11. Pneumonia Flashcards
(34 cards)
When is pneumonia considered HAP
> 48 hrs since hospitalised
Most common CAP pathogens
Strep pneumoniae (G+) and Haemophillius influenzae (G-)
SARS-COV-2, Influenza A and B
What CAP pathogen can occur in epidemics in autumn and what does the CXR show in this case and how to dx
M. pnuemoniae, CXR can show nodular infiltration, PCR can dx as part of viral throat swab
What pathogen which causes pneumonia can be commonly contracted from contaminated water and what are the Sx
Legionella pneumophillia
Headache, confusion, malaise and diarrhoea.
Test with specialist sputum PCR (urine ag less sensitive0
labs show hypona, deranged LFTs, may have AKI and can be severly hypoxic and multi-lobar on CXR
What pathogen can be contracted from contaminated soil/compost and how to test
L.longbbeachae, specialist sputum testing
Which infection has farm animals as its resevoir and what are the extrapulm manifestations, Ix
C.burnetti, endocardtitis
Serology
What causes post-influenza virus infxn and lung abscesses, Ix
S.aureus, sputum and blood culture
What Influenza virus can cause CAP and how to Ix and Mx
Influenza A, use PCR viral throat swab or POCT ag
Mx with oseltamivir
What patients should have pneumococcal vaccination
Chronic heart, liver, renal or lung disease
Diabetes Mellitus
Immunosuppression
>65 vaccines
How to Ix hospitalized pts with pneumonia and when should blood cultures be used
Sputum culture for conventional bacterial pathogen
PCR testing (throat swab) for resp virus and mycoplasma pneumoniae
HIV test
Blood cultures if moderate to severe based on CURB 65
What should be investigated microbiologically if there is effusion present and suspicion of empyema
Pleural fluid should be aspirated and sent for culture
How should non-conventional pathogens be investigated and what are these pathogens
TB, pneumocystis
What are late HAP pathogens
Ecoli, p aeruginosa (both gram -ve)
s.aureus (MSSA or MRSA)
Nosocomial influenza and SARS-CoV2 outbreak in
What lung diseases predispose a patient to pneumonia
COPD, fibrosis
Lung cancer - post-stenotic pneumonia
What does predispostition to recuurent sever infection from atypical pneumonia pathogens suggest about (wrt to immune system)
Problem with neutrophils - chronic granulomatous disease
What does CD4<200 suggest
HIV, opportunistic resp infxn
PCP, TB, non-tuberuculous mycobateria eg avian, CMV and bacterial pneumonia
What cells are affected in COPD and old age n and which pathogens are more likely to be involved in these pts
Defective phenotype with impaired ability to phagocytose conventional bacteria
(S pneumoniae, H influenzae)
What drugs work on T cells
CNI and MMF
What pathogens are more common in patients with T-cell fx
Viral (CMV, VSV, HSV), mycobacteria, pneumocystis jiroveci
Which kind of pneumonia has exercise-induced hypoxia and what are the main Sx
What Ix is more useful
How to dx and mx
pneumocystis
Desaturated on walking, have the ambulatory Spo2
Fever, non-productive cough and dyspnoea
May have normal chest auscultation or CXR
CT chhest may show ground glass inflammatory changes
Dx with PCR on induced sputum or BLAF
Mx with cotrim high dose (IV first)
Empiric antimicrobial therapy of CAP- how to treat
CURB score:
0-1, Oral Amox or usually doxy/clari
2, amox +clari (ORAL/IV) or oral doxy/IV `clari
3-5, IV Co-amox + clari or IV cef + clari if minor, Oral/IV cipro+ IV vanco if serious
What is CURB 65 criteria
Confusion (AMT <=8/10)
Urea >7
RR>=30
BP Systolic <=90 or diastolic <=60
65 >= age
Why might amox not work of H influenzae
Due to B lactamase presence
When should clarithro be stopped in CAP pts
If myco negative on PCR and legionella not suspected
