Flashcards in Pneumonia Deck (27)
What is meant by pneumonia?
It is an infection of the lung parenchyma (gas-exchange surface)
It can be lobar, interstitial, bronchopulmonary, chronic, aspirational
What are the common causes of typical bacterial pneumonia?
What are the common causes of atypical bacterial pneumonia?
Chlamydia pneumophilia, mycoplasma pneumonia, legionella pneumophilia
What are the common bacterial causes of hospital-acquired pneumonia?
Gram negative enteric bacteria
They occur 48 hours after hospital admission
What are the general signs and symptoms of pneumonia?
Fever, sweats, chills, dyspnoea, sputum production, haemoptysis, pleuritic chest pain
What are the specific chest signs of pneumonia?
Bronchial breath sounds, crackles, wheeze, dull percussion, reduced air entry and reduced vocal resonance
What investigations are needed in pneumonia?
Bloods: FBC, LFTs, U&Es, CRP
CXR within 4 hours
Micro (blood and sputum culture)
Also consider PCR for mycoplasma, urine antigen test for strep and legionella
What can we classify the severity of pneumonia?
Confusion, MMT 8 or less
Urea greater than 7mmol/L
Resp rate greater than 30
Blood pressure, systolic less than 90 or diastolic less than 60
Greater than 65 years old
0-1 home treatment is possible - mild
2 hospital therapy - moderate
3 or more, consider ITU of 4 or more - severe
What can be done in the prevention of pneumonia?
Immunisation (flu vaccine and pneumococcal vaccine)
Chemoprophylaxis - oral penicillin or erythromycin to patients with an increased risk of LRTIs
What are the aetiological clues for a strep pneumoniae infection?
Elderly, co-morbidities, acute onset, fever, pleuritic chest pain
Rusty coloured sputum
What are the aetiological clues for a h. influenzae infection?
What are the aetiological clues for a legionella infection?
Recent travel (Spain)
Deranged LFTs, hyponatraemia
What are the aetiological clues for a mycoplasma infection?
Cold agglutin test
What are the aetiological clues for a staph a infection?
Post-viral, IV drug user
CAP after influenza
What are the aetiological clues for a chlamydia infection?
Contact with birds - Chlamydia psittaci - treat with tetracycline
Begins with a combination of pharyngitis and otitis
What are the aetiological clues for a coxiella infection?
Animal contact (sheep)
What are the aetiological clues for a Klebisella infection?
Common in alcoholics
Predisposition for the upper lobes
Red currant jelly sputum
What are the aetiological clues for a s.milleri infection?
Dental infections, aspiration
What are the natural defences of the respiratory tract against infection?
Filtering of nasopharynx: hairs and sticky mucus
Removal of foreign material: muco-ciliary escalator
Immune defences: IgA
What are the causes of a non-resolving pneumonia?
Complication: empyema, lung abscess
Host - immunocompromised
Abx - inadequate dose, poor oral absorption
Organism - resistant
Second diagnosis - PE, cancer
What are the different classifications of pleural effusion associated with community acquired pneumonia?
Uncomplicated - exudate fluid
Complicated - bacterial invasion in to the pleural space, increased no. neutrophils, decreased glucose, pleural fluid acidosis, increased LDH conc
Empyema - pre-existing pleural fluid is required
If a patient has a very high CURB score, what further investigations need to be considered?
Atypical pneumonia screen: serology and urine legionella test
What is the difference between a pneumonia and LRTI?
Pneumonia: signs and changes on CXR
LRTI: signs but no changes on CXR e.g. IE of COPD
n.b. These are different pathways for UHL Abx guidelines
What is meant by organising pneumonia?
Presence of granulation tissue in the distal air spaces
What follow up arrangements should be made for a patient with pneumonia?
Pneumococcal IgG serotypes
Haemophilus influenzae b IgG
Follow up in clinic in 6 weeks with a repeat CXR to ensure resolution
What is the treatment for the different severities of pneumonia?
Low - oral amoxicillin 500mg TDS 5/7
Moderate - oral amoxicillin and oral macrolide 7-10/7 e.g Clarithromycin 500mg BD
Severe - IV co-amoxiclav (1.2g TDS) and IV macrolide 7-10/7
Treat for 14-21/7 if staph a or legionella