How does PNA develop?
when an organisms invades the lung’s parenchyma and the host’s defenses are depressed
What are the origins of PNA?
bacterial, viral, fungal, rickettsial, and parasitic
inflammatory processes
inhalation of toxic substances
S/S of PNA
cough, dyspnea, sputum production, fever, abnormal breath sounds (crackles)
the need for initial ________ to evaluate for _________ because of variability of PNA clinical presentations
- chest xray
- new or progressive infiltrates
What organisms is the most common cause for bacterial PNA?
strep pneumoniae
What is the goal of treatment for PNA?
- for patients to return to their original respiratory status before the illness
How do you know if a patient is responding well to a treatment
patient should respond to empiric therapy by showing improved clinical condition within 48-72 hours and the resolution of symptoms within 5-7 days
Severe CAP is defined as having one major criteria or three or more minor criteria which are
- septic shock needing vasopressors
- resp failure needing mechanical ventilation
- resp rate >30
- PaO2/FiO2 ratio <250
- multi lobar infiltrates
- confusion/AMS
- uremia
- leukopenia
- thrombocytopenia
- hypothermia
- hopytension requiring fluids resuscitation
what tools do clinicians use to determine prognosis and locations CAP treatment?
PSI and CURB-65
PSI considers
age, comorbidity, physical examination findings, and results of diagnostic testings such as ABGs and chest X-rays
is more invasive but more sensitive in predicting mortality
What are the most common pathogen in nursing home acquired PNA?
strep pneumoniae, h influenzae, k pneumoniae, p aeruginosa, and MRSA
CURB-65 considers
confusion, BUN, RR, BP, and age
less invasive
Treatment guidelines for inpatient/nursing home PNA are
beta lactam plus macrolides OR resp fluoroquinolone for non severe PNA
beta lactam plus macrolide or beta lactam plus fluoroquinolone for severe PNA
Why are pregnant women more predisposed for PNA?
physiological changes that occurs such as alterations in T lymphocyte function, increased O2 consumption, reductions in functional residual capacity, and increased risk of aspiration
What treatments for PNA are safe for prego?
- macrolides (erythromycin and azithromycin are first choice)
clarithyromycin is another option but risk of fetal harm has not been ruled out - do not use doxycycline or fluoroquinolones
- beta lactam plus macrolides should be used with women who has comorbidities or recent antibiotic use
What vaccines are recommended for prego women for prevent viral infections causing PNA?
- MMR BEFORE prego since it is contraindicated in prego women
- Hep B can be during prego
- flu and COVID can be during prego
- pneumococcal
What are indications for hospitalization in children beyond infancy?
- mod-severe resp distress
- failure to respond to oral antibiotics
- lobar consolidation in more than one lobe
- immunosuppression
- empyema
- abscess or pneumatocele
- underlying cardiopulmonary disease
What is the most common cause of bacterial infection in children of all ages?
strep pneumoniae
Symptoms of infants with chlamydial PNA are
- repetitive taccato cough and tachypnea
- cervical adenopathy
- rales
- wheezing is rare
- hyperinflation and bilateral diffuse infiltrates on chest X-ray
- nasal stuffiness and otitis media
treatment for chlamydial PNA is
- macrolides
Diagnosis for children with bacterial PNA are
- usually occurs secondary to a viral infection
- blood cultures unless patient is outpatient, improving, and are immunized
- sputum aspiriate
- chest xray (lobar consolidation
- CBC only if PNA is severe
- if pneumatoceles are shown on chestxray, most likely staph PNA
Treatment for bacterial PNA in children
- amoxicillin
- ampicillin for IV
- cef for PNC resistance
- vanco for life threatening situations
- clindamycin or levofloxacin if resistance for PNC/allergy to beta lactams
What is the most common cause of PNA in school aged children and young adults
- mycoplasma pneumoniae
