Pneumonia Flashcards
Disease/Illness:
- Community acquired, bacterial, and viral
Pneumonia
Essentials of Diagnosis:
- Symptoms and signs of an acute lung infection: Fever or hypothermia, cough with or without sputum, dyspnea, chest discomfort, sweats, or rigors.
- Bronchial breath sounds or rales are frequent auscultatory findings.
- Parenchymal infiltrate on chest radiograph.
- Occurs outside of the hospital or less than 48 hours after admission in a patient who is not hospitalized or residing in a long-term care facility.
Pneumonia
General Considerations:
Development of lower respiratory tract infections occurs from:
- Aspiration of secretions containing bacteria.
- Inhalation of infected aerosols.
Pulmonary defense mechanisms usually prevents this development.
- Cough reflex
- Mucociliary clearance system
- Immune responses
Community-acquired occurs:
- When there is a defect in one or more of the normal host defense mechanisms.
- When a very large infectious inoculum or a highly virulent pathogen overwhelms the host.
Pneumonia
Pneumonia
Streptococcus pneumonia (accounts for 2/3 of acquired pneumonia) Most COMMON
Haemophilus influenza
Mycoplasma pneumonia
Chlamydia pneumonia
Staphylococcus aureus
Neisseria meningitides
Moraxella catarrhalis
Klebsiella pneumonia
Other gram-negative rods
Legionella species
Pseudomonas aeruginosa
Bacteria are more commonly identified than viruses.
Pneumonia
Influenza virus
Respiratory syncytial virus
Adenovirus
Parainfluenza virus
Common viral causes of community acquired disease include:
Physical Findings:
- Acute or subacute onset of fever.
- Cough with or without sputum production.
- Dyspnea
- Fever or hypothermia
- Tachypnea
- Tachycardia
- Mild arterial oxygen desaturation.
- Many patients will often appear acutely ill.
- Chest examination is often remarkable for altered breath sounds and rales, crackles
- Dullness to percussion may be present if a par pneumonic pleural effusion is present.
Other common symptoms:
Rigors
Sweats
Chills
Chest discomfort
Pleurisy
Hemoptysis
Fatigue
Myalgias
Anorexia
Abdominal pain
Most patients with community acquired: Pneumonia
Patients with ________ infection usually present with:
- Constitutional symptoms such as fever, weight loss, and malaise.
- Cough with expectoration of foul- smelling purulent sputum suggests anaerobic infection.
- Absence of productive cough does not rule out such an infection
- Dentition is often poor.
- Patients are rarely edentulous; if so, an obstructing bronchial lesion is usually present.
- Hypo
Anaerobic pleuropulmonary: Pneumonia
Essentials of Diagnosis:
- History of/or predisposition to aspiration.
- Indolent symptoms, including fever, weight loss, malaise.
- Poor dentition.
- Foul-smelling purulent sputum (in many patients).
Aspiration Pneumonia and Lung Abscess
General considerations:
Aspiration of small amounts of oropharyngeal secretions occurs during sleep in normal individuals but rarely causes disease.
Sequelae of aspiration of larger amounts of material include:
* Nocturnal asthma
* Chemical pneumonitis
* Mechanical obstruction of airways by particulate matter.
* Bronchiectasis
* Pleuropulmonary infection
Aspiration Pneumonia and Lung Abscess
Individuals predisposed to disease induced by aspiration include:
- Those with depressed levels of consciousness.
- Drug or alcohol use
- Seizures
- General anesthesia
- Central nervous system diseases
- Those with impaired deglutition due to esophageal disease or neurologic disorders
- Those with tracheal or nasogastric tubes, which disrupt the mechanical defenses of the airways.
- History periodontal disease and poor dental hygiene
- Increased number of anaerobic bacteria in aspirated material.
Aspiration Pneumonia and Lung Abscess
Aspiration Pneumonia and Lung Abscess:
- The onset of symptoms is insidious. By the time the patient seeks medical attention, necrotizing pneumonia, lung abscess, or empyema may be apparent.
- Most aspiration patients with necrotizing pneumonia, lung abscess, and empyema are found to be infected with multiple species of anaerobic bacteria.
Aspiration of infected oropharyngeal contents initially leads to pneumonia in dependent lung zones:
Aspiration Pneumonia and Lung Abscess:
- Prevotella melaninogenica
- Peptostreptococcus
- Fusobacterium nucleatum
- Bactericides species
*Most of the remainder are infected with both anaerobic and aerobic bacteria. Commonly isolated anaerobic bacteria:
Radiographic findings:
- Range from patchy airspace infiltrates to lobar consolidation with air bronchograms to diffuse alveolar or interstitial infiltrates.
- Additional findings can include pleural effusions and cavitation.
- No pattern of radiographic abnormalities is pathognomonic of a specific cause of pneumonia.
- Progression of pulmonary infiltrates during antibiotic therapy or lack of radiographic improvement over time are poor prognostic signs.
-
Clearing of pulmonary infiltrates in patients with community- acquired pneumonia can take 6 weeks or longer.
Usually fastest in young patients, nonsmokers, and those with only single lung involvement
Pneumonia
Treatment:
- Antipyretics, cough suppressants as needed.
- Maintain hydration and oral intake.
- Empiric antibiotic options for patients with community-acquired:
Macrolides
* Clarithromycin
* Azithromycin: 500mg, 250 next 4 days
Teracycline
* Doxycycline
Fluoroquinolones
* Levofloxacin
* Moxifloxacin
Alternatives include:
* Erythromycin
* Amoxicillin-potassium clavulanate
* Cefuroxime
* Cefpodoxime
* Cefprozil
Treat symptomatic
Pneumonia
Disposition:
Uncomplicated can usually be treated on an outpatient basis with antibiotics and supportive care.
When to Admit:
* Failure of outpatient therapy, including inability to maintain oral intake and medications.
* Exacerbations of underlying disease that would benefit from hospitalization.
* Complications of pneumonia arise (such as hypoxemia, pleural effusion, sepsis, and encephalopathy).
* Other medical or psychosocial needs:
Cognitive dysfunction
Psychiatric disease
Homelessness
Drug abuse
Lack of outpatient resources
Poor overall functional status
Pneumonia
