Working problem 7-Pneumonia Flashcards
What is pneumonia?
Pneumonia is inflammation of the lungs with consolidation or interstitial lung infiltrates, most often categorised according to the causative organism.
Atypical pneumonia
• Atypical bacterial pneumonia is caused by atypical organisms that are not detectable on Gram stain and cannot be cultured using standard methods. The most common organisms are Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila.
Community acquired pneumonia
• Community-acquired pneumonia (CAP) is defined as pneumonia in a patient who has not been hospitalised or has not resided in a long-term care facility (such as a nursing home) within the past 14 days.
Hospital acquired pneumonia
• Hospital-acquired pneumonia (HAP) is an acute lower respiratory tract infection that is by definition acquired after at least 48 hours of admission to hospital and is not incubating at the time of admission.
How do you assess pneumonia?(Just read don’t go in depth)
Atypical Pneumonia
Key risk factors include close community settings (such as boarding schools, college dormitories, army basic training camps or even hospitals) and immunosuppression. A history of exposure to someone with respiratory infection is also a risk factor for atypical bacterial pneumonia. Many patients with atypical bacterial pneumonia are younger than 50 years.
Typically, patients complain about a persistent cough that does not resolve with time. The presence of a dry cough and a prolonged time from onset of symptoms to the presentation should prompt suspicion that an atypical pathogen is present. Fever, if present, is usually low grade. In many cases of Mycoplasma pneumoniae and Chlamydophila pneumoniae, pharyngitis, hoarseness and headache may also be present. Diarrhoea may accompanyLegionella infections. Bullous myringitis is rare sign (5%) that suggests M pneumoniaeinfection. Rash, mainly a self-limited maculopapular or vesicular rash can accompany M pneumoniae pneumonia. In some cases, a more severe form of Stevens-Johnson syndrome affecting the oral mucosa or other parts can be seen.
Clinical signs of pneumonia such as rales/crepitations may be mild or absent.
Community Acquired Pneumonia
There may be a history of recent chronic respiratory infection or exposure to other patients with pneumonia. Patients often have a past history of smoking, alcohol or drug abuse, recent travel, or occupational risk factors. Patients typically complain of productive cough, breathlessness, chest or abdominal pain, fever, and general malaise. Older people present with atypical symptoms including confusion, lethargy, and general deterioration.
On examination the patient may be febrile, tachycardic, and breathless at rest. Auscultation of the chest may reveal crackles, rales, or bronchial breathing, and there may be presence of dullness on percussion or tactile vocal fremitus
Hospital Acquired Pneumonia
The history should ascertain whether the patient is at risk of pneumonia caused by multi-drug-resistant (MDR) pathogens (e.g., Pseudomonas aeruginosa, Klebsiella pneumoniae, and MRSA). This is important to establish, as it affects empirical antibiotic options. The risk factors for MDR pneumonia are:
• Antimicrobial therapy in preceding 90 days
• Current admission to hospital of 5 or more days
• High frequency of antibiotic resistance in the community or in the current hospital unit.
• The physician also needs to establish whether there are any risk factors for healthcare-associated pneumonia (HCAP). Patients who fall into this category are considered to be at risk of pneumonia caused by an MDR pathogen. The risk factors for HCAP are:
• Admission to hospital for any reason for 2 or more days in the preceding 90 days
• Residence in a nursing home or extended-care facility
• Home infusion therapy (including antibiotics)
• Chronic dialysis within 30 days
• Home wound care
• Family member with MDR pathogen
• Immunosuppressive disease and/or therapy.
A patient may describe any of the following symptoms:
• Dyspnoea
• SOB
• Productive cough
• Chest pain
• Fever
• Malaise/anorexia.
The physical examination may reveal any of the following:
• Asymmetrical expansion of the chest
• Diminished resonance
• Abnormal auscultation of the lung (egophony, whisper pectoriloquy, crackles, or rhonchi)
• Tachycardia
• Fever
• Hypothermia
What are the investigations carried out?
Atypical pneumonia • CXR – infiltrates • WBC - may be slightly elevated, may see relative lymphocytosis if infection is viral • Haemoglobin – may show anaemia • LFTs – elevated enzyme level • SpO2 – decreased
What is the management for pneumonia?
amoxicillin
