pneumonia - Eric Flashcards by Lindsey Dutton

what is pneumonia

inflammation of the alveoli and bronchioles
#1 most deadly hospital acquired infection

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what are the causes of pneumonia

infection (bacteria, viruses and fungi) or aspiration

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what are the common bacterial pathogens of pneumonia

strep pneumoniae #1
H. Influenze B
S. aureus

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what are the most common virus pathogens of pneumonia

influenza
RSV
Parainfluenza
adenovirus
COVID

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what are the most common fungi pathogens of pneumonia

aspergillosis
histoplasma
coccidiomycosis
blastomycese
candida

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what is the most rare type of pneumonia

fungal pneumonia

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who is at risk of getting pneumonia

immunocompromised
children
CF
smoking - COPD
sickle cell disease
asthma
underlying lung disease
DM
intubated

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who are considered immunocompromised in association with pneumonia

bone marrow transplant, organ transplant, cancer, immunosuppressive drugs, HIV, steroids

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why are immunocompromised patients at increased risk of developing pneumonia

neutropenia and impaired granulocyte function which causes infection to happen

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what pathogens are immunocompromised patients most likely to get

s. aureus
aspergillus
candida
gram-negative bacilli

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what are the classifications of community acquired pneumonia

typical and atypical

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what is typical community acquired pneumonia

caused by bacteria leading to alveolar inflammation and exudate
productive cough
lobar consolidation on CXR
S. pneumonia

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what are atypical community acquired pneumonia

organisms invade and destroy interstitium of the lungs
lack of alveolar exudate
dry cough
patchy infiltrate on CXR
mycoplasma, chlamydia, viral

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what causes typical community acquired pneumonia

aspiration + loss of cough/damage to cilia/impaired immunity / changes in flora
most common pathogen S. pneumonia

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what are the symptoms of typical community acquired pneumonia

fever, chills, productive cough, crackles or absent lung sounds, malaise, chest pain

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where are S. pneumonia antibodies created

within the spleen

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what are the diagnostics for typical community acquired pneumonia

pt is ill appearing
crackles on exam
absent lung sounds
increased in whispered pectoriloquy
egophony e-a
bronchophony - 99
increased tactile fremitus
lobar consolidation

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what are out patient treatment options for typical community acquired pneumonia

adult: Azithromycin OR Doxycycline OR levofloxacin
Peds: Amoxicillin 90mg/kg/day BID

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what are inpatient treatments for typical community acquired pneumonia

adult: ceftriaxone + azithromycin OR levofloxacin
peds: ampicillin (if fully immunized) or ceftriaxone (if not fully immunized)

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what is community acquired Atypical community acquired pneumonia

more common in children
known as bronchopneumonia = patchy infiltrate on CXR
cough is usually dry
crackles on exam
mycoplasma, chlamydia, influenza, adenovirus, RSV, parainfluenza

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what is the most common pneumonia in children and young adults

mycoplasma Atypical community acquired pneumonia

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what is mycoplasma Atypical community acquired pneumonia

damaged the epithelium allowing bacteria to over grow
fever, headache, dry cough, bullous myringitis (not common)
chlamydia pneumonia presents similarly (college aged, sore throat, koalas, no bullous myringitis)

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what is the gram negative bronchopneumonia

legionnaires Atypical community acquired pneumonia

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what is legionnaires disease (Atypical community acquired pneumonia)

not transmitted human-human
pathogen grown in water of ventilation systems
onset 2-10 days

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what are the symptoms and tests used for legionnaires disease

fever, chills, malaise, dry cough, diarrhea urine antigen or sputum fluorescent antibody tests

what is the treatment for legionnaires disease

levofloxacin any delay in abx will increase risk of mortality

what are the common pathogens for hospital acquired pneumonia

pseudomonas, S. aureus, enterobacter, klebsiella, e. coli

what patients are at risk for hospital acquired pneumonia

intubation tracheotomy immunocompromised chronic lung disease

what is the common college age person presenting with coughing with minimal production

