Lecture 24: Fever and cough - pneumonia Flashcards Preview

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Flashcards in Lecture 24: Fever and cough - pneumonia Deck (11):

where does pneumonia infection start vs bronchitis vs URTI

terminal bronchials pneumonia
conduction bronchioles bronchitis
anything above is URTI


most common cause of pneumonia?

-Streptococcus pneumoniae (most common)
-haemophilllus influenza (5-10%)
-Staph aureus (severe cases)


distinguish bronchitis from pneumonia?

clinical features:
-pneumonia affected lung breath decreased (kids)
-respiratory distress
-listening to lungs - dullness
pneumonia is worse


Pneumonia in elderly

-increased RR
-50% fever
- Problems outside lung e.g delirium (systemic illness)


How do you develop pneumonia?

-Bacteria Aspiration from upper airway, usually happens when asleep


Risk factors for pneumonia?

-<2 , >65
-Chronic lung disease
-Immune dysfunction


Treatment of pneumonia

-depends on how sick
-Not overly sick: no tests just give generalised antibiotics
-really sick: do tests, give ABs, alter based on tests


Pneumococcal virulence features

-Capsule: prevents phagocytosis and complement
-Pneumococcal surface protein A binds to epithelial cells and prevents C3b binding (opsonisation)
-PspC prevents no complement activation
-Choline binding protein binds to Ig receptor on epithelial cell, allowing transport into
-Pneumolysin: lyses neutrophils and epithelial cells
-pilli contribute to colonisation and cytokine (TNF a) production


Investigations and management of pneumonia

kidney function?

-CXR first line, if negative no antibiotics
-Sputum culture: yield dependent on sample
-Nasopharyngeal swab: if admitted- viral PCR, if positive stop antibiotics
- if admitted, yield low
-Urine ICT- if admitted moderate yield for Strep pneumoniae, lower for legionella
-CT chest/bronchoscopy



Ribosome targets
Are broad spectrum
Limited activity against gram -ve bacteria
Active against streptococci, staphylococci and other pneumonia causes (used in skin infection when allergic to penicillin)
Treatment of chlamydia

e.g erythromycin, azithromycin and clarithromycin


Adverse effects of macrolides

GIT upset, erythromycin agonist of motilin receptor
Sudden death
drug interactions

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