PNA / Influenza Flashcards
(28 cards)
T/F: pneumonia is a disease of the lungs that is characterized by inflammation of the parenchyma
True
Definition: A disease of the lungs that is characterized by inflammation of the parenchyma of the lung (alveoli) and accumulation of abnormal alveolar filling with fluid of lung tissue
**Most commonly caused by infection
What is most commonly caused of infectious pneumonia?
Inhalation of infectious particles!
Other causes:
- Inhalation of oropharngeal or gastric contents
- Hematogenous spread
- Infection from adjacent or contiguous structures
- Direct inoculation
- Reactivation
What two types of classic differentiations can pneumonia be categorized into? What kinds of bugs cause these?
- Typical:
* S. pneumoniae, H. influenzae, S. aureus, group A streptococci, Moraxella catarrhalis, anaerobes, and aerobic gram-negative bacteria - Atypical
* Legionella spp, M. pneumoniae, C. pneumoniae, and C. psittaci (All the weird ones)
What types of things should you ask about when getting a clinical history?
- Age
- Presentation (Acute, Subacute, or Chronic)
- Personal Factors: Smoking History, Alcohol/Drug Abuse. HIV Risk Factors, Occupational History/Allergic History
- Underlying Cardiopulmonary Disease
- Co-Morbidities (Aspiration Risk, IV Drug Use, Pregnancy)
- Drugs (allergies, abuse)
What are some typical presentations of pneumonia? What could you find on physical exam?
Symptoms:
- Fever, cough, SOB, pleuritic chest pain, sputum production, GI symptoms, mental status changes
Physical Exam
- Fever – 80% (may be absent in elderly)
- Tachypnea – 45 to 70%
- Audible crackles
- Evidence of consolidation – bronchial breath sounds, egophany, dullness to percussion
T/F: blood cultures are the most sensitive test to detect pneumonia
False
Blood Cultures – positive in <20% of patients
Sputum Cultures – positive in <10% of patients
What different patterns could exist on an Xray?
- Alveolar
- Lobar
- Multifocal
- Interstitial
- Pleural Effusion
- Nodular
- Millary
- Cavitation
DISCLAIMER: x-ray alone cannot differentiate or confirm diagnosis, but its a good place to start
What is the acronym for all the types of fluids that can fill alveoli?
Poor - Pus
Funny - Fluid
Boy - Blood
Can’t - Cells/Cancer
Piss - Protein
For - Fat (Lipid)
Crap - Calcium
What pneumonia pattern is shown?
Lobar consolidation
What pneumonia pattern is shown?
Multifocal pneumonia
What pneumonia pattern is shown?
Cavitation
What pneumonia pattern is shown?
Miliary pneumonia: from hematogenous spread or tuberculosis
What pneumonia pattern is shown?
Interstitial Pneumonia
What are some differentials for airway diseases?
- Cryptogenic Organizing Pneumonia (COP)
- Allergic Bronchopulmonary Aspergillosus (ABPA)
- Bronchiectasis
- Bronchopulmonary sequestration
- Bronchocentric granulomatosis
What are some differential diagnosis for vascular disease?
- Alveolar Hemorrhage Syndromes
- Eosinophilic lung diseases
- Pulmonary infarction
- Fat emboli
- Vasculitis
- Collagen Vascular Diseases
- Vascular tumors
- Acute chest syndrome in sickle cell crisis
Can you think of some other differentials for parenchymal disease?
- Hypersensitivity pneumonitis (occupational)
- Drug reaction
- Transfusion reaction
- Alveolar proteinosis
- Granulomatous lung diseases
- Lipoid pneumonia
- Pulmonary edema
- Neoplasms
- ARDS
- Radiation pneumonitis
- Idiopathic interstitial pneumonias
What does CAP, HAP, VAP, and HCAP stand for?
- Community Acquired Pneumonia (CAP)
- Hospital (Nosocomial) Acquired Pneumonia (HAP)
- Ventilator Associated Pneumonia (VAP)
- Healthcare-Associated Pneumonia (HCAP)
Strep pneumo is the most common cause of CAP. What are the in-patient and outpatient pharmacologic treatments?
Outpatient Treatment (5 days)
- Macrolide or Doxycyline
- Respiratory Fluoroquinolone
Inpatient Treatment (6 days)
- Non - Intensive Care Unit (ICU)
- Respiratory Fluoroquinolone
- Beta-lactam + Macrolide
- Intensive Care Unit (ICU)
- Beta-lactam + Macrolide
- Beta-lactam + Respiratory Fluoroquinolone
- Consider Anti-MRSA Therapy (Vancomysin)
- 21yoF with 3 days of fevers, chills, cough, and purulent sputum presenting to clinic
- VS: 38.5, 105, 120/80, 24, 92% on RA
- Exam: appears mildly ill, tachycardic, tachypnic, crackles@LLL, dullness@LLL
- WBC 12, nl BMP
What is your diagnosis? What’s the treatment?
Community acquired pneumonia (not hospital related)
Outpatient Treatment
- Macrolide or Doxycyline
- Respiratory Fluoroquinolone
How do you differentiate between the healthcare related HAP / VAP/ HCAP?
Hospital (Nosocomial) Acquired Pneumonia (HAP)
- PNA > 48 Hrs after Hospital Admission
Ventilator Associated Pneumonia (VAP)
- PNA > 48 - 72 Hrs after Endotracheal Tube Intubation
Healthcare Associated Pneumonia (HCAP)
- PNA in a non-hospitalized patient with extensive healthcare contact
- IV Therapy, Wound Care, IV Chemotherapy within 30 days
- Resident of Nursing Home or Long-Term Acute Care (LTAC)
- Hospitalized in Acute Care Hospital > 2 Days with prior 90 Days
- Attendance at Hospital or Hemodialysis Clinic with 30 Days
Explain how HAP / VAP/ HCAP organisms infect the patient? Describe the organisms
- Organism that colonize the oropharynx enter lower respiratory tract (LRT) by micro- or macro-aspiration
- Infections are frequently polymicrobial in origin
- Organisms tend to be Multi-drug Resistant (MDR)
- Gram negative pathogens= “SPACE”
- Serratia
- Pseudomonas*
- Acinetobacter
- Citrobacter
- Enterobacter* or Escherichia coli*
Its important to treat HCAP / VAP / HAP within 48 -72 hours and can last 7- 8 days. What medications would you use?
- Antipseudomonal Agent:
- Beta-Lactam + Beta-lactamase Inhibitor
- 4th Generation Cephalosporin
- Carbopenem
- Plus 1 of the Following:
- Anti-pseudomonal Fluoroquinolone
- Anti-Gram Negative Aminoglycoside
- Plus 1 Anti-MRSA Medication:
- Linezolid
- Vancomycin
Recognize that there are a lot of different viruses that cause respiratory infection. Influenza outbreaks vary and can change properties- what causes this variation in the IFN virus?
IFN viruses undergo periodic changes in the antigenic characteristics of their envelope glycoproteins:
- Hemagglutinin
- Neurominidase
**Major changes in these glycoproteins are referred to as antigenic shifts
**Minor changes in these glycoproteins are referred to as antigenic drifts.
Describe how the pathogenesis of how the influenza virus is initiated and spread
- 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.
