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Flashcards in Pneumonia and Influenza Deck (22):
1

Definition and Features of Pneumonia

Infection of the lung parenchyma
Common clinical signs and symptoms include fever, chills, pleuritic chest pain, dyspnea and cough that can be productive or sputum (bacterial) or with minimal sputum (viral vs atypical). Possible anorexia, nausea, vomiting, diarrhea, and mental status changes.

PE: crackese, rhonchi and bronchial breath sounds. Egophany and dullness to percussion. Leukocytosis with left shift. Leucopenia with pneumonia portends to poor diagnosis

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Definition and Features of Pneumonia

Infection of the lung parenchyma

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Pneumonia Pathogenes

Infectious particles, inhalation of oropharngeal or gastric contents, hematogenous spread, infection from adjacent or contiguous structures, direct occlusion and reactivation.

Inhalation of infectious particles commonly legionella specials and M. tuberculosis. Pneumonia occurs when host's ability to fight against microbes is compromised.

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Differential diagnosis of PNA

Diagnosis requires clinical evidence of pulmonary paremchymal inflammation due to infection in which the purulence develops and fills the alveoli.

In the absence of clinical or microbiological supportive evidence the DD includes: Pulmonary edema, Pulmonary or diffuse alveolar hemorrhage, Pulmonary embolism, Malignancy, Drug induced lung disease, Inflammation secondary to non-infectious causes

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Pneumonia classification or types

*Outside of hospitals or health-care facilities = "community acquired (CAP)"
*Pts hospitalized within 90 days of infection = "health-care associated (HCAP)"
*Pneumonia occurs within 48 of hospital admission = "hospital-acquired (HAP)"
*Pneumonia occuring 48 hours or more after ventilation = "ventilator associated (VAP)"

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Basics of PNA treatment

When a specific pathogen is identified, pathogen specific therapy can be used.

If a pathogen can not be identified....
Outpatient: Macrolide or Doxycycline
Inpatient not severely ill: Macrolide and cefotaxime/cefriaxone, or beta-lactam or beta-lactamase inhibitor
Outpatient severely ill: Azithromycin or fluoroquinolone and cefotaxime

Most cases are treated within 10-14 days of antibiotics. There are also immunizations for prevention

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Multiple viruses of influenza

Can be caused by either influenza A or B.
Three major subtypes of hemagglutinins (H1, H2 and H3) and two subtypes of neuraminidases (N1 and N2).
Influenza B viruses have a lessor propensity for antigenic changes and only antigenic drifts in the hemagglutinin have been described

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Multiple viruses of influenza

Can be caused by either influenza A or B.

9

Understand influenza pathogenesis

IFN viral incubation period is 1-4 days prior to onset of illness occurring within 3-4 days. Virus can "shed" from infected individuals 24-48 hours prior to onset of illness and continue for as long as 10 days.

Pathogenic nature is related to antigenic changes in its hemagglutinin. As the virus reproduces, the virions are also bound to the host cell. Neuraminidase cleaves these links and liberates the new virions; it also counteracts hemagglutinin-mediated self-aggregation entrapment in respiratory secretions

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Clinical features of influenza

Uncomplicated influenza is an abrupt onset of fever, headache, myalgias and malaise. Can be associated with URI symptoms such as cough, nasal congestion and sore throat.
Complications of influenza include: Pneumonia, Myositis and rhabdomyolysis (occurs most commonly in children). CNS complications (encephalopathy, transverse myelitis, meningitis, Guillain-Barre syndrome), and Cardiac complications (myocarditis, increased risk of MI, pericarditis)

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Understand the basics of influenza prevention and treatment

Treatable within 48 hours of illness.
Neuroaminidase inhibitor (oseltamivir or zanamivir)

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Clinical features of influenza

Uncomplicated influenza is an abrupt onset of fever, headache, myalgias and malaise. Can be associated with URI symptoms such as cough, nasal congestion and sore throat.

13

Understand the epidemiology of influenza

Distinct outbreaks occur yearly and reflect the changing antigenic properties of the virus. IFN A virus easily undergoes changes in the antigenic characteristic of their envelope glycoproteins.

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Basics of PNA treatment

When a specific pathogen is identified, pathogen specific therapy can be used.

If a pathogen can not be identified....
Outpatient: Macrolide or Doxycycline
Inpatient not severely ill: Macrolide and cefotaxime/cefriaxone, or beta-lactam or beta-lactamase inhibitor
Outpatient severely ill: Azithromycin or fluoroquinolone and cefotaxime

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Differential diagnosis of PNA

Diagnosis requires clinical evidence of pulmonary paremchymal inflammation due to infection in which the purulence develops and fills the alveoli.

Risk factors: Alcoholism, COPD, exposure to bats, birds or rabbits, HIV, travel to desert, aspiration, IV drug use, obstruction of large airway,

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Main organisms associated with PNA types

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Basics of PNA treatment

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Multiple respiratory viruses

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Understand the epidemiology of influenza

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Understand influenza pathogenesis

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Clinical features of influenza

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Understand the basics of influenza prevention and treatment

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