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Pneumonia Flashcards

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1
Q

What are the signs and symptoms of pneumonia

A

Symptoms -

  • Fever >38 degrees
  • Malaise
  • Cough (purulent - rust coloured sputum)
  • Dyspnoea
  • Pleuritic pain (may hear pleuritic rub)

Sign-

  • Dull percussion note
  • Reduced breath sounds
  • Bronchial breathing (transmission of bronchial sounds to peripheries due to consolidation)
  • Coarse crepitations
  • Increased vocal fremitus (increased transmission of ’99’ through consolidated lung)
  • Tachycardia
  • Hypotension
  • Confusion
  • Cyanosis
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2
Q

Describe 3 main respiratory defence mechanisms against infection?

A
  • Mucus layer - traps pathogens
  • Cilia - sweeps mucus and pathogens out of airway
  • Alveolar macrophages -bind and ingest pathogens and particles
  • Recruitment of additional white blood cells in times of sever infection e.g neutrophils
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3
Q

What is empyema and what are its key clinical features?

A

Collection of puss (abscess) in the lung tissue.

Features -
Failure to fully recover from antibiotic therapy

swinging fever

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4
Q

What is pneumonia?

A

inflammation of the parenchyma of the lung

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5
Q

What can cause pneumonia?

A

most common cause of pneumonia is infection and the majority of these are bacterial in nature. Viruses, fungi and parasites may also cause pneumonia.

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6
Q

Bacteria can reach the lungs in which 3 routes?

A

Inhalation
Aspiration
Haematogenous

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7
Q

Community acquired pneumonia is split into 2 categories, what are they?

A

Typical and Atypical

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8
Q

What are the common causes of typical community acquired pneumonia?

A
  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae
  • Moraxella catarrhalis
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9
Q

What are the common causes of Atypical community acquired pneumonia?

A

Non-zoonotic -

  • Mycoplasma pneumoniae,
  • Legionella pneumophila, - Chlamydophila pneumoniae

Zoonotic -

  • Chlamydophila psittaci (psittacosis)
  • Coxiella burnetii (Q fever),
  • Francisella tularensis (tularemia).
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10
Q

What is the difference between typical and atypical pneumonia?

A

Typical - presents with usual symptoms - a productive cough, fever and pleuritic chest pain

Atypical - present with a combination of pulmonary and extrapulmonary symptoms

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11
Q

What is hospital acquired pneumonia?

A

pneumonia contracted > 48 hrs after hospital admission that was not incubating at the time of admission.

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12
Q

Which bacteria are known to cause hospital acquired pneumonia?

A
  • Gram-negative bacilli (e.g. Pseudomonas aeruginosa)
  • Staphylococcus aureus
  • Legionella pneumophila
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13
Q

Which types of patients are most at risk of aspiration pneumonia?

A

Reduced conscious level

Neuromuscular disorders

Oesophageal conditions

Mechanical interventions such as endotracheal tubes.

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14
Q

Which bacteria are often associated with aspiration pneumonia?

A
  • Streptococcus pneumoniae,
  • Staphylococcus aureus,
  • Haemophilus influenzae,
  • Enterobacteriaceae, in

the hospital Gram-negative bacilli (e.g. pseudomonas aeruginosa)

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15
Q

Which test can be used to diagnose pneumococcal pneumoniae and legionella pneumophilia. What should be done is the test is positive?

A

Urinary antigen tests - then PCR

If positive - need to do a specific spot culture

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16
Q

State specific features of Streptococcus pneumoniae

A
  • Gram-positive alpha-haemolytic streptococci
  • causes a significant leucocytosis (high WBC) and a raised CRP
  • Gives rust coloured sputum
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17
Q

Which extrapulmonary symptoms are associated with atypical pneumonia?

A 
Erythema multiforme and erythema nodosum (Mycoplasma pneumonia.)
Arthralgia, myalgia, malaise
Myocarditis, pericarditis
Haemolytic anaemia
Headache

Abdominal pain, diarrhoea and vomiting (Hepatitis can be a feature of Legionella pneumonia)

Labial herpes simplex (reactivation is relatively common in pneumococcal pneumonia)

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18
Q

State specific features of Mycoplasma pneumoniae?

