Pneumonia (Resp Infection) Flashcards
What can cause cause community acquired pneumonia?
Strep pneumoniae (rusty red sputum), heamophilus influenza or viral influenza
What can cause atypical community acquired pnemonia?
Mycoplasma pneumoniae, Chlaymida psittici, Coxeilla or Legionella
What can cause hospital acquired pneumonia?
Strep pneumoniae, Heamophilus Influenzae, Coliforms (e.g. Ecoli)
When might Mycoplasma pneumoniae type pneumonia occur?
Comes in waves every four years and most likely to infect children and elderly
When might Chlaymida psittici type pneumonia occur?
Seen in individuals who have pet birds, as they are the source of the infection
When might Coxeilla type pneumonia occur?
Spread from animals such as sheep / goats, so most commonly seen in farmers. Can cause culture negative endocarditis.
When might Legionella type pneumonia occur?
Usually colonises water tanks and is commonly seen in those who have been abroad and been in contact with contaminated water, air con systems or swimming pools.
What is the best antibiotic to use for atypical community acquired pneumonia?
Clarithromycin
When might Staph Aureus type pneumonia occur?
Can be seeded from SAB or endocarditis. May develop secondary to viral influenza.
When might Klebseilla type pneumonia occur?
Caused by aspiration. At risk patients are: alcoholics, elderly, diabetics, neuro-muscular disease.
When might Pneumocystis pneumonia type pneumonia occur?
Seen in those who are immunocompromised
When might Pseudomonas type pneumonia occur?
Seen in those with CF / bronchiectasis. Treated with ciprofloxacin.
What is the general presentation of Chlaymida psittici type pneumonia?
Presents with mucoid sputum
What is the general presentation of Legionella type pneumonia?
Commonly presents with dry cough, flu like symptoms, GI upset and hyponatremia
What Urine test results are indicative of Legionella type pneumonia?
Antigen Positive
What is the general presentation of Staph Aureus type pneumonia?
Presents as bilateral cavitating pneumonia
What is the general presentation of Klebseilla type pneumonia?
Presents with red jelly sputum
What is the general presentation of Pneumocystis pneumonia type pneumonia?
Presents with dry cough and excertional SOB
What is the treatment for Legionella type pneumonia?
Levofoxacin or clarithromycin + rifampicin
What is the treatment for Pneumocystis pneumonia type pneumonia?
Co-trimoxazole, as either active or prophylactic treatment
What is the treatment for Pseudomonas type pneumonia?
Ciprofloxacin
What are the general symptoms in pneumonia?
Fever, malaise, sweats, rigors and confusion
What are the respiratory symptoms in pneumonia?
SOB, pleuritic chest pain, productive cough (purulent sputum) and haemoptysis
What are the GI symptoms in pneumonia?
Upper quadrant abdominal pain
What are the signs of pneumonia on examination?
Tachypnoea, dull percussion, bronchial breath sounds, crackles, tachycardia, hypotension and fever
What is meant by the term BUFALO, in terms of sepsis 6?
- Blood Cultures
- Urine output
- Fluids
- Antibiotics
- Lactate
- Oxygen
What are the investigations that should be done to confirm a diagnosis of pnemonia?
Sepsis 6, Bloods (FBC, U/E, LFT, CRP, +/- cultures and ABG), Sputum (culture and sensitivity), Urine (urinalysis, legionella antigen) and CXR
What CXR results would be indicative of pneumonia?
Consolidation and effusion
What is the CURB 65 score?
Measures the severity of community acquired pneumonia
What level of confusion scores you a CURB 65 point?
Less than 8
What level of urea scores you a CURB 65 point?
Greater than 7
What respiratory rate scores you a CURB 65 point?
Greater than 30
What systolic blood pressure scores you a CURB 65 point?
Less than 90
What diastolic blood pressure scores you a CURB 65 point?
Less than 60
What age scores you a CURB 65 point?
Greater than 65
What CURB 65 score indicates mild pneumonia?
0-1
What CURB 65 score indicates moderate pneumonia?
2
What CURB 65 score indicates severe pneumonia?
3
What is the first line management of mild/moderate community acquired pneumonia?
1g Amoxicillin TDS for 5 days
What is the second line/penicillin allergy management of mild/moderate community acquired pneumonia?
Doxycycline, 200mg first day and then 100mg daily for 4 days (NBM: IV Clarithromycin)
What is the first line management of severe community acquired pneumonia?
1.2g Co-Amox IV + 100mg doxycycline BD for 7 days
What is the second line/penicillin allergy management of severe community acquired pneumonia?
Levofloxacin 500mg BD + 100mg doxycycline BD for 7 days
What is the first line management of severe community acquired pneumonia in ITU?
1.2g Co-amox IV + IV clarithromycin 500mg BD
What is the second line/penicillin allergy management of severe community acquired pneumonia in ITU?
Levofloxacin 500mg BD + Clarithromycin 500mg BD.
What is the definition of hospital acquired pneumonia?
Any pneumonia that develops 48 hours or more after admission to hospital
What is the first line management of severe hospital acquired pneumonia?
IV amoxicillin (1g TDS), Metronidazole (500mg TDS) and Gentamicin for 7 days
What is the second line/penicillin allergy management of severe hospital acquired pneumonia?
IV Co- Trimoxazole (960mg BD), Metronidazole (500mg BD) and Gentamicin
What is the first line management of severe step down hospital acquired pneumonia?
Co-trimoxazole + metronidazole
What is the first line management of non severe hospital acquired pneumonia?
Oral Amoxicillin (1g TDS) and Metronidazole (500mg BD)
What is the second line/penicillin allergy management of non severe hospital acquired pneumonia?
Co-trimoxazole (960 BD) and Metronidazole (500mg BD)
