Pneumonia Flashcards
(32 cards)
What is pneumonia?
Inflammation of the substance of the lungs - an acute lower respiratory tract infection
What is pneumonia usually caused by?
Bacteria but can also be viruses and fungi
How is pneumonia usually categorised?
Community acquired and hospital acquired
What are the two most common causes of community acquired pneumonia?
- Streptococcus pneumonia (gram positive cocci)
- Haemophilus influenza (gram negative coccobacilli)
What is the treatment for a community acquired pneumonia caused by streptococcus pneumonia?
Β-lactam e.g Amoxicillin OR cefuroxime OR cefotaxime
What is the treatment for a community acquired pneumonia caused by haemophilia influenzae?
B-lactam - amoxicillin AND co-amoxiclav’
OR Doxycycline
But NOT Macrolides
What are the atypical causes of community acquired pneumoniae?
- Chlamydia pneumonia
- Mycoplasma pneumoniae
- Legionella species
What treatment do you use for atypical pneumonia causes?
Macrolides OR Fluoroquinolones OR Tetracyclines
How would you test for S. Pneumoniae?
- Alpha haemolytic and optochin sensitive
What is different about an aytipical pathogen?
- Difficult to grow so you need serology to test them
- Also need special antibiotics to treat them as they’re not susceptible to B-Lactams
What can legionella spp. be caught from?
Warm water, showers and air conditioning as its a free living amoeba
What is hospital acquired pneumonia?
It is defined as a new onset cough with purulent sputum along with a compatible x-ray demonstrating consolidation - 48h since admission or in healthcare within 3 months
What aerobic gram negative bacilli are most commonly involved with HAP?
- Pseudomonas aeruginosa
- E. coli
- Klebsiella pneumoniae
What is the risk to immunocompromised patients?
The risk is extended, not just from the usual organisms but also opportunistic pathogens that would not be expected to cause disease
Give an example of an opportunistic pathogen?
Pneumocystis jiroveci
What is aspiration pneumonia?
- Acute aspiration of gastric contents into the lungs can produce and extremely severe and sometimes fatal illness owing to the intense destructiveness of gastric acid.
How is pneumonia spread?
By respiratory droplets
How does pneumonia occur?
When the host defence is overwhelmed the alveolar macrophages change roles and instruct th17 to stimulate neutrophils and fill the alveolar space.
Cells and pus in the alveoli reduce the lungs ability to exchange gas
What are the risk factors for pneumonia?
- Under 16/over 65
- Nursing home resident
- Comorbidities
- Immunosuppression
What are the signs of pneumonia?
- Raised RR - dyspnoea and breathlessness (as alveoli become filled with pus and debris limiting gas exchange
- Coarse crackles are often heard on auscultation - due to consolidation
- Dull to percussion
- Bronchial breath sounds
- Dry or productive cough (cough isn’t productive in atypical causes)
What are the symptoms of pneumonia?
- Fever
- (night) sweats
- Rigors
- Cough
- SOB
- Malaise
- Anorexia
What would you see on the CXR in pneumonia?
- Look for ‘air bronchogram’ in consolidated area - black branch
- Multi-lobar is suggestive of S.pneumoniae, S.aureus and legionella spp.
- Multiple abscesses is suggestive of s.aureus
- Upper lobe cavity is then klebsiella pneumoniae but MUST EXCLUDE TB FIRST
What would you see on the blood tests for pneumonia?
- ESR and CRP significantly elevated
What is the CURB-65 score?
It is used to assess severity of CAP
