KCP: Chest Infections Flashcards
A 75 year old woman has five days of productive cough, breathlessness and fever. She has become confused over the last 24 hours. She has hypertension and type 2 diabetes mellitus.
Her temperature is 38.5ºC, pulse 100 bpm, blood pressure 135/72 mmHg, respiratory rate 30 breaths per minute and oxygen saturation 86% breathing air. She has bronchial breathing at the right base.
What investigations are indicated?
What is her CURB65 score?
A 50 year old man has seven days of cough, breathlessness, fever, headache and myalgia. He has not been vaccinated against Covid-19.
His temperature is 38.5ºC, pulse 90 bpm, blood pressure 133/80 mmHg, respiratory rate 26 breaths per minute and oxygen saturation 88% breathing air.
What investigations are needed?
What treatment should he be given?
Microbial cultures - sputem
Oxygen aim for oxygen saturation 94-96%
Glucocorticoid e.g. dexamethasone
Anti-virals e.g. Remdesivir
IL-6 inhibitors e.g. Tocilizumab
JAK inhibitors e.g. Baracitinib
What is CURB65?
What do the scores mean?
C-confusion
U-urea >7 mmol/L
R-respiratory rate 30 breaths per minute
B-blood pressure (systolic < 90 mmHg, diastolic < 60 mmHg)
Age > 65 years
- Score of 0 or 1: Low risk, < 3% mortality risk
- Score of 2: Moderate risk, 3-15% mortality risk
- Score 3-5: High risk, 15-40% mortality risk
What is Pneumocystis Jirovecii?
It is a fungus, specific for humans
Airborne spread
Many of us may have asymptomatic colonisation
Common cause of pneumonia in HIV infected patients in the 80’s and 90’s
Lung infection in those who are immunosuppressed
Common fungal lung infection?
Pneumocystis Jirovecii
Diagnosis of Pneumocystis Jirovecii
- Induced sputum - give hypertonic saline nebulizer and physiotherapist then obtains a sample.
- Bronchoscopy
- Microscopy-silver stain
- PCR for microbial DNA
Treatment of Pneumocystis Jirovecii
High dose intravenous cotrimoxazole and corticosteroids
Prophylaxis for those at risk with oral cotrimoxazole
Out of these bacterial causes of pneumonia which are considered atypical pneumonias?
- S. pneumoniae(most common bacterial cause)
- Haemophilus influenzae
- Moraxella catarrhalis
- Staphylococcus aureus
- Legionella pneumophila
- Mycoplasma pneumoniae
- Coxiella burnetti
- Chlamydia pneumoniae and psittaci
- Legionella pneumophila
- Mycoplasma pneumoniae
- Coxiella burnetti
- Chlamydia pneumoniae and psittaci
Most common bacterial cause of community aquired pneumonia?
Streptococcus pneumoniae
What is the unique presentation of pneumonia caused by Haemophilus Influenzae?
Particularly common in the elderly
What defines hospital aquired pneumonia?
Pneumonia occuring > 48h after admission
Gram negative pathegens more likely cause (antibiotic resitance)
How to treat hospital aquired pneumonia?
- IV Fluids
- IV Antibiotics
- OXygen
- NBM - NG
