CAP - LRTI Flashcards
clinical signs and symptoms of pneumonia
cough sputum production crackles consolidation tachypnea dyspnea hypoxia hemoptysis pleural pain fever chills tahcycardia leukocytosis
elderly presentation of pneumonia
wihtout cough sputum or leukocytosis
fever not as common
more difficult to diagnose
most common pathogen in pneumonia
strep pneumoniae COPD cardiovascular or renal disease asplenic diabetes immunocompromised
mycoplasma pneumoniae
chlamydophilia pneumoniae common pathogens in
adolescents
young and elderly adults
saureus common pneumonia pathogen in
immunocompromised
hinfluenza and moraxella catarrhalis common pneumonia pathogens in
COPD
smokinh
klebsiella pneumoniae, ecoli, enterobacter common pneumonia pathogen in
COPD
smoking
diabetes
alcoholism
paeruginose common pneumonia pathogen in
cystic fibrosis
COPD
corticosteroids
immunocompromised
anaerobes common pneumonia pathogens in
aspiraion
cerebrovascular disease
neurological disease
alcoholism
how is community acquired pneumonia diagnosed
clinical signs and symptoms
lung infiltrate on xray
low culture yield in sputum due to poor quality sampling and fastidious or slow growing pathogens
improved yield in endothelial lining fluid obtained by bronchoaveolar lavage
postive blood culture in 25% of cases
ie. very hard to determine pathogen
mycoplasma pneumoniae infection characteristics
peak incidence in older children young adults and elderly
incubation 2-3 weeks
pharyngitis, tracheobronchitis, pneumonia
gradual onset fever, headache, GI, malaise, arthralgia,, myalgia, rash for 1-2 weeks followed by nonproductive cough for 3-4 weeks
chlamydophila pneumoniae infection presentation
young adults
mild resp symptoms, fever, headache
legionella pneumophilia infection presentation
ubiquitous in water and soil
outbreaks wiht peak in summer and fail, associated with air ventilation systems
rapidly progressiv epneumonia with multisystem involvement
fever, malaise, arthralgia, pleuritic pain, cns and gi symptoms
what AM classes are effective against atypical pathogens
fluoroquinolones
macrolides
tetracyclines
empiric treatment for mild-mod infection
amox +/- macro or doxy
*macro or doxy for moderate illness or no improvement with amox after 3 days
macro - resistance concerns
doxy - less clinical dat
what are some risk factors for resistance or poor outcomes
prior AM or hospitalization within 3 months
chronic lung, heart, liver, or renal dysfunction
diabetes
alcoholism
malignancy
asplenia
IC
empiric treatment for patients with risk factors for resistance or poor outcomes
amoxi -clav +macro or doxy (want to cover atypicals)
cefproz/cefurox + macro or doxy
levo/moxi only in serious illness, treatment failure, or in allergy
why do we restrict the use of fluoroquinolones
concern of resistance
increase AE: CNS, hypersensitivity, QT prolongation, tendinitis
cant be used in pregnant women or children
empiric treatment for severe infection requiring hospitalization
levo/moxi
cefotax/cetriax + azithro
if ICU cefotax/ceftriax + levo/moxi
response to mild mod CAP
clinical improvement in 2-3 days
complete resolution in weeks
duration of therapy for mild-mod CAP
5-7 days
based on clinical response and resolution
risk factors for LRTI
elderly copd congestive heart failure end stage renal disease diabetes smoking alcoholism cerebrovascular or neurological disease IC
what is used to stratify risk mortality
PSI - pneumonia severity index
CURB65
in CAP that requires hospitalization what should you monitor
cough improve or is absent 2-3/7+ days
HR,RR, temp twice daily every 2-3 days
WBC every other day for 5-7days
chest xray repeat if deterioration >6wks
