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Flashcards in Pneumonia Review Deck (31):
1

Typical CAP?

- Strep pneumoniae
- H-flu
- Staph aureus
- Moraxella catarrhalis

2

Atypical CAP?

- mycoplasma pneumoniae
- Legionella
- Chlamydophila pneumoniae
- Pseudomonas
- Viruses

3

Most common CAP?

- Strep pneumoniae

4

H Flu is common in which pts?

- elderly and pts with underlying pulmonary disease

5

What patients does mycoplasma pneumonia affect and what is this also known as?

- also known as Walking Pneumonia
- affects scool aged childrem college students, and military recruits

6

Legionella is associated with what?

- contaminated water
- associated with exposure to aerosol producing devices: air conditioners, shower, mist machine and whirlpool spas

7

Who is at risk for Klebsiella?

- alcoholics
- COPD pts
- Diabetes pts

8

When does Chlamydia peak and who is it common in?

- common in 65-79 y/o
- peak rate in winter months
- associated bronchitis

9

Who does pseudomonas affect?

- the immunocompromised

10

Who does staph aureus affect?

- elderly and young recovering from influenza virus

11

PCP is common in which patient group?

- patients infected with HIV

12

Clinical presentation in patients with atypical CAP?

- usually have less acute presentation than typical CAP
- CAP due to atypical pathogens may have one or more extrapulmonary features
- patients with Legionella infections may have a productive or nonproductive cough. Pts with mycoplasma pneumoniae or chlamydia pneumoniae usually present with a nonproductive cough

13

What antibiotics are ineffective for atypical pneumonia?

- PCN and cephalosporins won't be as effective because atypical bacteria lack a cell wall

14

What are predisposing host conditons/risk factors for pneumonia?

- elderly and very young
- pre-existing lung disease: COPD, cystic fibrosis, bronchiectasis
- smoking
- malnutrition
- immunosuppressed
- previous episodes of pneumonia or chronic bronchitis

15

Clinical features of pneumonia?

- abrupt onset
- fever
- productive cough: purulent sputum
- tachycardia
- chills and rigors
- HA
- N/V
- malaise (atypicals - flu like sxs)
- dyspnea
- consolidation
- hypoxia
- pleuritic chest pain
- pleural effusion

16

Characteristic of strep pneumococcal pneumonia sputum?

- bloody, rust colored sputum

17

Characteristic of sputum of a pt with klebsiella pneumonia?

- bloody, currant jelly, blood tinged

18

Characteristics of pseudomonas pneumonia?

- green sputum, and grape smelling

19

Clinical presentation of strep pneumococcal pneumonia?

- abrupt onset
- shivering rigors and chills
- rust colored sputum

20

Clinical presentation of mycoplasma pneumonia?

- slower onset
- general malaise
- HA
- rash
- diarrhea
- sometimes the CXR isn't conclusive

21

What will you see on a CXR of pneumonia?

- consolidation
- interstitial infiltrates
- air bronchograms
- cavitary lesions and pleural effusions: H flu, observed with staph aureus, anaerobic and TB infection
- legionella has a predilection for lower lung fields
- Klebsiella: upper lobes
- TB has a predilection for apex

22

Lab indications for CAP?

- not typically done in outpatient setting since empiric therapy is usually successful but inpatients require further dx
- labs are always done in inpatient setting
CMP: hyponatremia - associated with Legionella
CBC: leukocytosis with left shift, and leukopenia (ominous sign of impending death, clinical absence shouldnt rule out possibility of bacterial infection)
Sputum culture and gram's stain: specimen should be a deep cough specimen obtained prior to abx
- ABGs: hypoxia and respiratory acidosis (inpatient)
- blood cultures

23

How should you select a antimicrobial therapy?

- for the most likely pathogen
- clinical trials proving efficacy
- risk factors for resistance
- medical comorbidities

24

Tx guidelines for ambulatory pts with CAP?

- macrolides or newer flouroquinolones to provide coverage for both S. pneumoniae and atypical pathogens
- macrolides are effective in absence of signifant RFs for macrolide resistant S. pneumo
- tx: Azithro 500 mg pox day, 1, followed by 4 days of 250 mg a day
clarithro: 500 mg po bid for 5 days
doxy: 100 mg po bid for 7-10 days

25

How common is HAP?

- nosocomial pneumonia is 2nd most common cause of hospital acquired infection and is leading cause of death due to nosocomial infection (any contact with health care worker)
- occurs more than 48 hrs after admission (especially common in pts requiring ICU or mechanical ventilation)
- will present with at least 2 of the following:
fever, cough, leukocytosis, purulent sputum
- new or prgoressive parenchymal infiltrate on CXR

26

How is HAP acquired?

- colonization of pharynx
- stomach bacteria: NG and ET tubes
elevations in gastric pH (gastric microbial overgrowth), contamination by dirty hand and equipment, and drug resistant organisms

27

What pts are at risk for HAP?

- malnutrition
- advanced age
- altered consciousness
- swallowing disorders
- underlying pumlmonary and systemic disease

28

Dx tests for HAP?

- CXR
- CBC
- ABGs
- sputum: gram stain and culture, fluorescent ab staining with suspected Legionella
- blood cultures: from 2 different sites
- thoracentesis: pleural effusion

29

Common HAP bacteria?

- pseudomonas
- staph aureas
- enterobacter
- klebsiella
- E-coli

30

Tx for HAP

- empiric like CAP
- may need to switch or add abx according to sputum and/or blood culture results

31

Prevention of pneumonia?

- PPV: 23 strains of S pneumo
a single dose offers lifetime immunitiy
- indications: 65 or older, any chronic illness that increases risk, and immunocompromised
- one time revaccination after initial vaccination for:
those at highest risk, those over 65 who received the vaccine 5 years or more previously and were under age of 65 at time of first vaccination
- influenzae vaccine: for those at high risk for development of primary influenzae pneumonia and secondary bacterial pneumonias: age 65 and older, resident of long term care facilities, pts with pulmonary or cardiovascular disease
- both vaccines can be given simultaneously and there are not CIs to use immediately after episode of pneumonia