Pneumonia II Flashcards
causes of community acquired pneumonia
typical: S. pneumo, H flu, klebsiella
atypical: mycoplasma, chlamydia, legionella, flu, RSV, adenovirus
aspiration: anaerobes and mouth flora
causes of hospital acquired pneumonia
S pneumo, gram negative rods, pseudomonas
asbiration: enteric GNRs, pseudomonas
Candida and enterococcus DON’T cause pneumonia
Clinical presentation of typical pneumonia
typical pneumonia: rapid onset, fever, rigors, productive cough and chest pain, increased WBCs, CXR with consolidation
(s. pneumo, klebsiella, H flu)
clinical presentation of atypical pneumonia
sudden onset, cough (may not be productive), WBCs. may be normal or high in lymphocytes. CXR with patchy infiltrates
clinical presentation of chronic pneumonia. causative agents
insidious onset, chronic, usually productive cough, fever low or absent, cavitary formation. Think TB, fungi, or actinomyces.
Evaluating sputum for pneumonia
fewer than 10 epithelial cells and more that 25 polys/LPF. exception is legionella
Why is blood culture needed in diagnosis of pneumonia
to look for s aureus and s pneumonia
role of blood galactomanan
may detect asperigllis
CURB65
C: confusion, urea above 7 mmol, resp rate above 30/min, BP less than 90 systolic or 60 diastolic, pt over 65. If score is 0-1, treat at home.
treating community acquired pneumonia at home. no recent abx.
if no abx in past 3 mo, give azithromycin for 5 days ir clarithromicin for 5 days (or dexycydin 7-10 days)
treating community acquired pneumonia with recent abx exposure
moxifloxacin 5 days or beta lactam AND macrolid 5 days
treating pneumonia in the hospital
moxifloxacin or 3rd gen cephalosporin + macrolide. if aspiration is possible, also use clindamicin or beta lactam + macrolide.
