Pulmonology #3 (Pneumonia) Flashcards
Community acquired pneumonia (CAP) is defined as…
-Acquired outside the hospital OR
-develops PNA within 48 hours of hospital admission
On the other hand, hospital acquired pneumonia (HAP), is acquired…
> 48 hours after hospital admission
What two organisms should you be concerned about with HAP?
Pseudomonas and MRSA
What are the etiologies of typical PNA?
Atypical PNA?
Typical: Strep Pneumo (MC), H. Influenzae, Klebsiella, Staph Aureus
Atypical: Mycoplasma (MC), Chlamydophila, Legionella, Viruses
What are the signs and symptoms of typical PNA?
Fever, productive cough, pleuritic chest pain, signs of consolidation (bronchial breath sounds, dullness to percussion, increased tactile remits, ego phony, inspiratory crackles/rales)
What are some symptoms of atypical PNA?
-Fever, dry cough
-Extrapulmonary symptoms (myalgias, malaise, n/v, diarrhea
-Pulmonary exam often normal
The MCC of CAP is ______
This bacteria is shaped like _______
what are some symptoms specific to this organism?
Strep Pneumo
Gram positive diplococci
Sudden onset of chills, rigors, fever, productive cough with blood-tinged/rusty sputum
Another typical cause of PNA, H. Influenzae, occurs MC in those with ________. Who is at increased risk for this type of PNA?
Underlying pulmonary disorder (COPD, Asthma, CF)
Extremes of age, immunocompromised (DM, elderly, HIV)
Staph Aureus, another typical cause of PNA, occurs MC after…
What shape is this bacteria?
What is unique about the CXR with this organism?
MC post-viral infection (flu, etc.)
Gram-positive cocci in clusters
Bilateral infiltrates on CXR
The last cause of typical PNA, Klebsiella, occurs in those who are…
on CXR you see…
What is one unique symptom with this type of PNA?
Chronic alcoholism, sick patients, chronic illnesses
Cavitary lesions on CXR
Purple/currant jelly sputum
The MCC of atypical PNA ________, occurs in those who are…
What are some symptoms of this type of PNA?
Mycoplasma PNA
Young and healthy living in close proximity (college students, military, etc.)
Pharyngitis and URI prodrome, dry/nonproductive cough, bullous myringitis (blisters on TM)
What is one important complication to remember with Mycoplasma (walking) PNA?
Cold autoimmune hemolytic anemia (IgM)
Treatment for Mycoplasma PNA?
-Macrolides (Azithromycin) or Doxycycline
Legionella, another cause of atypical PNA, is from outbreaks from _______.
What are some symptoms of this type of PNA?
Contaminated water sources
-GI Symptoms (non-bloody diarrhea, n/v)
-Hyponatremia and increased LFT’s
-Neuro Symptoms: headache, confusion, AMS
What test is best for legionella PNA?
PCR, Urine Antigen (nucleic acid detection)
Treatment for Legionella (atypical) PNA?
Macrolides or Respiratory Fluoroquinolones (Levofloxacin, Moxi, Gemi)
How does CXR differ in typical VS atypical PNA?
-Typical: Lobar PNA
-Atypical: Hazy, patchy infiltrates
Explain the components of the CURB-65 score and how many points you need to admit the patient.
Confusion
Uremia (>30)
Resp Rate (>30)
BP low (SBP <90, DBP <60)
Age > 65
Need 2 points to admit the patient
Describe the treatment for CAP, both outpatient and inpatient. Think, you’re MAD and then you’re BAD!
CAP Outpatient: Macrolides, Amoxicillin, Doxycycline
CAP Inpatient: Ceftriaxone (Beta-Lactam) + Macrolide (Azithromycin) + Doxycycline OR Fluoroquinolone
Treatment for HAP (Pseudomonas and MRSA)
-Pseudomonas: Pip/Tazo, Ceftazidime or Cefepinem, + Amikacin, Gentamicin
-MRSA: Vanco or Linezolid
What is the treatment for Legionella PNA?
Levofloxacin or Azithromycin
Aspiration Pneumonia, caused by anaerobes and has increased incidence in _______, MC is in what part of the lung?
What is one common symptom of this?
Increased incidence in periodontal disease
Right lower lobe
Foul-smelling sputum (rotten egg smell)
Treatment for aspiration PNA
-Think double whammy
-Ampicillin-Sulbactam or Amoxicillin-Clavulanate
Histoplasmosis is caused by inhalation of….
What else should you remember about this disease?
Inhalation of soil containing bird and bat droppings in Ohio and Mississippi River Valleys
-AIDS defining illness if CD4 <150
What is the most specific diagnostic for Histoplasmosis?
Culture
Treatment for histoplasmosis?
Itraconazole (1st line)
Amphotericin B if severe
What acronym should you remember for histoplasmosis?
-BIRD
–Bird/Bat droppings
–Itraconazole
–River Valleys (Ohio and Mississippi)
–Defining illness for AIDS if CD4 <150
Pneumocystis Pneumonia (PCP) is caused by pneumocystis jirovecii, which is a yeast-like fungus. What should you remember about this pathogen?
MC opportunistic infection in HIV, especially if CD4 <200
Symptoms of PCP
-Dyspnea on exertion
-Nonproductive cough
-Oxygen desaturation with ambulation*****
What diagnostics are done for PCP?
CXR: diffuse bilateral interstitial infiltrates (bat wing pattern)
Labs: Increased LDH
Lung Biopsy: Definitive
What lab finding should you look for if you suspect PCP?
Increased LDH!
Treatment for PCP
if HIV+, what should you add?
Bactrim x 21 days
If HIV+, add Prednisone if hypoxia
What is used for prophylaxis against PCP?
If CD4 < 200, give the patient Bactrim!
What anecdote/sentence should you remember to remember the facts about PCP?
Posterior is course and prickly (PCP), you need your back trimmed (Bactrim)
Pneumonia vaccines are given at two different series. Explain.
PCV 13 in 4 dose series: 2, 4, 6, and 12-15 months of age
PPSV23 given to all adults 65 or older AND younger patients with PNA risks
Can you get the PNA vaccine when you are pregnant?
Yes, it is safe while pregnant
