Resp - Pneumonia

Question 1

Definition

Answer 1

Infection of the lower respiratory tract and lung parenchyma which leads to consolidation

Question 2

Epidemiology

Answer 2

• Highest incidence in infants
• Viral cause more common in young infants
• Bacterial more common in older children
• Viral disease more common in the winter

Question 3

Aetiology

Answer 3

Neonates:
- Group B Strep,
- E coli,
- Klebsiella,
- Staph Aureus
Infants:
- Strep pneumoniae,
- Chlamydia
School age:
- Strep pneumoniae,
- Staph Aureus,
- group A Step,
- Mycoplasma pneumoniae

Question 4

Clinical presentation

Answer 4

Usually precede an upper respiratory tract infection
- Cough
- Fever (>38.5)
- Tachypnoea
- Tachycardia
- Delirium
- Lethargy
- Signs of respiratory distress

Question 5

Signs of sepsis

Answer 5

Tachypnoea (raised respiratory rate)
Tachycardia (raised heart rate)
Hypoxia (low oxygen)
Hypotension (shock)
Fever
Confusion

Question 6

Characteristic chest signs

Answer 6

• Auscultation signs:
  1. Dullness to percuss,
  2. Focal course crackles,
  3. Dcreased breath sounds,
• Bronchial breathing = equally loud on insp and exp
• Wheeze and hyperinflation more typical of viral infection

Question 7

Investigations

Answer 7

• Mainly clinical
• CXR - fluid in the lunds (associated with Staph)
• Sputum culture and throat swab = bacterial
• Viral PCR
• Septic:
  = blood cultures - capillary blood gas analysis in assessing or monitoring respiratory or metabolic acidosis + blood lactate

Question 8

Treatment

Answer 8

• Management at home with analgesia
• If admitted: Oxygen therapy and IV fluids
• Abx:
  FIRST LINE = AMOXICILLIN
  SECOND LINE = + MACROLIDES (ERYTHROMYCIN) to cover for atypical bacterial strains
  Macrolides can be used as monotherapy in Px with a penicillin allergy.
  IV Abx can be used in septic Px

Question 9

Complications

Answer 9

Risk of parapneumonic collapse and empyema if so follow up at 4-6 weeks with a fluid sample