Pulmonology Flashcards
Common causative agents of community acquired pneumonia (CAP)
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Staphylococcus aureus
- Klebsiella pneumoniae
Atypical causative agents of CAP
Legionella, mycoplasma, and chlamydia
Mycoplasma pneumoniae typical manifestations
- Low grade fever
- Cough
- Bullous myringitis
- Cold agglutinins
Pneumocystis jiroveci (nee carinii) typical manifestations
- Slower onset, immunosuppression
- Increased lactate dehydrogenase
- More hypoxemic than appears on CXR
- Intersitital infiltrates
Legionella pneumoniae typical manifestations
- Chronic cardiac or respiratory disease
- Hyponatremia
- Diarrhea, other systemic symptoms
Chlamydia pneumoniae typical manifestations
- Longer prodrome
- Sore throat, hoarseness
Streptococcus pneumoniae typical manifestations
- Single rigor
- Rust-colored sputum
Klebsiella pneumoniae typical manifestations
- Currant jelly sputum
- Chronic illness, including alcohol abuse
What patient group is more likely to have klebsiella pneumoniae?
Alcohol abuse
What patient group is more likely to have hameophilus pneumoniae?
COPD
What patient group is more likely to have pseudomonas sp.?
cystic fibrosis
What patient group is more likely to have mycoplasma pnemoniae and/or chlamydia pneumoniae?
Young adults, college settings
What patient group is more likely to have legionella pneumoniae?
Air conditioning/aerosolized water
What patient group is more likely to have encapsulated organisms, streptococcus pneumoniae, and/or haemophilus pneumoniae?
Postesplenectomy
What patient group is more likely to have fungus as the causative organism in CAP?
Leukemia, lymphoma
What patient group is more likely to have RSV as the causative organism in CAP?
Children <1 year
What patient group is more likely to have parainfluenza virus as the causative organism in CAP?
Children <2 years
Treatment of CAP in outpatient setting
A macrolide (azithromycin, clarithromycin) or doxycycline
Treatment of CAP in outpatient setting for patients with underlying chronic disease
Fluoroquinolone (levofloxacin, moxifloxacin) or a macrolide (azithromycin, clarithromycin) plus a beta lactam (amoxicillin, amoxicillin-clavulanate, cefpodoxime, or cefuroxime)
What are indications for hospitalization in CAP?
- Neutropenia
- Poor host resistance
- Involvement of more than one lobe
What are other considerations for hospitalization in CAP?
- Patients >50 years of age w/comorbidities
- Altered mental status
- hemodynamic instability
Inpatient treatment of CAP
Fluoroquinolone (levofloxacin or moxifloxacin) or a combination beta lactam (i.e., ceftriaxone or cefotaxime) plus a macrolide (i.e., azithromycin)
Pneumococcal polysaccharide vaccine (PPSV) recommendations
- Recommended for children 2-5 years of age who have not been previously immunized
- Persons >65 years of age
- Any person with a chronic illness that increases the risk of CAP
Chronic illnesses that increases the risk of CAP
- Cardiopulmonary diseases
- Sickle cell disease
- Tobacco use
- Splenectomy
- Liver disease