Respiratory Infections - Pneumonia Flashcards
Organisms associated with ventilator associated pneumonia
S.aureus Klebisella and other coliforms Pseudomonas spp Acinetibacter Legionella
Organisms associated with hospital acquired pneumonia
S. Pneumoniae H. Influenzae S. Aureus Klebsiella and other coliforms Pseudomonas spp. Legionella
Organisms associated with aspiration pneumonia I.e. Post stroke/difficulty swallowing
Streptococci
Coliforms
Anaerobes
From oro-pharynx and vomitus
What is used to rate the severity of pneumonia?
Curb-65 score?
What does CURB65 stand for and represent?
Confusion (new onset)
Urea > 7 mmol/L
Resp rate >= 30/min
BP Systolic 65 years
What is the empiric abx treatment of mild/moderate CAP?
PO amoxicillin +- erythromycin/Clarithromycin
OR po levofloxacin (quinolone)
Clarith or doxy if pen allergic
ADD Macrolide if atypical pathogen suspected
What is the empiric treatment for a severe CAP?
Co-amoxiclav and IV Clarithromycin
Pen allergic = cefuroxime and Clarithromycin
Severe pen allergic = vancomycin IV PLUS levofloxacin
Symptoms of pneumonia caused by s. Pneumoniae
Sustained fever 39-41 Single shaking episode at onset Productive cough in 75% Pleuritic chest pain Rusty, blood streaked, mucopurulent sputum
Micro diagnosis of S. Pneumoniae
Alpha haemolysis on blood agar
Sensitive to optochin
Draftsman colonies
GPdiplococci on gram
Symptoms of pneumonia caused by H. Influenzae
Fever variable Rigors unusual Productive cough Wheezy in children Purulent sputum Lobar consolidation may occur
Microbiological diagnosis of h.influenzae
Short gram negative cocco bacilli on gram
Grows with x and v factors
Symptoms of pneumonia with mycoplasma pneumoniae
Gradual and subtle onset Fever usual 38-40 Rigors in 25% Persistent hacking non productive cough Scant mucoid sputum
Diagnosis of mycoplasma pneumoniae
PCR or serology
No cell wall so doesn’t gram stain
Symptoms of pneumonia caused by S. aureus
Fever intermittent, swinging or sustained 39-40.5
Rigors common
Pleuritic pain common
Often non productive cough (when haematogenous)
Purulent sputum, blood streaked, occasionally gross haemoptysis
Lung abscess/empyema common
Cavitating lesions on chest X-ray
Symptoms of pneumonia caused by klebsiella pneumoniae
Uncommon but severe Swinging 39-40.5 Multiple rigors Productive cough, severe pleuritic pain Thick, bloody, mucopurulent sputum Upper lobes often affected, abscess formation common
Symptoms and manifestation of pneumonia caused by e.coli; proteus spp. , and Enterobacter spp.
Prominent cou
Thick, purulent sputum,
Lower lobes commonly involved
When is klebsiella pneumoniae pneumonia seen?
Seen in setting of alcohol abuse and diabetics c
When is pneumonia caused by gram negative coliforms seen?
Associated with pre-existing chronic debilitating illness or ventilator associated pneumonia on intensive care unit
Symptoms and manifestation of pneumonia caused by pseudomonas aeruginosa
Prominent cough
Copious yellow or green sputum
Diffuse broncho-pneumonia in patients with underlying pulmonary or cardiac disease.
When is p. Aeruginosa seen in pneumonia?
Associated with hospitals as environmental organism that colonises moist surfaces
Symptoms associated with pneumonia caused by legionella pneumophila
Fever 37.5-40
Rigors uncommon
Cough prominent
Scant sputum
Who is at risk of acquiring legionella pneumophila pneumonia?
Elderly, male smokers, patients with underlying pulmonary or cardiac disease.
Communities near cooling towers, use of swimming or spa facilities.
Diagnostic characteristics of legionella pneumophila
Slow growing 3-5 days on BCYE agar
Ground glass surface under microscope, white colonies on agar
Fluorescent yellow green pigment under UV
PCR, Urine antigen detection and immunofluorescence
Symptoms and manifestations of pneumonia caused by chlamydia psittaci
Variable Fever 38-40.5 Rigors occur in one third Dry, hacking cough Pleurisy rare Small amount of blood streaked sputum Hepatosplenomegaly common Can cause culture negative endocarditis - rare Neurological presentations - confusion, meningitis and encephalitis Rashes common
Which abx for psittacosis?
Tetracyclines
Symptoms of pneumonia caused by Coxiella burnetti
Fever up to 40.5
Rigors common
Cough and pleurisy are late manifestations
Systemic illness with headaches and myalgias
Scant sputum
May cause endocarditis
How is q- Fever diagnosed?
Clinical history - lambing, sheep. Cattle, goats
Serology
Organisms associated with community acquired pneumonia
S. Pneumoniae; H. Influenzae, S. Aureus, Klebsiella, Legionella,
Atypicals - M. Pneumoniae, C. Burnetti, Chlamydia spp.
