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Flashcards in pneumonia Deck (34):
1

1. Describe why pneumonia is a "great neglected disease of mankind."

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

2

Sx of pneumonia

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

3

complications of pneumonia

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

4

For typical CAP- list organisms, signs/sx

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

5

For atypical CAP- list organisms, signs/sx

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

6

List other causes of CAP

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

7

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

8

List the hospital acquired pneumonia organisms

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

9

pneumonia mortality

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

10

Pneumococcal pneumonia risk groups and treatment

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

11

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)

12

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

13

Who should be suspected for M. tuberculosis pneumonia

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

14

who gets chlamydia trachomatis, chlamydia psittaci and chlamydia pneumoniae pneumonia

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

15

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

16

List the important causes of fungal pneumonia

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

17

Which bacteria have the highest pneumonia mortality

legionella > s. pneumoniae, influenza A

18

risk factors for community acquired pneumonia

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

19

Tests for diagnosing pneumonia

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

20

List the causes of pneumonia in elderly

s. pneumonia, H. flu, influenza

21

list causes of pneumonia in young adult

Mycoplasma pneumoniae, chlamydophila pneumonia, strep pneumonia.

22

List causes of pneumonia in AIDs

s. pneumonia, p. jirovecii.

23

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

24

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

25

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

Macrolide or doxycycline

26

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

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

27

Inpatient, non-ICU CAP treatment

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

28

Inpatient, ICU CAP treatment

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

29

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

30

treatment of Hospital acquired pneumonia and ventilator acquired pneumonia.

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

31

treatment of MRSA pneumonia

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

32

treatment of influenza

oseltamavir

33

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

34

Efficacy of influenza vaccines

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