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Flashcards in PNA/Influenza Deck (27)
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1

Pneumonia definition +  main types

  • infection of the lung parenchyma
  • community acquired pneumonia (CAP) = infection outside of health-care system
  • health-care associated pneumonia (HCAP) = infections relating to health-care system
    • hospital-acquired
    • ventilator associated

2

Pathogenesis of Pneumonia

  • **inhalation of infectious particles ==> CAP
  • inhalation of oropharyngeal/gastric contents
  • hematogenous spread
  • infectious from adjacent structures
  • direct inoculation
  • reactivation

3

Pneumonia symptoms

  • fever, chills
  • pleuritic chest pain
  • dyspnea
  • cough
    • productive ==> bacterial
    • non-productive ==> viral/atypical
  • anorexia, nausea, vomiting, diarrhea
  • mental status changes

4

Pneumonia signs

  • tachypnea
  • tachycardia
  • lungs ==> crackles, rhonchi
    • egophany
    • dullness to percussion
  • bronchial breath sounds

5

Historical features ==> infectious differential diagnosis

  • COPD ==> S. pneumo, H. influenzae, M. catarrhalis, Legionella sp.
  • HIV ==> M. tuberculosis
  • Postinfluenza ==> S. pneumo, S. aureus, Strep pyogenes, H. influenzae
  • Aspiration ==> mixed aerobic, anaerobic

6

Common radiographic reatures of pneumonia

  • lboar consolidation
  • interstitial infiltrates
  • cavitation

7

Differential dx of radiographic abnormalities on CXR

  • pneumonia
  • pulmonary edema
  • pulmonary/diffuse alveolar hemorrhage
  • pulmonary embolism
  • malignancy
  • drug-induced lung disease
  • inflammation 

8

Radiographic patterns ==> infections differential dx

9

Pneumonia Severity Index definition

  • risk scale developed by PORT (patient outcome research team) study
  • divides pts into risk classes (I ==> V) based on risk factors and helps provide indications for admission

10

Tests recommended for all suspected pneumonias

  • CXR
  • CBC
  • metabolic profile
  • blood gas or pulse ox

11

Advanced dx testing for pneumonia

  • sputum sample + staining
    • gram-staining ==> gram + or - bacteria
    • acid fast stain ==> mycobacteria
  • bronchoalveolar lavage or pleural fluid analysis for organisms
  • sputum culture ==> tailor therapy
  • blood cultures
  • fiberoptic bronchoscopy
  • biopsy: transbronchial or open lung 

12

Serologic testing in pneumonia

  • high IgG titers in blood can indicate infection w/:
    • Legionella 
    • Mycoplasma
    • C. pneumonia

13

Molecular techniques used to dx pneumonia

  • DNA probes detect bacteria in sputum:
    • Legionella
    • M. pneumoniae
    • M. tubuerculosis
  • PCR assay of sputum:
    • atypical bacteria
    • viruss
    • mycobacteria
  • procalcitonin in blood:
    • elevated levels indicate inflammation/bacterial infections

14

Possible substances that can fill alveoli

  • Poor Funny Boy Cant Piss For Crap

Poor   -   Pus

Funny  -  Fluid

Boy    -  Blood

Can’t  -  Cells/Cancer

Piss   -  Protein

For   -  Fat (Lipid)

Crap  -  Calcium

15

Pneumonia DDX: airway diseases

  • •Cryptogenic Organizing Pneumonia (COP)
  • •Allergic Bronchopulmonary Aspergillosus (ABPA)
  • •Bronchiectasis
  • •Bronchopulmonary sequestration
  • •Bronchocentric granulomatosis

16

Pneumonia DDx: vascular diseases

•Alveolar Hemorrhage Syndromes •Eosinophilic lung diseases •Pulmonary infarction •Fat emboli •Vasculitis •Collagen Vascular Diseases •Vascular tumors •Acute chest syndrome in sickle cell crisis

17

Pneumonia DDx: parenchyma diseases

  • •Hypersensitivity pneumonitis
  • •Drug reaction
  • •Transfusion reaction
  • •Alveolar proteinosis
  • •Granulomatous lung diseases
  • •Lipoid pneumonia
  • •Pulmonary edema
  • •Neoplasms
  • •ARDS
  • •Radiation pneumonitis
  • •Idiopathic interstitial pneumonias

18

Common causes of CAP

  • Typical Organisms
    • •Streptococcus pneumoniae - 30 - 60% of CAP
    • •Haemophilus influenzae
    • •Moraxella Catarrhalis
    • •Staphylococcus aureus
    • •Group A Streptococci
    • •Anaerobes
    • •Aerobic Gram Negatives
  • –Atypical Organisms - 10 - 20% of CAP
    • •Legionella species
    • •Mycoplasma pneumoniae
    • •Chlamydia pneumoniae

19

Outpatient tx of CAP

–Macrolide or Doxycyline

–Respiratory Fluoroquinolone

–Beta-lactam + Macrolide

20

Inpatient tx of CAP

  • –Non - Intensive Care Unit (ICU)
    • •Respiratory Fluoroquinolone
    • •Beta-lactam + Macrolide
  • –Intensive Care Unit (ICU)
    • •Beta-lactam + Macrolide
    • •Beta-lactam + Respiratory Fluoroquinolone

21

Antiobiotic tx of HCAP

  • •Antipseudomonal Agent:
    • •Cephalosporin
    • •Carbopenem
  • •Plus 1 of the Following:
    • •Anti-pseudomonal Fluoroquinolone
    • •Anti-Gram Negative Aminoglycoside
  • •Plus 1 Anti-MRSA Medication:
    • •Linezolid
    • •Vancomycin

22

Common community-acquired respiratory viruses

  • •Orthomyxovirus
  • •Paramyoviruses
  • •Picornaviruses
  • •Enteroviruses
  • •Herpes Viruses
  • •Adenovirus
  • •Coronavirus
  • •Papilloma Virus
  • •Hantavirus

23

Pathogenesis of influenza

  • •IFN Hemagglutinin surface glycoprotein binds to sialic acid residues on respiratory epithelial cell surface glycoproteins - Infection Initiation.
  • • After viral replication, progeny virions are also bound to the host cell membrane.
  • Neurominidase cleaves these links to liberate new virons and spread infection.

24

Clinical features of influenza infection

  • signs/sx:
    • fever
    • lethargy
    • runny nose, sore throagt
    • coughing, wheezing
    • anorexia, nausea, vomiting, diarrhea
  • ==> primary viral pneumonia and/or secondary bacterial pneumonia

25

Influenza prevention

  • vaccines developed every year
  • targeted groups:
    • 6-18 yo + >50yo
    • chronic care facility pts
    • adults w/chornic diseases
    • pregnant women
    • healthcare workers

26

Treatment of influenza

  • Antiviral drugs:
    • - Adamantanes - Active only against IFN A
    • -Amantadine and Rimantidine - Neurominidase Inhibitors - Active against IFN A and B
    • Oseltamivir and Zanamivir
  • Benefits of Treatment
    • Can shorten duration and severity of symptoms
    • Greatest Benefit if given within the first 24 - 30 Hrs

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