W22 - Pneumonia Flashcards
what is pneumonia
inflmmation of the lung parenchyma of infective origin characterized by consolidation
how can pneumonia be prevented
immunization
adequate nutrition and addressing environmental factor
if caused by bacteria what can it be treated by
antibiotics
what is the difference between primary and secondary pneumonia by aetiology
Primary has no apparent pre existing conditions that may predispose to pneumonia
Secondary pneumonia risk factors predisposing for pneumoniaare present
What are the three forms of pneumonia by affected lung area
bronchopneumonia
lobar
interstitial
what is bronchopneuomonia
acute inflammation of the wallers of the smaller bronchial tubes.
what is lobar
severe infection of one or more of the 5 major lobes of the lungs that if untreated eventually results in consolidation
what is interstitial
a condition of diffuse, chronic inflammation of the lungs beyond the terminal bronchioles, characterized by fibrosis and collagen formation in the alveolar walls and by the presence of large mononuclear cells in the alveolar spaces
what are the 2 locations catagories for pneumonia
community
hospital
what are the 3 classifications
Aetiology
Lung Affected
Location
what risk factors exist for community acquired (CAP)
Age <2 or >65
Living or working with in nursing home or in contact with children
smoking
preexisting pathologicla conditions e.g. COPD
influenza
Hospitilization in the past 5 years
what is a common cause of pneumoniae
streptococcus pneumonia
what are some other common causes
gram positive bacteria
Viruses e.g. influenza
gram negative
what are symptoms of CAP
cough Temp >38 Sputum production Breathlessness Feeling generally unwell
what are the four stages of pneumonia
Consolidation
Red hepatization
Grey hepatization
Resolution
when does consolidation occur
first 24 hours
what happens during consolidation
cellular exudates containing neutrophils,lymphocytes and fibrin replaces the alveolar air
capillaries in the surrounding alveolar walls become congested and the infection spread to the hilum and pleura fairly rapidly
Pleurisy occurs marked by coughing and deep breathing
when does red heaptization occur
2-3 after consolidation
what happens in red hepatization
consistency of lungs resembles liver as they become hypeamic
alveolar capillaries are engorged with blood
fibrinous exudates fill the alveoli
what is red hepatization characterized by
presence of many erythrocytes, neutrophils, desquamated epithelial cells and fibrin within alveoli
when dose grey hepatization occur
2-3 days after red hepatization
what happens in gray hepatization
avascular stage where the lungs go gray brown to yellow because of fibrinopurulents exudates and disintegration of red cells and hemosiderin.
Pressure of exudates in the alveoli causes compression of the capillaries, leukocytes migrate into the congested alveoli.
when does resolution occur
8-9 days after infection
what occurs during resolution
large number of macrophages enter the alveolar spaces
Phagocytosis of the bacteria-laden leucocytes occur
consolidation tissue re aerates and the fluid infiltrate causes sputum
what is resolution characterized by
resorption and restoration of the pulmonary architecture
How can we make a diagnosis in primary care
acute illnes <21 days
cough
at least one symptom of lower respiratory tract infections
how do we rank severity
we use CRB65 score to rank the mortality risk
what should be done if there was no score
home based treatment 1% risk of death
what should be done if there was 1 or 2 scored
hospitilization required as there is a moderate 1-10% risk of death
what should be done if there is a 3 or 4 scored
hospitilization required as there is a larger than 10% chance of mortality
how do you get scored on the CRB65
Confusion < 8 points
Respiratory rate > 30BPM
Low Blood Pressure
- Sys <90
- Diast <60
Age >65
how can we differentiate bacterial pnumonia from covid 19 pneumonia
Its covid if:
- History of typical symptoms of covid 19 for about a week
- loss sense of smell
- breathless but no pleuritic pain
- history of exposure to known or suspected covid 19
its bacterial if
- becomes rapidly unwell after only a few days of symptoms
- does not have a history of typical covid symptoms
- has pleuritic pain
has purulent sputum
what is pleuritic pain
pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing
How do we determine severity in primary care
CRB65
Oxygen saturation level
Signs and symptoms
how do we treat low severity community aquired pneumonia
5 day course of antibiotic e.g.
Doxycycline or amoxicillin
what is the preferred first line treatment of CAP
Doxycycline 200mg 1st day then 100mg 4days
what is the second line treatment of CAP
Amoxicillin 500 mg x3 x5 days
what can be used in place of penicillin or amoxicillin
Clarithromycin 500mg x 3 x 5
Erythromycin 500mg x4 x 5
what can we use to form a diagnossi in hospital
Chest X Ray
Oxygen saturation - measuring the haemoglobin binding site in the bloodstream occupied by oxygen
CURB65 score - urea and electrolytes for mortality risk assessment in hospital
C-reactive protein
Microbiological test
Full blood count
Liver function tests
Since covid what new tests do we do to distinguish the pneumonia and covid.
SARS - CoV2 polymerase chain reaction assay
Legionella and pneumococcal antigen tests
what are two penicillins that we use
amoxicillin, ampicillin
what are two macrolides we use
erythromycin, chlarithromycin
what are two teracyclins we use
tetracylin doxycyclin
What should we do with a diagnosis of pneumonia or sepsis
start empiric treatment with antibiotic
within 1-4 hours of presentation to hospital max
do not wait for microbiological test results
what should we treat moderate CAP
coamoxiclav with clarithromycin
cefuroxime with clarithromycin (second line)
what should we treat severe CAP with
levofloxacin
what happens as a result of therapeutic failure
increase of lung infiltration is indication of therapeutic failure
what are some possible causes of therapeutic failure
Wrong diagnosis Unexpected pathogen Pathogens not covered by selected antibiotic Antibiotic resistance Inadequate dose Non-compliant patient Complicating condition Impaired local or systemic defences Local or distant complications of CAP Overwhelming infection
What is hospital acquired Pneumonia
defined as pneumonia that occurs 48 hours or more after hospital admission and is not incubating at hospital
What are the risk factors HAP
stroke chronic lung disease mechanical ventilation recent surgery previous antibiotic treatment
what are the causes HAP
bacteria and virus
resistant pathogens
may need treatment with extended spectrum antibiotics
what is a diagnosis often confirmed by HAP
confirmed by chest X ray
are there any validated tools to assess severity of HAP in context of covid 19 `
Nop
what should be given in low risk HAP
oral 5 day single of
doxycycline
co amoxiclav
co trimoxazole
levofloxacin
what should be given in high risk HAP
intravenous piperacillin with tazobactam
ceftazidime
levofloxacin if other options unsuitable
