Lecture 9,10 LRTI (Pneumonia)

Question 1

What are clinical Signs of Infection

Answer 1

• inflammation
• Redness
• Heat
• Pus

Systemic Signs; fever, Increased HR, Increased RR, Increased WBC

Question 2

What are the characteristics of a fever

Answer 2

fever most common & most non-specific feature of infection
❑ > 37.5 (oral / armpit) (99.5 oF)
❑ > 38oC (tympanic / rectal) (100.2oF)

• Very young and Elderly may not respond with a fever
• HR is increased by 10-15BPm for each 1* increase

Question 3

What are potential results of an untreated fever

Answer 3

❑ enhanced leukocyte migration
❑ augmented lymphocyte function
❑ reduced microbial replication
❑ improved survival

Question 4

White blood count ranges and meanings

Answer 4

WBC increased (leukocytes) in most bacterial or fungal infections
Normal ; 4-11
> 11; suspect of infection
> 15-17; very sick
Sepsis- either very low or very high -50

Question 5

What’s the risk involved with Pneumonia

Answer 5

• Those > 65 years of age at greatest risk
• >50% of cases and 90% of mortality in these patients
• Mortality is <1% in outpatients but 14% in those hospitalized
• A viral infection precedes pneumonia in up to 50% of
cases

Question 6

What is community acquired Pneumonia (CAP)

Answer 6

• defined as an acute infection of the pulmonary

Question 7

Blood culture and sensitivity test

Answer 7

Should be performed in ill febrile pt’s

Should be taken from two different peripheral sites at least a few minutes to an hour apart from one one another

Question 8

Sputum C&S

Answer 8

Usually performed in LRSTI

❑ Specimen quality can be assessed by considering
the relative proportions of the components seen
under the microscope
❑ PMNs
❑ Epithelial cells

Question 9

What are the systemic signs of infection?

Answer 9

Fever, increased heart rate (HR), increased respiratory rate (RR), and increased white blood cell count (WBC).

Question 10

What is the normal range for white blood cell count (WBC)?

Answer 10

4.0-11.0 x 10^9/L (4,000-11,000/mm^3).

Question 11

What is a common cause of fever besides infection?

Answer 11

Drug fevers, transfusion reactions, lymphoma, or post-myocardial infarction (MI).

Question 12

What is the most common bacterial pathogen causing community-acquired pneumonia (CAP)?

Answer 12

Streptococcus pneumoniae.

Question 13

What are the risk factors for resistant S. pneumoniae?

Answer 13

Antibacterial use in the past 3 months, age >65, exposure to children from daycare, alcoholism, and immunosuppression.

Question 14

What is the typical presentation of Mycoplasma pneumoniae infection?

Answer 14

Gradual onset of fever, headache, malaise, followed by a persistent hacking cough, often with non-pulmonary symptoms like nausea, vomiting, and skin rashes.

Question 15

What is the role of procalcitonin (PCT) in diagnosing bacterial infections?

Answer 15

PCT is a biomarker used to predict the likelihood of bacterial infection and can guide antibacterial therapy, especially in respiratory infections and sepsis.

Question 16

What are the 2016 IDSA/ATS guidelines for procalcitonin use in HAP/VAP?

Answer 16

Procalcitonin levels plus clinical criteria should be used to guide discontinuation of antibiotic therapy in HAP/VAP (weak recommendation, low-quality evidence).

Question 17

What are the clinical signs of pneumonia?

Answer 17

Fever >37.8°C, hypothermia, rigors, sweats, new cough with sputum, chest discomfort, dyspnea, and abnormal breath sounds (rales, rhonchi).

Question 18

What are the risk factors for poor outcomes in pneumonia?

Answer 18

Respiratory rate >30, systolic BP <90, acute renal dysfunction, malnourishment, functional impairment, and leukopenia <4 x 10^9/L.

Question 19

What is the CURB-65 score used for?

Answer 19

It is a risk assessment tool for community-acquired pneumonia (CAP) to determine the need for hospitalization based on confusion, uremia, respiratory rate, blood pressure, and age >65.

Question 20

What is the first-line empiric treatment for outpatient CAP with no comorbidities?

Answer 20

Amoxicillin 1 g PO TID or doxycycline 200 mg PO once, then 100 mg PO BID.

Question 21

What is the empiric treatment for severe CAP requiring ICU admission?

Answer 21

Ceftriaxone 1-2 g IV daily plus azithromycin 500 mg IV/PO daily. If MRSA is suspected, add vancomycin or linezolid.

Question 22

What are the criteria for clinical stability in pneumonia patients?

Answer 22

Temperature ≤37.8°C, heart rate ≤100 bpm, respiratory rate ≤24 breaths/min, systolic BP ≥90 mmHg, O2 saturation ≥90%, ability to maintain oral intake, and normal mental status.

Question 23

What are the common pathogens in nursing home-acquired pneumonia (NHAP)?

Answer 23

S. pneumoniae, H. influenzae, S. aureus, Enterobacterales, and C. pneumoniae.

Question 24

What is the empiric treatment for late-onset hospital-acquired pneumonia (HAP)?

Answer 24

Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg PO/IV daily, plus gentamicin if P. aeruginosa is suspected.

Question 25

What are the prevention strategies for ventilator-associated pneumonia (VAP)?

Answer 25

Elevate the head of the bed 30-45°, mouth care, remove NG/ET tubes ASAP, continuous sub-glottic suctioning, and hand hygiene.

Question 26

What are the common pathogens in aspiration pneumonia with risk factors for gut anaerobes?

Answer 26

*S. pneumoniae*, *H. influenzae*, *S. aureus*, Enterobacterales, and anaerobes.

Question 27

What is the empiric treatment for aspiration pneumonia with risk factors for gut anaerobes?

