Pneumonia SR Flashcards

1
Q

Features of pneumonia in the elderly

A

RR increase
crackles
consolidation
fevers/chills

*lower areas of lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bacteria with capsules (can’t be phagocytosed)

A
Streptococcus pneumoniae 
Staphylococcus aureus 
Haemophilus influenzae 
Neisseria meningitidis 
Escherichia coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common causes of pneumonia

A
Streptococcus pneumoniae 
Haemophilus influenzae 
Staph aureus
Enterobacteriaceae
Legionella pneumophila 
(rare) Mycoplasma pneumoniae 
Chlamydophilia pneumoniae
Aspiration
Influenza viruses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Features of strep pneumoniae

A
  1. alpha-haemolytic streptococcus

2. colonizes nasopharynx of 5-10% of adults, 20-40% of children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pneumococcal virulence

A
  1. pneumococcal surface protein A - binds to epithelial cells and also prevents deposition of C3b
  2. PspC prevents activation of complement cascade
  3. pili contribute to colonisation and cytokine production (TNFa) during invasion
  4. choline binding protein - binds Ig receptor on epithelial cells to allow transport into cell
  5. pneumolysin (toxin) lyses neutrophils and epithelial cells
  6. polysaccharide capsule prevents phagocytosis and complement deposition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pneumonia investigations

A
1. PRIMARY CXR
(if none no antibiotics)
2. Sputum culture
(only on admission)
3. Nasopharyngeal swab
(if admitted) - if viral shown on PCR stop antibiotics
4. blood cultures 
5. urine ICT (immunochromatographic test)
6. serology
7. CT chest/ bronchoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment

A
  1. Antibiotics! reduce duration of illness and risk of death
  • Penicillin resistance is increasing - mediated by altered PBP/transpeptidace which reduces penicillin binding affinity
  • *oral dosing inadequate. IV dosing okay - important in treating menigitis caused by s. pn
  • **penicillin resistance is associated with resistance to other antibiotics - quinolones, recently developed macrolides, ketolides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ribosome targets

A

50S transpeptidation -
1. macrolides eg erythromycin A, azithromycin, clarithromycin,

(broad spectrum, limited activity against gram negative bacteria, active against streptococci, staphylococci and other causes of pneumoniae, tratment of chlamydia)

  1. lincosamides

50S peptidyl transferase - chloramphenicol

30S initiation - aminoglycosides

30S tRNA binding - tetracyclines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Macrolides adverse effects

A

GIT upset
Sudden death
drug-drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Empiric therapy

A

A medical term referring to the initiation of treatment prior to determination of a firm diagnosis.

Community acquired
Mild (can stay home) - doxycycline, amoxycillin 500mg tds

Moderate (often in hospital)
amoxycillin 1g oral/IV Q6H AND roxithromycin 300mg daily OR doxycycline 200mg on day 1 then 100mg daily

Very sick (ICU)
amoxycillin/clavulanic acid 1.2gm IV Q8H and erythromycin 1g IV Q6H or moxifloxacin 400mg IV daily

Health care associated pneumonia
cefuroxime 1.5gm IV Q8H +/- gentamicin IV daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bronchitis

A

Viral illness
Antibiotics not beneficial
Treatment for cough include NSAIDS, sedating antihistamines, chlorpheniramine

  1. Influenza
  2. Adenovirus
  3. other viruses
  4. measles
  5. bordetella pertussis
  6. chlamydia/mycoplasma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly