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Flashcards in pneumonia Deck (34)
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1. Describe why pneumonia is a "great neglected disease of mankind."

Often misdiagnosed, mistreated and underestimated. Pneumonia kills more children than any other illness


Sx of pneumonia

Acute fever, tachypnea, cough, purulent sputum, lung consolidation. Infiltrate on CXR.


complications of pneumonia

effusion/empyema, respiratory failure, cavitation, pneumothorax. PE, and increased MI, stroke, CHF, arrythmia


For typical CAP- list organisms, signs/sx

Pneumococcus, H. flu, Moraxella catarrhalis, Staph aureus. Lobar infiltrate on CXR. Purulent sputum


For atypical CAP- list organisms, signs/sx

Mycoplasma pneumoniae, chlamydophila pneumoniae, legionella pneumophila, influenza, RSV, adenovirus


List other causes of CAP

fungal (histoplasmosis, blastomycosis, coccidiomycosis, aspergillus), anaerobes (aspiration). Non infectious: reactive (chemicals), radiation, autoimmune, infiltrative cancer, CHF


List the organisms involved in health care associated pneumonia (HCAP)

Usually atypicals, H. flu, some GNRs and staph aureus. Seen in pts on dialysis, chemo in last 30 days, hospital in 180days


List the hospital acquired pneumonia organisms

also ventilator associated. GNR (pseudomonas aeruginosa) and staph aureus are prominent.


pneumonia mortality

Non hospitalized CAP <2%. Hospitalized CAP is 6.7%, HCAP is 17.8% and HAP is 18.4%


Pneumococcal pneumonia risk groups and treatment

elderly, liver dz, immunosuppression, alcoholism, hematologic malignancy, smoking. Treatment: decreasing penicillin sensitivity


haemophilus influenza pneumonia - other conditions, antimicrobial susceptibility

Also causes febrile tracheobronchitis (cough, purulent sputum, fever but NOT pulm infiltrate on CXR). 36% are ampicillin resistant (b-lactamase)


Staph aureus pneumonia - who is affected, toxin involved, sx, therapy

Often in children, native americans, gay men, crowding (jail), HIV, homeless youth. Panton-Valentine leukocydin toxin and type IV staph cassette chromosome mec gene. Sx: can lead to necrotizing penumonia, shock, abscess, empyema, respiratory failure. Therap: IV linezolid, vancomycin. oral TMP-SMX, mino/doxycycline +/- clindamycin


Who should be suspected for M. tuberculosis pneumonia

subacute/ chronic pneumonia, immigrants, HIV-1+, lower SES


who gets chlamydia trachomatis, chlamydia psittaci and chlamydia pneumoniae pneumonia

trachomatis: infants. Psittaci: birds and adults. Pneumoniae: young adults


List the associations for the following bacteria which can cause pneumonia: Coxiella burnetti, Rickettsia rickettsii, yersinia pestis

Coxiella burnetti: farm animals and placenta. Rickettsia rickettsii: causes rocky mountain spotted fever, rash, April-June. yersinia pestis: causes the plague, rats, rodents, fleas


List the important causes of fungal pneumonia

blastomycosis (blastomyces dermatitidis), histoplasma capsulatum, coccidioides immitis, pneumocystis jirovecii (AIDS), Aspergillus


Which bacteria have the highest pneumonia mortality

legionella > s. pneumoniae, influenza A


risk factors for community acquired pneumonia

smoking > cardiovascular dz > COPD > chronic alcoholism > malignancy > diabetes


Tests for diagnosing pneumonia

CXR, O2 sat, CBC, Cr, LFT, blood culture/ gram stain. Sputum culture (no Abx yet), HIV test


List the causes of pneumonia in elderly

s. pneumonia, H. flu, influenza


list causes of pneumonia in young adult

Mycoplasma pneumoniae, chlamydophila pneumonia, strep pneumonia.


List causes of pneumonia in AIDs

s. pneumonia, p. jirovecii.


Pneumonia severity index

Based on age, co-existing ocnditions, and PE findings (mental status, respiratory rate, temp, etc) pts are given a score. If Score is 90 admit to hospital


CURB-65 scoring for pneumonia

Confusion, BUN > 19mg/dl, Resp. rate > 30/min, BP (sys 65. 1 point for each. The higher the points, the higher the mortality


outpatient CAP treatment for previously healthy pt with no Abx within 3 months

Macrolide or doxycycline


Outpatient CAP treatment with co-morbidities OR Abx within previous 3 months

Fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin). Beta lactam (amox/clav) plus macrolide


Inpatient, non-ICU CAP treatment

Fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin). Beta lactam (tertiary cephalosporin) plus macrolide


Inpatient, ICU CAP treatment

Beta lactam (cefotaxime, ceftriaxone or ampicillin-sulbactam) PLUS either azithromycin or fluoroquinolone


CAP treatment if pseudomonas is a concern

anti-pseudomonal b-lactam: piperacillin-tazobactam, cefepime, imipenem or meropenem) PLUS ciprofloxacin or levofloxacin. OR antipseudomonal plus aminoglycoside plus azithromycin


treatment of Hospital acquired pneumonia and ventilator acquired pneumonia.

Direct empiric therapy against gram negative rods (pseudomonas aeruginosa) and Staph aureus (MRSA)


treatment of MRSA pneumonia

Linezolid for IV. Oral- TMP-SMX, mino/doxycycline or clindamycin


treatment of influenza



types of pneumococcal vaccines and efficacy

1. 23-valent for adults. 60% effective for bacteremia. Not effective for pneumonia (mucosal) 2. Prevnar: 13-valent for children. Reduces bacteremia >90% and reduces bacterial pneumonia


Efficacy of influenza vaccines

Decreases illness by 60-80% in children/young adults. Decreases serious illness and death by 70% in elderly