Flashcards in Pneumonia Deck (64):
What is the definition of pneumonia (PNA)?
- infection of the pulmonary parenchyma
What are the types of PNA?
- community acquired (CAP)
- nosocomial/hospital acquired (HAP), healthcare associated (HCAP), ventilator associated (VAP)
- anaerobic PNA and lung abscess
- HIV related
What is the pathophysiology of PNA?
- increased microbial pathogens at alveolar level
- host's inability to fight off said pathogens
How can microorganisms gain access to the lungs in PNA?
- MC: aspiration from oropharynx
- inhaled as contaminated droplets
- hematogenous spread
- extension from infected pleural or mediastinal space
What is the physiologic result of PNA?
- alveolar capillary leak results in an infiltrate and rales
- alveolar filling results in hypoxemia
- leakage of erythrocytes can lead to hemoptysis
What are the etiologies of CAP-typical?
- *MC: S. pneumonia*
- H. influenza
- S. aureus
- Klebsiella pneumonia
- P. aringinosa
What is CAP-atypical resistant to?
- beta-lactams (PCN, amoxicillin)
How does CAP-atypical present?
- zero to moderate sputum production
- no lobar consolidations
- only small increases in WBC
- few physical signs; patient looks better than symptoms/CXR suggest
What type of PNA is restricted to small areas rather than a whole lobe?
What are the etiologies of CAP-atypical?
- *MC: Mycoplasma pneumonia*
- Chlamydia pneumonia
- Legionella spp
- virus: flu, adenovirus, RSV
What is the patient population likly to be infected by the MC etiology of CAP-atypical?
What is the patient population likely to be infected by C. pneumonia?
What is the patient population likely to be infected by Legionella spp?
What infection is associated with exposure to contaminated water droplets from cooling and ventilation systems?
- CAP-atypical Legionella
What are CAP-typical S&S?
- acute or subacute onset of cough w/ or w/o production
- fever, chills, sweats
- chest pain
- GI complaints
- kids present with belly pain
What are CAP-atypical S&S?
- low grade fever
- relatively mild pulm symptoms
- myalgias & fatigue
T/F: CAP S&S in elderly patients are often discrete/obvious.
- False, subtle/vague
What are the common PE findings of CAP?
- increased tactile fremitus
- altered breath sounds
- dullness to percussion
What testing would an outpatient CAP patient get?
What testing would an inpatient CAP patient get?
- POC diagnostic tests
- blood cultures
- HIV testing
T/F: Treatment for CAP must with held until blood cultures return.
What can be found on CXR for CAP patients?
- patchy airspace infiltrates
- lobar consolidation
- diffuse alveolar or interstitial infiltrates
- pleural effusion
When is a CT scan indicated for CAP patients?
- in severe, unresolving cases of PNA or complicated cases
What is the treatment for outpatient CAP?
- healthy w/o abx in last 3 mo: macrolide
- comorbidities or abx w/in 3 mo: fluoroquinolones OR b-lactam + macrolide
How can CAP be prevented?
- flu and pneumo vaccine
What is the outpatient f/u in CAP?
- 2-3d w/o improvement or sooner if sx worsen
- fever resolves in 2-4d
When is a repeat CXR taken for CAP?
What is the inpatient f/u in CAP?
- repeat CXR in 4-6w
What should be ? if relapse or recurrence of CAP, particularly in same segment of lung?
- underlying neoplasm
- sx after hospitalization for 48 hours
- PNA that has developed more than 48 hours following endotracheal intubation and mechanical ventilation
What are the common etiologies of HCAP/HAP/VAP?
- S. pneumo
- S. aureus
- P. aeruginosa: MC in ICU
- E. coli
What are the S&S of HCAP/HAP?
- similar to CAP but may be nonspecific
- 2+ clinical findings in the setting of a new or progressiv pulm opacity on CXR
What test should be done for HCAP/HAP/VAP?
- gram stain & sputum culture
- blood cultures from 2 sites
- ABG/pulse ox
What is the tx of HCAP/HAP/VAP?
- start empirical and modify with culture results
What is the cause of anaerobic PNA & lung abscess?
- aspiration into dependent lung zones
What is a dependent lung zone?
- based on body position at time of aspiration
Describe the onset of anaerobic PNA & lung abscess?
What is the clinical presentation of anaerobic PNA & lung abscess?
- wt loss
- cough w/ FOUL-SMELLING PURULENT SPUTUM
- poor dentition
What diagnostic tests should be done for anaerobic PNA & lung abscess?
- sputum culture
What is the treatment for anaerobic PNA & lung abscess?
_______ disease is one of the most frequent complications of _______.
What are the 3 MC AIDS defining illnesses?
- recurrent bacterial pneumonia
- Pneumocystis jiroveci
How does HIV related pneumonia present?
- nonspecific symptoms
- fever, cough, SOB
- unexplained wt loss
What diagnostics should be done in HIV related PNA?
- sputum samples
- CT scan
What will be seen on CXR in HIV related PNA?
- ground glass appearance
What is the tx for HIV related PNA?
- Bactrim (TMP/SMX)
- steroids when hypoxic
How long should tx be for HIV related PNA?
What should follow HIV related PNA initial tx?
- prophylaxis with Bactrim or dapsone in all pts with CD4<200 or hx of PCP
What causes Tuberculosis?
- Mycobacterium tuberculosis
How is TB transmitted?
- airborne droplets
What are the risk factors for TB?
- HIV +
- foreign born
- disadvantaged populations
What are the stages of TB?
- primary progressive
Define primary TB
- clinically & radiographically silent
- granulomas form around organism to limit multiplication
How does TB present?
- slow, progressive, constitutional symptoms
- chronic cough
- patient appears ill & malnourished
What testing should be done for TB?
What will be seen on CXR of primary TB?
- small, homogeneous infiltrates
- paratracheal LN enlargement
- Ghon & Ranke complexes
What is a Ghon complex?
- calcified primary focus
Whar is a Ranke complex?
- calcified primary focus & hilar LN
What is used to determine if someone has even been infected with TB?
- PPD/Mantoux test
What must be seen on a + TB test?
- transverse induration
What are the 4 major drugs used as 1st line tx for TB?
What is the tx regimen in HIV (-) TB(+)?
- 2mo of all 4 drugs
-4 mo of isoniazid & rifampin