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Flashcards in Pneumonia Deck (75):
1

what is the leading cause of death in children < 5 yo?

pneumonia

2

What are the risk factors for pneumonia?

1. Smoking
2. Premature birth
3. Chronic medical conditions
A. DM
B. Heart disease
C. COPD

3

define Community Acquired Pneumonia

Pneumonia in patients with limited or no contact with medical/institutional setting

4

Define Atypical pneumonia

Pneumonia caused by certain “atypical” bacteria, including Mycoplasma, Chlamydia and Legionella

5

Define nosocomial pneumonia

Acquired after at least 48 hours of admission to hospital and is not incubating at the time of admission

6

Define HIV-related Pneumonia

Pneumonia in HIV patient

7

What are common bacterial pathogens for pneumonia?

1. Streptococcus pneumoniae

2. Hemophilus influenzae
3. Moraxella catarrhalis
4. Klebsiella pneumoniae

8

which pneumonia pathogen is Most common and
Most commonly fatal?

Streptococcus pneumoniae

9

What are the common viral pneumonia pathogens?

1. Influenza
A.Most common in adults
2. Adenovirus
A. Mild and self-limiting
3. Parainfluenza virus
A.Children < 2 years
4. Respiratory Synctial Virus (RSV)
A. Most common in infants < 1 yr

10

What are the symptoms of pneumonia?

1. Fever, rigors
2. Cough
4. Dyspnea
5. Pleuritic chest pain due to inflammed parenchyma or visceral pleura on inspiration
6. Hemoptysis
7. Fatigue
8. Myalgias

11

What are the signs of pneumonia?

1. Appears ill
2. Tachycardia
3. Tachypnea

12

What are the physical findings of pneumonia?

1. Inspiratory Rales
2. Dullness to percussion
3. Bronchial breath sounds
4. ↑ Tactile Fremitus
5. Egophony

13

What are the typical sxs of Mycoplasma pneumoniae pneumonia?

HA, malaise, low grade fever, dry cough, cold agglutinins titer

"walking pneumonia"

14

Who contracts Pneumocystis jirovecii
pneumonia?

Immunocompromised patients (HIV)

15

What are the typical sxs of Legionella pneumophila
pneumonia?

Pneumonia, pleurisy, HIGH fevers (temp > 102 F)

16

What are the typical sxs of Chlamydia pneumoniae
pneumonia?

Pneumonia, ST, hoarseness

17

What are the typical sxs of Streptococcus pneumoniae

pneumonia?

Rigors, rust colored sputum

18

What are the typical sxs of Klebsiella pneumoniae
pneumonia?

Pneumonia, current jelly sputum, alcoholics

19

What is the most common pneumonia pathogen for alcoholics?

Klebsiella pneumoniae

20

What is the most common pneumonia pathogen for COPD pts?

Hemophilus influenzae

21

What is the most common pneumonia pathogen for cystic fibrosis pts?

Pseudomonas species

22

What is the most common pneumonia pathogen for college students and young adults?

Mycoplasma pneumoniae (most common), Chlamydia pneumonia

23

What is the most common pneumonia pathogen for immunocompromised pts and smokers?

Legionella pneumophila

24

What is the most common pneumonia pathogen for post splenectomy pts?

Strep pneumoniae (Most common), Hemophilus influenzae

25

What are the Dx studies for pneumonia?

1. PA & Lateral CXR
2. Pulse Oximetry
3. ABG’s if needed
4. Sputum gram stain & culture
5. Blood cultures x 2
6. CBC w/diff

26

What can Streptococus pneumoniae cause?

Most common cause of CAP, bacterial meningitis, bacteremia, & OM
Cause of sinusitis, septic arthritis, osteomyelitis, peritonitis, & endocarditis
Causes bacterial co-infection in influenza pt
High morbidity & mortality

27

What is the epidemiology of pneumonia?

1. High-risk age groups
A. Children < 5 yrs, ↑ ≤ 2 yrs
B. Adults > 55-65 yrs
2. Immunocompromised
A. HIV, malignancy, DM
3. Decreased pulmonary clearance functions
A. Asthma, chronic bronchitis, COPD
4. Presents late fall to early spring

28

What is the treatment schedule for pneumonia?

1. Empiric based on epidemiologic data & PE
2. Antibiotics should be started promptly after obtaining appropriate cultures
3. Treat x 2 weeks

29

What are the outpt options for treating pneumonia?

