Pneumonia Flashcards by Ximenaherrera Barrones

What is the definition of pneumonia?

Pneumonia is an inflammation and consolidation of lung tissue due to an infectious agent. Consolidation is an inflammatory induration of a normally aerated lung caused by cellular exudate in the alveoli.

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What is the seasonal average of pneumonia cases?

The seasonal average (‘Promedio estacional’) of pneumonia cases fluctuates between 20,000 and 30,000 cases.

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What factors favor colonization in the development of pneumonia?

Disruption of mucociliary clearance (e.g., ciliary dysfunction)

Disruption of epithelial barrier (e.g., injury)

Altered consciousness

Intubation

Decreased immune function (e.g., immune suppression)

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What are the risk factors for developing pneumonia?

Smoking

Upper respiratory tract infections

Alcohol consumption

Corticosteroid therapy

Old age

Influenza infection

Pre-existing lung disease

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What are the stages of physiopathology in pneumonia?

Congestion: Proteinaceous exudate in alveoli

Red hepatization: Erythrocytes in exudate

Grey hepatization: Neutrophils and fibrin deposition

Resolution: Macrophages clear the infection

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What happens in an alveolus during community-acquired pneumonia (CAP)?

Pathogens arrive in the alveolar space.

Pathogens multiply uncontrollably.

Alveolar macrophages produce cytokines locally.

Neutrophils are recruited to the alveolar space, and cytokines enter systemic circulation.

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What are the anatomical classifications of pneumonia?

Bronchopneumonia: Affects lungs in patches around bronchi.

Lobar pneumonia: Involves a single lobe or section of a lung.

Interstitial pneumonia: Involves areas between the alveoli.

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What are the clinical classifications of pneumonia?

Community-acquired pneumonia (CAP)

Nosocomial (hospital-acquired) pneumonia

Ventilator-associated pneumonia

Typical pneumonia

Atypical pneumonia

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What are the typical symptoms of pneumonia?

General malaise, fever

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What is a typical physical sign of pneumonia?

Tachycardia

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What are the frequent pathogens causing pneumonia in neonates (<1 month)?

Group B streptococcus, E. coli

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What are the frequent pathogens in infants (1-3 months, febrile and afebrile)?

Febrile: RSV, influenza, parainfluenza, adenovirus, S. pneumoniae, H. influenza

Afebrile: Chlamydia trachomatis, Mycoplasma hominis, CMV

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What are the frequent pathogens in infants (3-12 months)?

RSV, influenza, parainfluenza, adenovirus, S. pneumoniae, H. influenza, C. trachomatis, M. pneumoniae, Group A streptococcus

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What are the frequent pathogens in children (2-5 years)?

Influenza, parainfluenza, adenovirus, S. pneumoniae, H. influenza, C. trachomatis, M. pneumoniae, Group A streptococcus, S. aureus

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What are the frequent pathogens in children and adolescents (5-18 years)?

M. pneumoniae, S. pneumoniae, C. pneumoniae, H. influenza, influenza viruses, adenovirus

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What are the frequent pathogens in adults (>18 years)?

M. pneumoniae, S. pneumoniae, C. pneumoniae, H. influenza, influenza viruses, adenovirus

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What pathogens are associated with alcoholism and COPD/smoking in CAP?

Alcoholism: S. pneumoniae, oral anaerobes, K. pneumoniae, Acinetobacter sp, M. tuberculosis

COPD/smoking: H. influenzae, P. aeruginosa, Legionella sp, S. pneumoniae, M. catarrhalis, C. pneumoniae

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What pathogens are associated with aspiration and lung abscess in CAP?

Aspiration: Gram-negative enteric pathogens, oral anaerobes

Lung abscess: CA-MRSA, oral anaerobes, endemic fungal pneumonia, M. tuberculosis, atypical mycobacteria

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What pathogens are associated with environmental exposures in CAP?

Bat/bird droppings: Histoplasma capsulatum

Birds: Chlamydophila psittaci (avian influenza if poultry)

Rabbits: Francisella tularensis

Farm animals/parturient cats: Coxiella burnetii (Q fever)

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What pathogens are associated with HIV infection in CAP?

Early HIV: S. pneumoniae, H. influenza, M. tuberculosis

Late HIV: Pneumocystis jirovecii, Cryptococcus, Histoplasma, Aspergillus, Mycobacterium kansasii, P. aeruginosa, H. influenza

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What pathogen is associated with a hotel or cruise ship stay in the past 2 weeks in CAP?

Legionella sp

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What pathogens are associated with specific travel or epidemiological conditions in CAP?

Southwestern US: Coccidioides sp, Hantavirus

Southeast/east Asia: Burkholderia pseudomallei, avian influenza, SARS

Influenza active: Influenza, S. pneumoniae, S. aureus, H. influenza

Cough >2 weeks with whoop: Bordetella pertussis

Bronchiectasis: P. aeruginosa, Burkholderia cepacia, S. aureus

Injection drug use: S. aureus, anaerobes, M. tuberculosis, S. pneumoniae

Endobronchial obstruction: Anaerobes, S. pneumoniae, H. influenza, S. aureus

Bioterrorism: Bacillus anthracis, Yersinia pestis, Francisella tularensis

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What are the systemic and skin symptoms of pneumonia?

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Systemic: High fever, chills

Skin: Clamminess, blueness

What are the lung and muscular symptoms of pneumonia?