mycoplasma or chlamydia

what is the most common ICU pathogen

pseudomonas - highest mortality rate

what is the presentation time for hospital acquired pneumonia

presentation 48 hours after admission

what is the treatment for hospital acquired pneumonia

no consensus on best abx treatment cefepime zosyn (pip+ tazo) meropenem levofloxacin aspiration pneumonia - clindamycin OR metronidazole + ceftriaxone

what is the leading cause of death for people with HIV worldwide

Pulmonary tuberculosis (TB) aka HIV associated Pneumonia

What is one of the first diseases seen in the AIDs pandemic

P, jirovecii (PJP) fungal infection found in the soil

what is the presentation of PJP

creates foamy exudates and cysts in lung cough, fever, weight loss CD4+ count < 200

what is the treatment for PJP

treat first with prednisone and them TMP-SMX (Bactrim) daily bactrim prophylaxis for CD4+ count < 200

what is the presentation of TB

fever, night sweats and weight loss

if a patient is hospitalized with HIV associated pneumonia what should they be treated with

Ceftriaxone and azithromycin

what are sickle cell disease patients at risk for

S. penumonia due to poor spleen function from infarcts

what is the vaccine for S. pneumonia

PCV 20 - all patients

what patients are prone to pneumonia due to damaged ciliary bodies and thickened mucous

CF patients

what is the most common pathogen associated with CF pneumonia

Pseudomonas aeruginosa

how is CF pneumonia treated

aggressively inpatient with tobramycin + Pip-tazo PCV 20 current studies recommended against prophylactic antibiotics

what can pre-dispose to bacterial infections

viral infection pneumonia

what is the treatment of viral pneumonia

antibiotics still - treated just the same

what is fungal pneumonia

most infected pts are symptomatic but can turn fatal HIV infxn and suppressed immunity make people more prone to fungal toxins there are no fungal toxins - hypersensitivity reactions

what is the presentation of fungal pneumonia

granulomas similar to TB on x-ray

what are the phases of fungal pneumonia

1. acute 2. chronic pulmonary disease 3. disseminated infection

what is the presentation of acute fungal pneumonia

mild- flu like illness with fever

what is the presentation of chronic pulmonary disease fungal pneumonia

creation of cavitary lesions cough, fever and night sweats very similar to TB

what is the presentation of disseminated fungal pneumonia

hepatosplenomegaly pancytopenia, elevated Alk Phos, elevated LDH multi-organ failure, septic shock, death

what is the fungus found in bird and bat droppings

Histoplasma capsulatum

how quickly can disseminated histoplasmosis be fatal

within 6 weeks

how do you confirm histoplasmosis

urine assay

what is the treatment of hisotplasmosis

itraconazole if patient is immunocompromised - itraconazole is used as lifelong prophylaxis

what is the Valley Fever - Southwest U.S

coccidiomycosis caused by coccidioides immitis

what is the presentation of coccidiomycosis

fever, fatigue, cough, SOB and night sweats symptoms onset is 1-3 weeks and can last several months

how is coccidiomycosis diagnosed

skin test <10% of cases become severe with long term effects

how is coccidiomycosis treated

usually self limiting, but can treat with 3-6 months of Diflucan

what is Cryptococcus found in

bird droppings and effects immunocompromised patients

how do you treat cyrptococcus

fluconazole x 10 weeks can start with amphotericin B x 2 weeks

what are the ways to prevent pneumonia

PCV 20 and influenza vaccines

what is the key feature about mycoplasma

children/young adults, dry cough, bullous myringitis

what is the key feature about P jirovecii

HIV-related, slow onset, hypoxia worse than CXR findings

what is the key feature about legionella

poor ventiltation, hyponatremia, diarrhea

what is the key feature about chlyamdia

sore throat, dry cough, college age, koala

what is the key feature about s. pneumonia

most common, sickle cell, rust colored sputum

what is the key feature about klebsiella

currant jelly colored, alchol abuse

what is the key feature about h flu

COPD

what is the key feature about pseudomoas

ICU -related (worse prognosis), CF

what is the key feature about RSV

Children <1

what is the key feature about Parainflenza

children <2

what is the key feature about histoplasma

Bats, caving diving

what is the key feature about coccidiomycosis

southwest US

pneumonia - Eric Flashcards

(74 cards)