1. Macrolide (drug of choice in most ppl)
A. Erythromycin, azithromycin(Zithromax), clarithromycin (Biaxin)
OR
2. Doxycycline

30

What pneumonia pathogens do macrolides treat?

1. Atypicals
A. Mycoplasma, Legionella, Chlamydia
2. Hemophilus influenzae
3. Strep pneumoniae

31

What pneumonia pathogens does doxycycline treat?

1. Chlamydia pneumoniae
2. Strep pneumoniae
3. Gram (-)
Hemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bordetella pertussis, Moraxella catarrhalis

32

What are pneumonia pts under 5 treated with?

amoxicillin (90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses

33

What are pneumonia pts over 5 treated with?

amoxicillin + macrolide

34

What treatment is indicated if children are incompletely immunized against pneumonia?

3rd gen. cephalosporin IV (ceftriaxone or cefotaxime)

35

When is vancomycin indicated in young pneumonia pts?

Vancomycin should be added for any concerns of infection caused by S aureus in childhood patients

36

What treatment is indicated in pneumonia pts with comorbidities or antibiotics within 3 months?

1. Beta-Lactam Abx
A. Amoxicillin, Augmentin, 2nd - 3rd Gen. Cephalosporin (2nd cefuroxime/Ceftin; 3rd cefdinir/Omnicef, ceftriaxone/Rocephin)
+
Macrolide

OR
Fluoroquinolone
A. Levoquin, Avalox

37

What pneumonia pathogen do fluoroquinolones target?

Strep pneumoniae

38

What pneumonia pathogen does beta-lactam abx target?

H. influenza

39

What additional treatments are possible for pneumonia pts?

1. Analgesic/antipyretic
2. Fluids
3. Expectorant
4. Prednisone
5. Bronchodilator
A. Beta 2 agonists via nebulizer or MDI

40

What is the inpt treatment for pneumonia pts on the medical floor?

1. 3rd gen Cephalosporin (ceftriaxone/Rocephin)
+
2. Macrolide (azithromycin/Zithromax or clarithromycin/Biaxin)

41

What is the inpt treatment for pneumonia pts in the ICU?

1. 3rd gen Cephalosporin (ceftriaxone/Rocephin)
+
2. Macrolide or Fluoroquinolone (levofloxacin/Levaquin or moxifloxacin/Avelox)

42

What are the CDC immunization recommendations for pneumonia pts over 65?

All adults ≥ 65 years receive both (min. 8 weeks apart)
A. PCV13 (13-valent pneumococcal conjugate vaccine) Prevnar 13
and
B. PPSV23 (23-valent pneumococcal polysaccharide vaccine) Pneumovax 23

43

What are pneumonia prevention tactics?

1. Smoking cessation
2. Immunizations
A. Influenza vaccination
B. Prevnar 13 + Pneumovax 23
-Immunocompromised adults ≥ 19 yr
-Asplenia, renal failure, nephrotic syndrome, cochlear implants, lung dz, CVD, DM, etc.

C. Infants
-HIB (2,4,6,12-15 mo)
-Prevnar (2,4,6,12-15 mo)
-DTaP (2,4,6, 15-18 mo, 4-5 yr)

44

What agents cause atypical pneumonia?

1. Mycoplasma pneumonia
2. Legionella pneumophila
3. Chlamydia (Chlamydophila) pneumonia

45

What is the most common cause of atypical pneumonia?

Mycoplasma pneumonia

46

What are the characteristics of typical bacteria?

Typical bacteria have cell wall, cell membrane and ability to stain

47

What are some characteristics of atypical pneumonia?

Some lack cell wall (Mycoplasma)
Some lack ability to stain with gram stain

48

What symptoms are asst. with Mycoplasma pneumoniae
pneumonia?

Non productive cough, low grade fever, HA, malaise, slow progression

49

What symptoms are asst. with Legionella pneumophila
pneumonia?

1. High fevers( >102.2), watery diarrhea, dry cough, multilobar, M>F
2. Often asst with contaminated water supply

50

What symptoms are asst. with Chlamydia (Chlamydophila) pneumoniae

pneumonia?

1. 80% are asymptomatic
2. URI sx’s, “flu-like illness”

51

What are the physical findings in atypical pneumonia?

1. Fever
2. Dullness to percussion
3. Egophony
4. Tachycardia
5. Tachypnea

52

What are the CBC w/ diff results for atypical pneumonia?