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Lung: Cough with sputum/phlegm, shortness of breath, pleuritic chest pain, hemoptysis

Muscular: Fatigue, aches

What are the central, vascular, and gastric symptoms of pneumonia?

Central: Headaches, loss of appetite, mood swings Vascular: Low blood pressure, high heart rate Gastric: Nausea, vomiting

What is the joint symptom of pneumonia?

Pain

What is the treatment for community-acquired pneumonia (CAP) in healthy patients with no risk factors?

Macrolide (e.g., azithromycin).

What is the treatment for CAP in patients with comorbidities?

Fluoroquinolone (e.g., levofloxacin) or a beta-lactam (e.g., amoxicillin) plus a macrolide.

What is the treatment for inpatient non-ICU patients with CAP?

Beta-lactam (e.g., ceftriaxone) plus a macrolide or a fluoroquinolone.

What is the treatment for inpatient ICU patients with CAP and no risk for MRSA?

Beta-lactam (e.g., piperacillin-tazobactam, imipenem, or meropenem) plus a fluoroquinolone or a beta-lactam plus a macrolide.

What is the treatment for inpatient ICU patients with CAP and risk for MRSA?

Add vancomycin or linezolid to the regimen for MRSA coverage.

What are the minor criteria for severe community-acquired pneumonia (CAP)?

Respiratory rate >30/min PaO₂/FiO₂ <250 Multilobular infiltrates Confusion/disorientation BUN >20 mg/dL Leukopenia <4,000 cells/mm³ Thrombocytopenia <100,000 platelets/mm³ Hypothermia <36°C Hypotension requiring aggressive fluid resuscitation

What are the major criteria for severe community-acquired pneumonia (CAP)?

Need for invasive mechanical ventilation Septic shock with the need for vasopressors

What is the CURB-65 criteria for assessing pneumonia severity?

Confusion (new disorientation in person, place, or time) Urea >7 mmol/L Respiratory rate ≥30/min Blood pressure (systolic <90 mmHg or diastolic ≤60 mmHg) Age ≥65 years

What does a CURB-65 score of 0 indicate?

0.7% 30-day mortality, suitable for outpatient treatment.

What does a CURB-65 score of 1 or 2 indicate?

3% 30-day mortality, may require hospitalization.

What are the advantages and disadvantages of the SCOR scoring system for pneumonia severity?

Advantages: Well validated, simple Disadvantages: Underestimates severity in young patients

What are the advantages and disadvantages of the SMART-COP scoring system?

Advantages: Predicts need for ventilatory/vasopressor support Disadvantages: Complex to calculate

What are the advantages and disadvantages of the Modified ATS scoring system?

Advantages: Predicts ICU need Disadvantages: Not accurate for several hospitals

What are the advantages and disadvantages of using C-reactive protein for pneumonia severity?

Advantages: Cheap, simple, serial measurements can detect treatment failure Disadvantages: May be affected by other factors

What are the advantages and disadvantages of using procalcitonin for pneumonia severity?

Advantages: Simple, serial measurements can detect treatment failure Disadvantages: Not routinely available, expensive, may be affected by other factors

What is COVID pneumonia?

Pneumonia caused by the SARS-CoV-2 coronavirus.

What is the typical incubation period for COVID-19?

5.1 days (median), ranging from 5-10 days.

What are the hallmarks of the ARDS/pro-inflammatory phase in COVID-19?

Dyspnea, tachypnea, hypoxemia.

What are the symptoms of the acute mild phase of COVID-19?

Nonspecific symptoms including fevers, cough, myalgias, fatigue; nausea and diarrhea reported in <50% of cases.

What is the CO-RADS classification system used for?

To assess the probability of COVID-19 infection based on CT findings, with scores from 1 (very low probability) to 6 (proven).

What is the CT qualitative assessment category A for COVID-19 pneumonia?

Predominant pattern: Ground-glass opacities; Phase: Initial.

What is the CT qualitative assessment category B for COVID-19 pneumonia?

Predominant pattern: Crazy-paving; Phase: Progression of the disease.

What is the CT qualitative assessment category C for COVID-19 pneumonia?

Predominant pattern: Consolidation; Phase: Advanced disease.

What is the quantitative assessment scoring for CT findings in COVID-19 pneumonia?

1: ≤5% lung involvement 2: 5-25% lung involvement 3: 26-50% lung involvement 4: 51-75% lung involvement 5: >75% lung involvement

What is the key to diagnosing pneumonia according to the presentation?

Diagnosis is made through clinical evaluation combined with imaging.

How is the etiologic agent for pneumonia determined?

The etiologic agent is determined based on the patient’s risk factors.

When is empiric antibiotic treatment started for pneumonia?

Empiric antibiotics are started immediately upon suspicion of pneumonia.

When are culture or PCR tests needed for pneumonia?

Culture or PCR tests are not needed unless specifically indicated.

Why is clinical suspicion important in pneumonia diagnosis?

Clinical suspicion is critical because the diagnosis relies heavily on the clinical setting.

What is the overall approach to managing pneumonia as summarized in the presentation?

Suspect pneumonia based on clinical setting, confirm with imaging, determine the etiologic agent by risk factors, start empiric antibiotics, and avoid routine culture or PCR unless indicated.

Pneumonia Flashcards

(56 cards)