Specific Pneumonias

Question 1

Pneumococcis

Answer 1

Risk factors:

• Elderly
• ETOH
• IC
• CHF
• Pulmonary disease

Pulmonary features: lobar consolidation

Extrapulmonary: herpes labialis

Mx: amoxicillin, benzylpenicillin, cephalosporin

Question 2

S.aureus

Answer 2

Risk factors:

• influenza infection
• IVDU
• Co-morbodities

Pulmonary features: bilateral cavitating, bronchopneumonia

Mx: fluclox, vanc

Question 3

Klebsiella

Answer 3

Risk factors:

• rare
• elderly
• ETOH
• DM

Features: cavitating pneumonia, esp upper lobes

Mx: cefotaxime

Question 4

Pseudomonas

Answer 4

Risk factors:

• bronchiectasis
• CF

Mx: taz

Question 5

Mycoplasma

Answer 5

Risk factors:

• epidemics

Features: dry cough, reticulo-nodular shadowing or patchy consolidation

Extrapulmonary: flu-ilke prodrome headache and mylagia, arthralgia, cold agglutinins -AIHA, erythema multiforme, SJS, GBS, Hep

Mx: clarithro, cipro

Question 6

Legionella

Answer 6

Risk factors:

• travel
• air/con

Features: dry cough, dyspnoea, bi-basal consolidation

Extrapulmonary: flu like prodrome: anorexia, DV, hep, renal failure, confusion, SIADH HYPONATREMIA

Mx: clarithro ± rifa

Question 7

Chlamydia pneumonia

Answer 7

Features: pharyngitis, otitis then pneumonia

Extrapulmonary: sinus pain

Mx: clarithro

Question 8

Chlamydia psittaci

Answer 8

Risk factors: parrots

Pulmonary features: dry cough, patchy consolidation

Extra: Horder’s spots ~rose spots, splenomegaly, epistaxis, hep, nephritis, meningo-encephalitis

Mx: clarithro

Question 9

PCP

Answer 9

Risk factors: I/c

Pulm Features: dry cough, SOBOE, bilateral creps, cxr normal or perihilar interstitial shadowing

Mx: high dose co-trimoxazole or pentamidine, prohylaxis if CD4<200 or after 1st attack