1. Normal WBC to mild leukocytosis
2. Exception: leukopenia with influenza pneumonia

53

What are the CXR results for atypical pneumonia?

Infiltrate

54

What are the less common dx studies for pneumonia?

1. Urine Antigen Assay
A. Legionella pneumophila
2. Polymerase Chain Reaction (PCR)
A. Legionella pneumophila
B. Mycoplasma pneumoniae
-PCR highly sensitive & specific
C. Chlamydia pneumoniae

55

What drug is used to treat mycoplasma and legionella in atypical penumonia?

Macrolide

56

What drug is used to treat Chlamydia in atypical pneumonia?

Doxycycline

57

What drug is used to treat severe cases or comorbidities in atypical pneumonia?

Fluoroquinolone

58

How long must a pt be in the hospital for pneumonia to be considered nosocomial?

Occurs > 48 hours after hospitalization or admission to health care facility AND excludes any infection at time of admission

59

Who is at high risk for nosocomial pneumonia?

ICU pt
Ventilator pt

60

what are the mortality rates for nosocomial pneumonia?

Mortality rates 20% - 50%

61

What pt factors can increase risk for nosocomial pneumonia?

1. Malnutrition
2. Advanced age
3. Altered level of consciousness
4. Swallowing disorders
5. Chronic lung disease

62

What pathogen is asst. with ground glass opacities in pneumonia?

Mycoplasma

63

What is the most common pathogen in nosocomial pneumonia? What other pathogens?

1. Pseudomonas aeruginosa
A. MOST common in ICU HAP
2. Staph aureus (MSSA and MRSA)
3. Strep pneumonia (often drug-resistant)
4. Enterobacter
5. Klebsiella pneumoniae
6. E. coli

64

What are the sxs for nosocomial pnuemonia?

Fever
Cough
Purulent sputum
Leukocytosis

65

How are the bacteria colonized in nosocomial pneumonia?

Instrumentation in upper airway leads to bacterial colonization:

66

What are the dx studies in nosocomial pneumonia?

1. Sputum C&S
2. Blood C&S
3. ABG’s
A. Helps determine severity of illness
B. Determines need for supplemental oxygen
4. CXR
A. Progression of infiltrates during abx treatment is poor prognostic sign

67

What is the treatment timeline for nosocomial pneumonia?

Abx should be started ASAP due to high mortality rate
Abx selection determined by:
Severity of illness
Risk factors
Length of hospitalization

68

What pathogens are targeted in nosocomial pneumonia if pt has been there for more than 5 days?

Pseudomonas aeruginosa
Enterobacter sp.

69

What treatment is used for pathogens that are a low risk for multi-drug resistant (MDR) ? Where is this?

1. Nursing Home
A. Fluoroquinolone po
OR
B. Amoxicillin clavulanate po + macrolide po

2. Hospital
A. Fluoroquinolone IV
OR
B. Macrolide po + 3rd gen cephalosporin IV

70

What treatment is used for pathogens that are a high risk for multi-drug resistant (MDR) ? What is high risk?

1. Age > 60 years
2. Hospitalization in the previous year
3. Previous abx therapy
A. Imipenem IV (antipseudomonal coverage)
+
B. Levofloxacin IV (add’l antipseudomonal agent)
+
C. Vancomycin IV (MRSA coverage)

71

When is vancomycin used in pneumonia?

When MRSA is suspected

72

What pathogen is asst. with HIV related pneumonia?

Pneumocystis jirovecii
Formerly called Pneumocystis carinii (PCP)
Yeast-like fungal infection of lungs
MOST common opportunistic infection in patients with HIV/AIDS
Can also occur in cancer patients, organ transplant pts, pts w/ chronic lung disease
High mortality rate if untreated
Other organisms include bacteria, other fungi, Mycobacterium and Legionella

73

What is the clinical presentation for HIV related pneumonia?

Fever
Dry Cough
Dyspnea
DOE
Fatigue

74

What are the dx results in hiv related pneumonia?

1. CXR
A. Perihilar infiltrates
B. Diffuse granular opacities
2. CD4 counts are low
A. All HIV-infected pts w/ CD4 < 350 cells/μl get TMP-SMX prophylaxis
3. Induced sputum or bronchoalveolar lavage
4. PCR (Polymerase Chain Reaction)

75

What is the treatment of choice for hiv related pneumonia?

1. Antibiotic of choice
A. Trimethoprim/sulfamethazole (TMP-SMX) x
3 weeks minimum
2. Untreated- fatal disease