W22 - Pneumonia Flashcards by Jamie Sanderson

what is pneumonia

inflmmation of the lung parenchyma of infective origin characterized by consolidation

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how can pneumonia be prevented

immunization

adequate nutrition and addressing environmental factor

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if caused by bacteria what can it be treated by

antibiotics

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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

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What are the three forms of pneumonia by affected lung area

bronchopneumonia

lobar

interstitial

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what is bronchopneuomonia

acute inflammation of the wallers of the smaller bronchial tubes.

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what is lobar

severe infection of one or more of the 5 major lobes of the lungs that if untreated eventually results in consolidation

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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

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what are the 2 locations catagories for pneumonia

community

hospital

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what are the 3 classifications

Aetiology
Lung Affected
Location

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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

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what is a common cause of pneumoniae

streptococcus pneumonia

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what are some other common causes

gram positive bacteria

Viruses e.g. influenza

gram negative

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what are symptoms of CAP

cough
Temp >38
Sputum production
Breathlessness
Feeling generally unwell

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what are the four stages of pneumonia

Consolidation
Red hepatization
Grey hepatization
Resolution

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when does consolidation occur

first 24 hours

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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

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when does red heaptization occur

2-3 after consolidation

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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

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what is red hepatization characterized by

presence of many erythrocytes, neutrophils, desquamated epithelial cells and fibrin within alveoli

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when dose grey hepatization occur

2-3 days after red hepatization

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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.

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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