Pulmonology #6 (PNA #2, Tuberculosis) Flashcards
What are the 2 criteria to classify PNA as community-acquired PNA?
-Acquired outside the hospital setting OR within 48 hours of hospital admission
Hospital acquired PNA occurs ________ and is usually caused by _____, or _______
> 48 hours after hospital admission
-MRSA
-Pseudomonas
Management of CAP Outpatient
Macrolides (-mycin) or Doxy
-Fluoroquinolones if recent ABX use
Management of CAP Inpatient
B-lactam (Ceftriaxone, Unsayn) + Macrolide or Doxy OR broad spectrum fluoroquinolone (-oxacin)
Aspiration PNA, MCC by ________, has increased incidence with periodontal disease. What are some symptoms associated with this condition?
-Anaerobes
-MC in right lower lobe
-Foul-smelling sputum (rotten egg smell)
Treatment for aspiration PNA
-Ampicillin-Sulbactam (first line) or Amoxicillin-Clavulanate
Alternative: Metronidazole + Amoxicillin or Pen G
Treatment for HAP
-Anti Pseudomonal B-lactam + either anti-pseudomonas AG or FQ (Piper/Tazo, Ceftazidime, Cefepime + -acin or -oxacin)
If MRSA is suspected with HAP, what should you add to the treatment?
Vanco or Linezolid
If Legionella is suspected with HAP, what should you add to the treatment?
Levofloxacin or Azithromycin
What is the CURB-65 score and what are the points?
Criteria for admission with PNA
-Confusion
-Uremia (>30 mg/dL)
-RR < 30
-BP (SBP < 90 or DBP < 60)
-Age > 65
How do you transmit Histoplasmosis?
Inhalation of soil containing bird and bat droppings in the Mississippi and Ohio River Valleys
-Also seen with demolition, spelunkers, excavators
Risk factors for Histoplasmosis?
Immunocompromised states
-AIDS defining illness if CD4 <150
Although most patients with Histoplasmosis are asymptomatic, it does present as atypical PNA occasionally (fever, nonproductive cough, myalgias). Also, if disseminated, what are some symptoms?
Can mimic TB with hepatosplenomegaly, oropharyngeal ulcers, bloody diarrhea, adrenal insufficiency
Diagnostics for histoplasmosis
-Antigen testing via sputum (PCR) or urine
-Cultures are most specific
Treatment for Histoplasmosis
-Asymptomatic: no treatment
-Mild-Moderate: Itraconazole
-Severe: Amphotericin B
What is the schedule for the PCV-13 vaccine?
2, 4, 6, and 12-15 months of age
Who gets the PCV 23 vaccine?
All adults 65 and older or younger patients with conditions that increase the risk for developing complications from a PNA infection
True or False: Pregnancy is NOT a contraindication to the PNA vaccine?
True. Pregnant women can still get it
What are risk factors for Pneumocystis PNA (PCP)?
Immunocompromised states
Most common opportunistic infection in HIV (CD4 < 200)
What is the classic triad of symptoms for PCP PNA?
-DOE (MC)
-Fever
-Nonproductive cough
What is true about the oxygen desaturation with PCP PNA?
Desaturation with ambulation
DOC for PCP PNA
Trimethoprim-Sulfamethoxazole x 21 days
If the patient is HIV + and hypoxic, what drug should be added?
Prednisone
On CXR, what is seen with PCP PNA?
Diffuse bilateral interstitial infiltrates (but may be normal)
