Pneumonia

Question 1

What are the causes for pneumonia?

Answer 1

• immune system is weak
• organism is very strong
• body failed to filter organism -> smokers
• neutrophils -> exudate -> filled alveoli

Question 2

What are the risk factors for pneumonia?

Answer 2

• smoking
• immunocompromised
• elderly
• risk of aspiration -> alcohol, vocal cord paralysis, seizure
• prior viral upper respiratory tract infections -> influenza
• pre-existing lung diseases

Question 3

What are the types of pneumonia?

Answer 3

Community acquired pneumonia (CAP)
Hospital acquired pneumonia (HAP) -> < 48 hrs
Ventilator associated pneumonia (VAP) -> < 48hrs
Aspiration pneumonia -> seizure, stroke, vocal cord paralysis, multiple shocks, alcohol

Question 4

What are the organisms associated with pneumonia?

Answer 4

CAP

• typical -> Strep pneumonia, H. influenza, Moraxella catarrhalis
• atypical (no cell wall) -> Chlamydia pneumonia, Mycoplasma pneumonia, Legionella, viral

HAP
- Staph aureus, pseudomonas, enterobacteriaceae, acinetobacter, COVID-19

VAP
- pseudomonas & HAP

ASPIRATION
- oral flora

Question 5

What are the clinical features of pneumonia?

Answer 5

• fever
• sweating
• confusion
• productive cough
• SOB
• pleuritic chest pain

Question 6

What are the clinical signs of pneumonia?

Answer 6

• fever, tachycardia, tachypnea, hypoxia, cyanosis
• respiratory distress
• decrease chest expansion
• positive vocal fremitus
• dullness on percussion
• decreased breath sounds
• bronchial breathing
• crackles
• positive vocal resonance
• positive egophony

Question 7

What organism is associated with pneumonia & hyponatremia?

Answer 7

Legionella

Question 8

What is seen on gram stain of sputum in suspected typical CAP?

Answer 8

• Gram positive cocci in pairs -> Strept pneumonia
• Gram negative Cocci in pairs -> Moraxella catarrhalis
• Gram negative Bacilli -> Hemophilus influenza

Question 9

What are the indications for admission?

Answer 9

CURB-65

• Confusion
• Urea > 20mg or >7mmol
• RR >30/min
• BP <90 systolic or <60 diastolic
• age is 65 or more

0-1 -> outpatient
2 -> inpatient admission
3 or more -> ICU

Question 10

How is an inpatient case of pneumonia treated?

Answer 10

Inpatient

• beta lactam (ceftriaxone) + macroloides (Azithromycin)
• respiratory fluoroquinolones (Levofloxacin or Moxifloxacin)

ICU

• beta lactam (ceftriaxone) + macroloides (Azithromycin)
• beta lactam (ceftriaxone) + respiratory fluoroquinolones (Levofloxacin)

Question 11

How is an outpatient case of pneumonia treated?

Answer 11

No comorbidities
- amoxicillin or doxycycline

Comorbidities
- Amoxicillin-Clavulanate + Azithromycin or Doxycycline
OR
- respiratory fluoroquinolones

Question 12

How is HAP/VAP treated?

Answer 12

anti-pseudomonal + anti-staph aureus

• ceftazidime - vancomycin
• cefepime - linezolid
• piperacillin - teicoplanin
• carbapenem - ceftaroline