Pneumonia Review Flashcards
Typical CAP?
- Strep pneumoniae
- H-flu
- Staph aureus
- Moraxella catarrhalis
Atypical CAP?
- mycoplasma pneumoniae
- Legionella
- Chlamydophila pneumoniae
- Pseudomonas
- Viruses
Most common CAP?
- Strep pneumoniae
H Flu is common in which pts?
- elderly and pts with underlying pulmonary disease
What patients does mycoplasma pneumonia affect and what is this also known as?
- also known as Walking Pneumonia
- affects scool aged childrem college students, and military recruits
Legionella is associated with what?
- contaminated water
- associated with exposure to aerosol producing devices: air conditioners, shower, mist machine and whirlpool spas
Who is at risk for Klebsiella?
- alcoholics
- COPD pts
- Diabetes pts
When does Chlamydia peak and who is it common in?
- common in 65-79 y/o
- peak rate in winter months
- associated bronchitis
Who does pseudomonas affect?
- the immunocompromised
Who does staph aureus affect?
- elderly and young recovering from influenza virus
PCP is common in which patient group?
- patients infected with HIV
Clinical presentation in patients with atypical CAP?
- usually have less acute presentation than typical CAP
- CAP due to atypical pathogens may have one or more extrapulmonary features
- patients with Legionella infections may have a productive or nonproductive cough. Pts with mycoplasma pneumoniae or chlamydia pneumoniae usually present with a nonproductive cough
What antibiotics are ineffective for atypical pneumonia?
- PCN and cephalosporins won’t be as effective because atypical bacteria lack a cell wall
What are predisposing host conditons/risk factors for pneumonia?
- elderly and very young
- pre-existing lung disease: COPD, cystic fibrosis, bronchiectasis
- smoking
- malnutrition
- immunosuppressed
- previous episodes of pneumonia or chronic bronchitis
Clinical features of pneumonia?
- abrupt onset
- fever
- productive cough: purulent sputum
- tachycardia
- chills and rigors
- HA
- N/V
- malaise (atypicals - flu like sxs)
- dyspnea
- consolidation
- hypoxia
- pleuritic chest pain
- pleural effusion
Characteristic of strep pneumococcal pneumonia sputum?
- bloody, rust colored sputum
Characteristic of sputum of a pt with klebsiella pneumonia?
- bloody, currant jelly, blood tinged
Characteristics of pseudomonas pneumonia?
- green sputum, and grape smelling
Clinical presentation of strep pneumococcal pneumonia?
- abrupt onset
- shivering rigors and chills
- rust colored sputum
Clinical presentation of mycoplasma pneumonia?
- slower onset
- general malaise
- HA
- rash
- diarrhea
- sometimes the CXR isn’t conclusive
What will you see on a CXR of pneumonia?
- consolidation
- interstitial infiltrates
- air bronchograms
- cavitary lesions and pleural effusions: H flu, observed with staph aureus, anaerobic and TB infection
- legionella has a predilection for lower lung fields
- Klebsiella: upper lobes
- TB has a predilection for apex
Lab indications for CAP?
- not typically done in outpatient setting since empiric therapy is usually successful but inpatients require further dx
- labs are always done in inpatient setting
CMP: hyponatremia - associated with Legionella
CBC: leukocytosis with left shift, and leukopenia (ominous sign of impending death, clinical absence shouldnt rule out possibility of bacterial infection)
Sputum culture and gram’s stain: specimen should be a deep cough specimen obtained prior to abx - ABGs: hypoxia and respiratory acidosis (inpatient)
- blood cultures
How should you select a antimicrobial therapy?
- for the most likely pathogen
- clinical trials proving efficacy
- risk factors for resistance
- medical comorbidities
Tx guidelines for ambulatory pts with CAP?
- macrolides or newer flouroquinolones to provide coverage for both S. pneumoniae and atypical pathogens
- macrolides are effective in absence of signifant RFs for macrolide resistant S. pneumo
- tx: Azithro 500 mg pox day, 1, followed by 4 days of 250 mg a day
clarithro: 500 mg po bid for 5 days
doxy: 100 mg po bid for 7-10 days
How common is HAP?
- nosocomial pneumonia is 2nd most common cause of hospital acquired infection and is leading cause of death due to nosocomial infection (any contact with health care worker)
- occurs more than 48 hrs after admission (especially common in pts requiring ICU or mechanical ventilation)
- will present with at least 2 of the following:
fever, cough, leukocytosis, purulent sputum - new or prgoressive parenchymal infiltrate on CXR
How is HAP acquired?
- colonization of pharynx
- stomach bacteria: NG and ET tubes
elevations in gastric pH (gastric microbial overgrowth), contamination by dirty hand and equipment, and drug resistant organisms
What pts are at risk for HAP?
- malnutrition
- advanced age
- altered consciousness
- swallowing disorders
- underlying pumlmonary and systemic disease
Dx tests for HAP?
- CXR
- CBC
- ABGs
- sputum: gram stain and culture, fluorescent ab staining with suspected Legionella
- blood cultures: from 2 different sites
- thoracentesis: pleural effusion
Common HAP bacteria?
- pseudomonas
- staph aureas
- enterobacter
- klebsiella
- E-coli
Tx for HAP
- empiric like CAP
- may need to switch or add abx according to sputum and/or blood culture results
Prevention of pneumonia?
- PPV: 23 strains of S pneumo
a single dose offers lifetime immunitiy - indications: 65 or older, any chronic illness that increases risk, and immunocompromised
- one time revaccination after initial vaccination for:
those at highest risk, those over 65 who received the vaccine 5 years or more previously and were under age of 65 at time of first vaccination - influenzae vaccine: for those at high risk for development of primary influenzae pneumonia and secondary bacterial pneumonias: age 65 and older, resident of long term care facilities, pts with pulmonary or cardiovascular disease
- both vaccines can be given simultaneously and there are not CIs to use immediately after episode of pneumonia