A
  • Rod-shaped gram negative
  • affect a younger demographic and occurs in cyclical epidemics.
  • presents with flue like symptoms (arthralgia, myalgia, dry cough and headache)

Can present with following extrapulmonary symptoms

  • can cause cold autoimmune haemolytic anaemia
  • Erythema multiforme
  • Arthralgia
  • Myocarditis, pericarditis
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19
Q

State specific features of Legionella pneumophila?

A
  • gram-negative coccobacillus
  • encountered in those exposed to contaminated cooling systems, humidifiers and showers.
  • chest symptoms may present after several days of myalgia, headache and fever.
  • 50% associated related to foreign
    travel – Especially Mediterranean
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20
Q

How is Legionella pneumophila often contracted?

A

It is encountered in those exposed to contaminated cooling systems, humidifiers and showers

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21
Q

Which extrapulmonary features is Legionella pneumophila associated with?

A

myalgia, headache

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22
Q

Which biochemical and blood test abnormalities are associated with Legionella pneumophila?

Study These Flashcards
A
  • Hyponatraemia (secondry to SIADH)
  • hypophosphataemia
  • raised serum ferritin.
  • Lymphopenia (low lymphocytes)
23
Q

Which organisms causes pneumonia in immunocompromised people?

Study These Flashcards
A

Pseudomonas aeruginosa

Pneumocystis jirovecii (aids defining illness)

Candidiasis

Cytolomegalovirus

S. aureus

Gram negative bacteria

24
Q

Which bacteria causes characteristic green sputum in pneumonia?

