What is pneumonia?
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
True or False: Lower airways of the lungs usually remain organism-free due to pulmonary host defense mechanisms
What is the most common way that material and microbes enter the lower respiratory tract?
What are the 6 mechanisms of infections pneumonia?
- Inhalation of infections particles
- Inhalation of oropharyngeal or gastric contents
- Hematogenous spread (blood stream infection e.g. endocarditis)
- Infections from adjacent or contiguous structures
- Direct inoculation
What are the bugs in "typical" pneumonia? (7)
Group A Streptococci
Aerobic Gram-negative Bacteria
What are the bugs in atypical pneumonia? (4)
What are some clinical history factors that can change a person's immune response and their ability to manage infections?
HIV, immunosuppression, alcohol/drug abuse.
These change your differntial for which bacteria may be involved
Why is age important when assessing for pneumonia?
Elderly patients have less of a classic presentation and findings may be subtle. They also go from relatively healthy to critically ill much faster
How can mineral oil usage be a concern for pneumonia?
Patients that use a lot of mineral oil or vasaline can inhale particles and develop pneumonia.
How is occupational history/allergic history important when looking for pneumonia?
It is important to consider these things to decide what else is on your differential. These are important to think about particularly if you're treating someone for pneumonia and they aren't getting better.
What underlying cardiopulmonary diseases are important to keep in mind when assessing for pneumonia?
COPD and congenital or acquired pulmonary diseases.
Chronic infections (e.g. patients with CF), can develop bronchiectasis which can change the kind of microbes that can end up in the lower lung tract. This will change how you treat the infection
What are co-morbidities for pneumonia? (4)
- Aspiration risk (alcohol, oral hygiene, dysphagia, GETA)
- IV Drug use
- Pregnancy (later trimesters, women have decreased esophageal junction tone and are more likely to aspirate)
- Diseases associated with immunosuppression
What drug clinical history should you watch out for when assessing a patient for pneumonia?
- Allergy drugs
- IV drug abuse
- Drug induced lung diseases
- immunosuppressive agents
When assessing for pneumonia, it is important to think about healthcare risk factors. What are these? (3)
- Nursing Home
- Recent Hospital discharge
community acquired vs healthcare associated will help you determine treatment
What are systemic symptoms of pneumonia?
High fever and chills
What are skin symptoms of pneumonia?
Clamminess and blueness
What are lung symptoms of infections pneumonia? (4)
Cough with sputum or phlegm
Shortness of breath
Pleuritic chest pain
What are musculoskeletal symptoms of infectious pneumonia?
Fatigue and aches, joint pain
What are gastric symptoms of infections pneumonia?
Nausea and vomiting
What are central symptoms of infectious pneumonia?
Headaches, loss of appetite, mood swings
What are the cardiovascular symptoms for infectious pneumonia?
Low blood pressure and high heart rate
How might elderly patients present with pneumonia?
What kind of physical examination findings do you find with pneumonia?
Fever (80%, may be absent in elderly)
Evidence of consolidation (bronchial breath sounds, egophany, dullness to percussion)
How does pneumonia show on CBC?
Leukocytosis (increased WBC)
or if a patient is very sick Leukopenia (decreased WBC) - poor prognosis
What do you look for in a basic chemistry panel for pneumonia?
You want to check renal function and electrolytes to get a sense of if the problem is just in the lungs or if there is systemic involvement.
How are blood and sputum cultures used for assessing for pneumonia?
While blood and sputum cultures test positive infrequently (in less than 20% of patient for blood and 10% for sputum), it can help in treating healthcare related pneumonia and identifying resistant strains.
How is respiratory PCR used in diagnosing pneumonia?
This is a newer development that is helping to identify the infectious organism. Before, these results took days but new technologies are reducing the time to hours so we can use this to help in treatment.
Urine tests can be used to identify which two pneumonia organisms?
S. pneumonia and legionella
True or False: Radiographic features alone can differentiate etiology of pneumonia
What is better for imaging pneumonia--CXR or CT?
CXR is a good starting point but CT can see more.