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Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Pneumonia definition

A

Pneumonia is an acute inflammation of the terminal bronchioles and the area surrounding the alveoli.

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2
Q

Epidemiology of pneumonia

A

0.5-1% of people develop CAP in the UK every year, with mortality between 5-14%

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3
Q

Bacteria that cause pneumonia

A
  • MRSA
  • TB
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Staphylococcus aureus
  • Klebsiella pneumonia
  • Pseudomonas aeruginosa
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4
Q

What viruses cause Pneumonia?

A
  • Respiratory syncytial virus (RSV)
  • Influenza
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5
Q

What fungi cause pneumonia?

A

Pneumocystic jirovicii

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6
Q

What are idiopathic intersitial pneumonias?

A

group of non-infective causes e.g. cryptogenic organising pneumonia which may occur as a complication of rheumatoid arthritis or amiodarone use.

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7
Q

RFs for Pneumonia

A
  • Extremes of age: young children and the elderly are particularly at risk
  • Preceding viral infection
  • Immunosuppressed: e.g. due to steroid use
  • Intravenous drug abuse:Staphylococcus aureus
  • Respiratory conditions: asthma, COPD, malignancy, cystic fibrosis
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8
Q

Pneumonia is secondary to inflamamtion, what does inflammation do in the lungs?

A

brings water into the lung tissue, which makes it harder to breathe.

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9
Q

What do microbes do in pneumonia?

A
  • Enter and evade body defences
  • Multiply and cross over from airways into lung tissue > inflammatory respionse
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10
Q

What happens to lung tissue as it inflammed?

A

tissue fills with white blood cells as well as proteins, fluid, and red blood cells if a nearby capillary is damaged in the process.

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11
Q

Pneumonias categorised by how its acquired - what are the 2 types of pneumonia?

A
  • Community acquired pneumonia (CAP): pneumonia acquired outside a hospital setting
  • Hospital-acquired pneumonia (HAP): pneumonia that develops more than 48h after hospital admission
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12
Q

What is aspiration pneumonia?

A
  • due to foreign material lodging in the lungs.
  • Microbes on the foreign material can cause infection.
  • Aspiration pneumonia can also happen with drinks, or vomiting of gastric contents.
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13
Q

What is atypical pneumonia?

A

pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain.

They don’t respond to penicillins and can be treated with macrolides (e.g. clarithomycin), fluoroquinolones (e.g. levofloxacin) or tetracyclines (e.g. doxycycline).

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14
Q

What is bronchopneumonia?

A

infection can be throughout the lungs involving the bronchioles as well as the alveoli.

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15
Q

What is atypical/interstitial pneumonia?

A

infection is mainly just outside the alveoli in the interstitium.

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16
Q

What is lobar pneumonia?

A

infection causes complete consolidation of a whole lobe of the lung.

17
Q

S + S of Pneumonia

A

Pyrexia
Tachycardia
Hypoxia
Dyspnoea
Fever
Pleuritic chest pain
Productive cough

18
Q

Primary investigations for pneumonia

A
  • CXR
  • FBC:leukocytosis
  • U&Es:deranged in severe disease
  • CRP:raised
  • ABG:perform if hypoxic to assess for respiratory failure
  • Sputum culture:allows assessment of organism and antibiotic sensitivities
19
Q

What is CURB-65?

A

Criteria for pneumonia - nazias note good explanation

20
Q

Initial management for Pneumonia

A
  • O2, if needed
  • Analgesia
  • Antibiotics: will vary by trust
21
Q

Management for Community acquired pneumonia

A
  • Low severity (CURB ≤ 1):oral amoxicillinORdoxycycline/clarithromycin if penicillin-allergic or an atypical pathogen is suspected; usually a 5 day course
  • Moderate severity (CURB 2): amoxicillin;addclarithromycin if an atypical pathogen is suspected; usually a 5 day course
  • High severity (CURB ≥ 3):IV co-amoxiclavandclarithromycin are often used
22
Q

Treatment for Hospital acquired pneumonia

A

Severity is determined clinically

  • Low severity:oral co-amoxiclav
  • High severity:a**broad-spectrum antibiotic, such as IV tazocin or ceftriaxone
  • Suspected or confirmed MRSA:add vancomycin
23
Q

When should you not discharge a patient with CAP?

A

if in the last 24 hours they have had 2 or more of the following:

  • Temperature > 37.5°C
  • RR ≥ 24
  • HR ≥ 100
  • SBP ≤ 90 mmHg
  • SpO2≤ 90% on room air
  • Abnormal mental status
  • Inability to eat without assistance
24
Q

Complications of Pneumonia

A
  • Acute respiratory distress syndrome:associated with a 30-50% mortality rate and usually requires mechanical ventilation
  • Sepsis:complicates severe CAP and may be fatal, particularly in immunocompromised patients
  • Lung abscess:may require prolonged antibiotic therapy and drainage; can occur due toKlebsiellaorStaphylococcalpneumonia
  • Pleural effusion:parapneumonic effusions can either be sterile or infected (empyema
25
Q

Most common community acquired pneumonia bacteria

A

Streptococcus pneumonia - 80% of pneumonia
Haemophilus influenza - COPD assosciate
SA - causes secondary bacterial infection

26
Q

Common bacteria for HAP

A

Gram negative bacteria and SA

27
Q

Aspirational pneumoniae bacteria

A

Klebsiella pneuomniae
Streptococcus pneumoniae
SA

28
Q

What is pneumocystis pneumonia?

A

Pneumocystis pneumonia (PCP) is an opportunistic respiratory infection caused by the fungus, Pneumocystis jirovecii.

29
Q

PCP epidemiology

A
  • PCP is the most common opportunistic infection in patients with AIDS.
  • 40% of people with PCP have HIV/AIDS, whilst the remaining people are typically immunosuppressed due to conditions such as leukaemia, inflammatory diseases and solid organ transplantation.
30
Q

RFs for PCP

A
  • HIV/AIDS: PCP is associated with a CD4 count < 200/mm^3
  • Primary immunodeficiency conditions
  • Secondary immunodeficiency: e.g. steroids
  • Other causes of immunosuppression: e.g. haematological malignancies
31
Q

S + S of PCP

A

CXR often normal
Lymphadenopathy
Hepatosplenomegaly
Dyspnoea
Pyrexia
Cough
Fever

32
Q

Primary investigations for PCP

A
  • Oxygen saturation:patients with PCP characteristically desaturate onexertion
  • Arterial blood gas:type 1 respiratory failure
  • Chest X-ray:may reveal bilateral interstitial infiltrates but can be normal
  • Induced sputum:silver staining to identify PCP
33
Q

Other investigation for PCP

A

Broncho-alveolar lavage
High res CT chest
HIV serology and CD4 count

34
Q

Treatment for PCP

A
  • Trimethoprim/sulfamethoxazole (co-trimoxazole):first-line therapy
  • Prednisolone:indicated if hypoxic with pO2< 9.3 kPa, to reduce the risk of respiratory failure (< 50% risk) and death
  • ## IV/ nebulised pentamidine:this is reserved for severe cases where co-trimoxazole is contraindicated or has failed
35
Q

Prophylaxis for PCP

A

Trimethoprim/sulfamethoxazole (co-trimoxazole): primary prophylaxis is recommended in all patients with a CD4 < 200/mm3 or a history of an AIDS-defining illness

Respiratory (21 decks)

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