Study These Flashcards
A

Pseudomonas aeruginosa

25
What type of sputum is associated with Klebsiella pneumophila? Which other clinical features are associated with this type of pneumonia?
- red-currant jelly like sputum - Mainly effects upper lobes - Associated with people who have a weak immune system (alcoholics, diabetics - Gram negative anaerobic rod (baccilus) bacteria) - Symptoms include a cough, fever and flu-like features -
26
What are the pulmonary complications of pneumonia? (4)
``` Parapneumonic effusion Pneumothorax Abscess Empyema acute respiratory failure ```
27
What are the systemic extrapulmonary complications of pneumonia? (2)
Sepsis | Atrial fibrillation
28
In somone you suspect may have pneumonia, which investigation would you obtain? (bedside, blood, imaging)
``` Bedside - - Observations - sputum sampling (bronchoalveolar lavage) Urinary sampling - Urinary antigen tests - ECG (for atrial fibrillation) ``` Blood - - FBC - U and E - CRP - Blood cultures (moderate to sever case- take before antibiotics) HIV test- pneumonia is a common initial presenting illness in patients undiagnosed HIV infection Imaging - Chest X ray
29
Which x-ray findings are associated with pneumonia?
Consolidation | parapneumonic effusions, pneumothorax, abscess and empyema.
30
Which scoring system is used to assess mortality in pneumonia patients? Describe the score.
CURB-65 - Confusion - Urea >7 - Respiratory rate >30 - Blood pressure <90 systolic and <60 diastolic - Age >65 ``` 0-1 = low mortality 2 = intermediate mortality 3-5 = high mortality ``` 5 is maximum
31
How is low severity community acquired pneumonia treated?
Oral therapy with a broad spectrum beta-lactam (e.g. amoxicillin). A tetracycline or macrolide may be used in those with a penicillin allergy (doxycycline or clarithromycin). Alternative: Levofloxacin 500mg PO OD A typical antibiotic course would be 5-7 days.
32
How is intermediate severity community acquired pneumonia treated?
Most can be treated adequately with oral therapy. Dual therapy with a beta-lactam (e.g. amoxicillin) and a macrolide (e.g. clarithromycin). Doxycycline may be used as an alternative in those with a penicillin allergy. A typical antibiotic course would be 7-10 days.
33
How is high severity community acquired pneumonia treated?
IV beta-lactamase stable beta-lactam (e.g co-amoxiclav) and a macrolide (e.g. clarithromycin). Alter - Benzylpenicillin IV plus either levofloxacin or ciproflaxcin Alt - Cefuroxime IV or cefotaxime or ceftriaxone plus clarythromycine Use levofloxacin if legionella strongly suspected An antibiotic course of 7-10 days may be extended to 14 or 21 days depending on clinical circumstance.
34
How is hospital acquired pneumonia treated?
Should follow local guidelines based upon local microbial knowledge. Co-amoxiclav 625mg TDS may be used in mild infections. Tazocin (piperacillin/tazobactam) 4.5g IV TDS may be used in severe infections.
35
How are smokers with pneumonia followed up?
A CXR at 6-8 weeks post-event should be used to screen for underlying lung cancers in this age group. 11% of smokers over the age of 50 who have pneumonia have lung cancer.
36
List 7 markers for sever community acquired pneumonia
Chest X-ray – more than one lobe involved PaO2 – <8 kPa Low albumin – <35 g/L White cell count – <4 × 109/L or >20 × 109/L Blood culture – positive Other co-morbidities Absence of fever in the elderly
37
State specific features of Pseudomonas aeruginosa
- gram-negative bacillus - opportunistic - effects those who are immunosuppressed or with chronic lung disease - can effect many body systems and cause bacteraemia - cause the symptoms classically associated with pneumonia - green sputum - Treatment often involves a cephalosporin and aminoglycoside. Aerosolised antibiotics may be used in patients with cystic fibrosis.
38
State specific features of Pneumocystis jirovecii
- A fungi - Associated with aids - causes fever, cough (frequently non-productive) and exertional dyspnoea - Hypoxia and a raised LDH are also common findings. - Does not respond to antifungals and is instead treated with co-trimoxazole (trimethoprim-sulfamethoxazole).
39
COPD predisposes individuals to pneumonia from which microorganisms?
H.influenzae & M.catarrhalis
40
For target therapy to be successful the bacteria must be identified. How is this conducted for the different causes of pneumonia?
Most - Blood and sputum cultures Pneumococcal- urinary antigen if positive specific sputum culture Legionella - urinary antigen and sputum collection -Mycoplasma - PCR (sputum/throat) Chlamydophilia (PCR/complement fixation) VIRAL PCR (nose and throat swab)
41
What might cause a patient to fail to recover?
``` Incorrect diagnosis or complicating condition – Unexpected/resistant pathogen – Impaired local or systemic immunity – Local or distant complications of CAP ```
42
How often should a patients X ray be followed up? What should be done if the x ray does not improve?
Follow up s and 52 days Consider bronchoscopy and (CT)
43
Which infections can be caused by antibiotic use?
Clostridium difficile | MRSA
44
Which antibiotic types has S.pneumoniae developed resistance to?
Penicillin Resistance | Macrolides Resitance
45
When prescribing antibiotics - which dates must you always include?
Start and stop date
46
What are the indications for someone to be vaccinated against influenza?
``` Influenza- All >65 yo + 2-4 >6 months in at risk groups: - Asthma - COPD - Chronic respiratory, heart, kidney, liver or neurological disease - Immunosuppression - Pregnant ``` Health care workers
47
What are the indications for someone to be vaccinated against pneumococcus?
- All >65 - >2 year olds in at risk groups - asplenia/ splenic dysfunction - cochlear implants - CSF leaks ``` Revaccinate every 5 years - Asplenia/ splenic dysfunction - CKD otherwise only once Reduces septicaemia Poorly protective ```
48
Which class of antibiotics are atypical pathogens
B lactams
49
State specific features of C.psittaci
Acquired from birds but only 20% have bird contact
50
State specific features of C.burnetii
Younger males, dry cough & high fever
51
What are the signs and symptoms of cold autoimmune haemolytic anaemia?
``` Symptoms of anaemia - Pallor fatigue Shortness of breath Dizziness Palpitations ``` Symptoms of brisk and sever haemolysis Chest pain Lethargy Confusion Transient loss of consciousness (syncope), Deregulation of heart rate and blood pressure (hemodynamic instability) Dark pigmented urine (haemoglobin in urine) Jaundice (degraded haemoglobin forming bilirubin) Circulatory symptoms - coldness of the fingers and/or toes (digits) - Painful bluish or reddish discoloration of the skin of the digits, ankles, and wrists (acrocyanosis or Raynaud phenomenon). - Severe cases, ulcers may develop on the extremities of digits.
52
How is erythema multiform described?
Round lesions with bulls eye
53
Which bacteria can cause caviting pneumonia?
klebsiella and pseudamonas (aeruginosa)

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