Answer 27

Amoxicillin/clavulanate or ceftriaxone 1-2 g IV daily plus metronidazole 500 mg IV/PO BID.

Question 28

What is the most common cause of acute bronchitis?

Answer 28

Viral infections (≥90% of cases).

Question 29

What is the recommended supportive treatment for acute bronchitis?

Answer 29

Increased humidity, smoking cessation, antitussives, and bronchodilators (if needed).

Question 30

What is the mortality rate for outpatients with pneumonia?

Answer 30

Less than 1%.

Question 31

What is the mortality rate for hospitalized patients with pneumonia?

Answer 31

Approximately 14%.

Question 32

What are the common non-infectious outcomes of pneumonia?

Answer 32

Acute cardiac events (e.g., myocardial infarction, atrial fibrillation) and worsening heart failure.

Question 33

What is the Pneumonia Severity of Illness (PSI) scoring system used for?

Answer 33

To assess the severity of community-acquired pneumonia (CAP) and guide treatment decisions.

Question 34

What are the common symptoms of *Chlamydia pneumoniae* infection?

Answer 34

Mild respiratory symptoms, fever, headache, and gradual onset, with re-infection common in older adults.

Question 35

What is the typical presentation of *Haemophilus influenzae* pneumonia?

Answer 35

Bronchopneumonia or acute exacerbation in COPD patients, with cough, fever, and pleuritic chest pain.

Question 36

What are the common pathogens in early-onset ventilator-associated pneumonia (VAP)?

Answer 36

Enterobacterales, *S. pneumoniae*, *H. influenzae*, and *S. aureus*.

Question 37

What is the empiric treatment for early-onset VAP?

Answer 37

Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily. If MRSA is suspected, add vancomycin or linezolid.

Question 38

What is the empiric treatment for late-onset VAP with risk factors for multidrug-resistant pathogens?

Answer 38

Piperacillin/tazobactam 4.5 g IV q6h or meropenem 500 mg IV q6h, plus tobramycin or ciprofloxacin. If MRSA is suspected, add vancomycin or linezolid.

Question 39

What are the common pathogens in aspiration pneumonia without risk factors for gut anaerobes?

Answer 39

*S. pneumoniae*, *H. influenzae*, *S. aureus*, and Enterobacterales.

Question 40

What is the empiric treatment for aspiration pneumonia without risk factors for gut anaerobes?

Answer 40

Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily.

Question 41

What are the common symptoms of viral pneumonia?

Answer 41

Upper respiratory symptoms, patchy pulmonary infiltrates, and normal or minimally elevated white blood cell count.

Question 42

What is the recommended duration of antibacterial therapy for CAP?

Answer 42

Minimum of 3-5 days and until clinically stable.

Question 43

What are the common pathogens in hospital-acquired pneumonia (HAP)?

Answer 43

Enterobacterales, *P. aeruginosa*, *S. aureus*, and *S. pneumoniae*.

Question 44

What is the empiric treatment for mild-moderate hospital-acquired aspiration pneumonia?

Answer 44

Amoxicillin/clavulanate or ceftriaxone 1-2 g IV daily plus metronidazole 500 mg IV/PO BID.

Question 45

What is the empiric treatment for severe hospital-acquired aspiration pneumonia?

Answer 45

Piperacillin/tazobactam 4.5 g IV q6h or meropenem 500 mg IV q6h.

Question 46

What are the common symptoms of influenza pneumonia?

Answer 46

Sudden onset of flu-like syndrome, upper respiratory symptoms, and positive diagnostic test for influenza virus.

Question 47

What is the role of macrolides in pneumonia treatment?

Answer 47

Macrolides have immunomodulatory effects, suppressing inflammatory cytokines and reducing morbidity and mortality in CAP when added to β-lactams.

Question 48

What are the common symptoms of lobar pneumonia?

Answer 48

Sudden onset of fever, chills, cough, and pleuritic chest pain, often with dense consolidation on chest X-ray.

Question 49

What is the recommended follow-up for pneumonia patients?

Answer 49

Follow-up chest X-ray at 6 weeks for patients with extensive/necrotizing pneumonia, smoking history, alcoholism, or weight loss.

Question 50

What are the common symptoms of *Mycoplasma pneumoniae* infection?

Answer 50

Gradual onset of fever, headache, malaise, and persistent hacking cough, often with non-pulmonary symptoms like nausea and skin rashes.

Question 51

What is the recommended treatment for acute bronchitis?

Answer 51

Supportive care, including increased humidity, smoking cessation, antitussives, and bronchodilators if needed. Antibiotics are not recommended.

Question 52

What is the recommended treatment for *Haemophilus influenzae* pneumonia?

Answer 52

Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily.

Question 53

What are the common symptoms of *Streptococcus pneumoniae* pneumonia?

Answer 53

Sudden onset of fever, chills, cough, and pleuritic chest pain, often with lobar consolidation on chest X-ray.

Question 54

What is the recommended treatment for *Mycoplasma pneumoniae* pneumonia?

Answer 54

Azithromycin 500 mg PO daily or doxycycline 100 mg PO BID.

Question 55

What are the common symptoms of *Chlamydia pneumoniae* pneumonia?

Answer 55

Mild respiratory symptoms, fever, headache, and gradual onset, with re-infection common in older adults.

Question 56

What is the recommended treatment for *Chlamydia pneumoniae* pneumonia?

Answer 56

Azithromycin 500 mg PO daily or doxycycline 100 mg PO BID.

Question 57

What are the common symptoms of *Haemophilus influenzae* pneumonia?

Answer 57

Bronchopneumonia or acute exacerbation in COPD patients, with cough, fever, and pleuritic chest pain.