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2B week 1 - lung infection > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

what is pneumonia

A

inflammation of the lungs, usually caused by infection (invasion and overgrowth of pathogens in lung parenchyma resulting in intra-alveolar exudates and alveolar inflammation

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2
Q

what is pneumonitis

A

inflammation of the lungs, usually caused by chemical damage

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3
Q

pneumonia brief pathophysiology

A

infection of the lungs -> inflammatory response initiated -> alveolar oedema + exudate formation -> alveoli and respiratory bronchioles fill with serous exudate, blood cells, fibrin, bacteria etc. -> consolidation of lung tissue

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4
Q

what is a consolidation

A

fluid filling of lobular areas

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5
Q

what are the 3 types of pneumonia (classificaiton)

A

community acquired (CAP); hopsital acquired (HAP); immunocompromised

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6
Q

who does CAP affect

A

all ages; people who have recently been travelling; people with occupational exposure

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7
Q

typical CAP causing organisms

A

streptococcus pneumoniae
haemophilus influenza
Moraxella catarrhalis

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8
Q

when is pneumonia considered to be HAP

A

if occurs 3 days or more post admission

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9
Q

3 ways in which HAP can be acquired

A

from a ventilator; aspiration pneumonia (e.g. stroke pts.); environmental source

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10
Q

what organisms cause HAP

A
  • pseudo. aeruginosa
  • Acinetobacter. Species
    depends on method of acquisition
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11
Q

examples of immunocompromised pts

A

HIV; transplant; cancer; primary immunodeficiency

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12
Q

what age groups does CAP affect the most

A

<5 and >65

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13
Q

what are the 3 different patterns on pneumonia (and what happens)

A

bronchopneumonia → filling with fluid and caused by inhalation (diffuse)
lobular pneumonia → entire lobule is filled with fluid (consolidation)
interstitial pneumonia → diseased intersitium without parenchymal disease (virus can survive due to mucus area)

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14
Q

how differentiate between bacterial and viral pneumonia (clinically)

A

bacterial - sudden onset, rapid progression, productive cough;
viral - slow onset, wheezing

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15
Q

what do the sputum colours indicate (which pathogens-which colours, 4)

A

rust coloured - S.pneumoniae;
green - Pseudomonas aeruginosa;
redcurrent jelly - Klebsiella;
bad smelling/tasting - anerobes

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16
Q

what does viral hijacking allow for?

A

bacteria to more easily enter the cells

17
Q

what type of immunocompromised pts are particularly vulnerable to CAP

A

people with aspleenia (capsule is particularly infective);

18
Q

what is empyema

A

pockets of pus that have collected inside a body cavity

19
Q

how do coronaviruses attach to cells

A

viral protein envelope binds to glycoprotein receptors on cells

20
Q

what is CURB 65

A

scoring system to assess whether a patient should be admitted to hospital (admit if over 2)
C - confusion
U - urea >7mmol/L
R -respiratory rate >25
B - BP <90/60mmHg
65 - over 65 yrs old

21
Q

investigations for pneumonia (8)

A

-CRP/ESR
- CXR
- FBC, U&E, LFT
Microbe investigation
- Serology
- Sputum culture and gram stain
- Bronchoalveolar lavage
- PCR
- Urinary antigens (legionella and pneumococcus)

22
Q

management for CAP

A

Depends on microbe! Generally immediate antibiotics are empirical and macrolide
Mild: Amoxicillin or doxycycline
Moderate: Amoxicillin + Doxycycline
Severe: Benzylpenicillin + clarithromycin
Very severe: clarithromycin + co-amoxiclav (or vancomyocin if allergy)
antiviral can be given if viral suspected (oseltamivir but only if started within 3-5 days)

23
Q

management for HAP

A

empircal and macrolide antibiotics
Mild: Doxycycline
Severe: Co- amoxiclav or Vancomycin + ciprofloxacin

24
Q

preventative measures for CAP (2)

A

smoking cessation; vaccines

25
Q

risk factors for HAP

A

antibiotics; surgery; chronic lung disease; advanced age; immunosuppression; tracheal intubation; mechanical ventilation

26
Q

examples of ventilator associated HAP organisms

A

P.aeruginosa; S.aureus (MRSA); E.coli; acinetobacter; haemophilus spp.

27
Q

examples of aspiration pneumonia organisms

A

haemophilus spp.; Strep. pneumoniae; anerobes; mouth related streptococci

28
Q

apsiration pneumonitis v aspiration pneumonia

A

Aspiration pneumonitis (Mendelson’s syndrome) - chemical injury caused by the inhalation of sterile gastric contents;
Aspiration pneumonia - infectious process caused by the inhalation of oropharyngeal secretions that are colonized by pathogenic bacteria (starts as pneumonitis and progresses to pneumonia)

29
Q

what can a low CD4+ count leads to during infection

A

reactivation of virus (HIV); reactivation of dormant bacteria (TB); susceptible to intracellular bacteria; susceptible to fungi

30
Q

what can poor phagocyte function lead to

A

susceptibility to pneumococcus

31
Q

what causes Pneumocystis pneumonia (PCP)

A

the fungus Pneumocystis jirovecii

32
Q

PCP CXR/CT findings

A

ground glass shadows (predominantly in perihilar or mid zones, though if on inhaled medications then may be in upper zones as these are the least ventilated); subpleural blebs; fine reticular interstitial changes

33
Q

PCP managment

A

trimethoprin; sulfamethoxazole

34
Q

what causes CMV pneumonitis

A

Human cytomegalovirus - opportunisitc pathogen so usually only affects those who are immunocomprimised

35
Q

CMV pneumonitis treatment

A

Ganciclovir

36
Q

what can cause neutropenia

A

chemotherapy; leukemia; bone marrow transplant; steroids

37
Q

why might sputum samples not be reilable

A

poor quality - contaminated with other things e.g saliva, squamous cells

38
Q

what staining is needed for mycobacteria

A

Ziehl-neelson stain (acid fast)

39
Q

aspiration pneumonia treatment

A

amoxicillin + metronidazole (+gentamicin if severe)

2B week 1 - lung infection (6 decks)

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