Pneumonia(s) Flashcards
Pneumonia definition
Inflammation of the lungs.
LRTI + new infiltrate shown on CXR
Clinical presentation
Breathlessness Cough Haemoptysis Chest pain - pleurisy Confusion Malaise Sweats and rigors Headache Anorexia Weight loss Arthralgia and Myalgia
Clinical signs
Tachypnoea Cold sores Cyanosis Hypotension Trachea centre Reduced chest expansion Dull percussion note - as affected area is consolidated with fluid Bronchial breath sounds Crackles and pleural rub Increased vocal resonance Whispering pectoliloquy
Investigations
CXR Blood culture Viral PCR Sputum microscopy ABG
CAP
Pneumonia acquired in the community
Causitive organisms: Strep pneumonia, H. Influenzae, Mycoplasma Pneumoniae
CAP severity score
CURB 65 Confusion Urea >7 Resp rate >30 Blood Pressure <90 systolic or <60 diastolic 65 or older
CAP management
0-2 : mild, amoxicillin or doxycycline
3-5 : severe, hosp admission, co-amoxiclav (IV) + doxycycline OR clarithromycin
HAP
Pneumonia acquired in the hospital setting (after 48hrs admission)
Causative organisms: Strep pneumonia, H. Influenzae, Staph aureus, Klebsiella
HAP management
Mild: Amoxicillin (oral) + Metronidazole
Severe: Amoxicillin (IV) + Metronidazole + Gentamicin
- step down to co-trimoxazole + metronidazole
Mycoplasma pneumonia
Atypical pneumonia Cause of CAP Common in children and young adults Investigations: PCR, serology Management: tetracycline and macrolides (clarithromycin)
Chlamydia Psittaci
Atypical pneumonia
Cause of CAP
Caught from pet birds
Managmenet: Clarithromycin or Doxycycline
Moraxella Catarrhalis
Common cause of pneumonia in patients with COPD
Legionella pneumonia
Atypical pneumonia
Lives within amoeba which provide it with growth factors and nutrients
No person-person spread
Transmission: inhalation of water droplets
Sources: air conditioning units, showers
Investigations: Legionella urinary antigen, blood culture, serology, PCR, CXR
Management: Macrolides (clarithromycin) or quinolones (levofloxacin)
PCP (pneumocystis pneumonia)
Cause of pneumonia in immunocompromised patients
Organism involved: pneumocystis jiroveci
Investigations: CXR - bilateral hilar shadowing, Sputum microscopy, BAL, lung biopsy
Management: Co-trimoxazole
Klebsiella
Risk: elderly, diabetic, alcoholic
Upper lobe cavitating pneumonia
Red jelly sputum
