interstitial pneumonia
(can be acute leading to acute respiratory distress syndrome or chronic causing fibrosis and permanent scarring)
what are the presentations of community acquired pneumonia?
Fever
Shortness of breath
Productive cough +/- crepitations
Focal signs (i.e. in one area)
Haemoptysis (coughing up blood)
Pleuritic chest pain (sharp chest pain worse on inspiration)
If very severe:
Delirium (acute confusion associated with infection)
Sepsis
what are the signs of pneumonia on examination?
Bronchial breath sounds
(harsh breath sounds equally loud on inspiration and expiration secondary to consolidation of the lung tissue)
Focal coarse crackles
(air passing through sputum in the airways)
Dullness to percussion
(full of exudate due to lung tissue collapse and/or consolidation)
what are the 2 common causative organisms of community acquired pneumonia?
Streptococcus pneumoniae (50%)
Haemophilus influenzae (20%)
list some differential diagnoses of pneumonia:
Tuberculosis
Lung cancer
Pulmonary embolism
Pulmonary oedema
give 3 commmon causative organisms of hospital acquired pneumonia:
Staphylococcus aureus
Antibiotic resistant (e.g. Methicillin-Resistant Staphylococcus aureus: MRSA)
Gram-negative bacilli (e.g. E. coli, Enterbacter species, Klebsiella pneumonia, Pseudomonas aeruginosa)
what are the causative organisms of Atypical Pneumonia?
Remembered as Legions of Psittaci MCQs
Legionella pneumophila (Infected water & Air conditioning)
Chlamydia psittaci (Birds)
Mycoplasma pneumoniae (Erythema multiforme and Neuro symptoms)
Chlamydia pneumoniae (Coronary heart disease)
Q fever aka Coxiella burnetti (Farm animals)
what are the presentations of atypical pneumonai?
Dry cough
Flu-like symptoms
Deranged LFTs/U&Es
Bilateral crackles and dullness to percussion
Unresponsive to first-line treatment (i.e. penicillins)
describe what aspiration pneumonia is:
a lung infection that occurs when food or liquid is breathed into the airways instead of being swallowed
list some risk factors of aspiration pneumonia:
Alcohol
Confusion
Delirium
Stroke
Swallowing dysfunction
what types of imaging is done to investigate for pneumonia?
ICXR (shows consolidation, usually unilateral unless atypical)
CT (for hospital acquired, can show interstitial pneumonia, aspiration, abscess, empyema)
what score is used to assess for pneumonia?
CURB-65
C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic
65 – Age ≥ 65
what blood tests are used to investigate for pneumonia?
FBC (raised white cells: WCC)
U&Es (may show raised urea)
CRP (raised in inflammation and infection)
what does different CURB65 scores indicate?
0-1: low risk, treated at home
2: moderate risk, treated at hospital
3-5: high risk, high dependency unit of intensitve care unit
what is the first line treatment for pneumonia?
If presenting with 2 days fever, cough +/- crepitations, and focal signs (i.e. in one area)
First-line: Amoxicillin (If Penicillin-Allergic: Clarithromycin OR Doxycycline)
what is the treatments and durations of different non penicillin allergic level?
Level 0-1: Amoxicillin for 5 days
Level 2: Amoxicillin + Clarithromycin for 5-7 days
Level 3-5: Co-amoxiclav + Clarithromycin for 7-10 days
what is the management for Non-Severe Hospital-Acquired Pneumonia (HAP)?
Oral co-amoxiclav
If allergic to penicillin: oral doxycycline or co-trimoxazole
what is the treatments and durations of different penicillin allergic level?
Level 0-1: Clarithromycin OR Doxycycline for 5 days
Level 2: Levofloxaci for 5-7 days
Level 3-5: Levofloxacin OR Co-trimoxazole for 7-10 days
what is the management for Severe Hospital-Acquired Pneumonia (HAP)?
IV Tazocin (tazobactam and piperacillin)
IV Ceftazidime
what is the management for MRSA Hospital-Acquired Pneumonia (HAP)?
IV Vancomycin or IV Teicoplanin
