Pneumonia Overview and Types

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Questions and Answers

Which organism is NOT typically associated with lower respiratory infections?

Mycoplasma pneumoniae (correct)

Staphylococcus aureus

Legionella pneumophilia

Klebsiella

What does the abbreviation CURB-65 stand for in determining the severity of pneumonia?

Chills, Urea, Respiratory condition, Blood work, Age

Confusion, Urea, Respiratory rate, Blood pressure, Age (correct)

Cough, Urea, Respiratory rate, Breathing, Aspirations

Clinical assessment, Urea levels, Respiratory signs, Blood tests, Age

Which sign indicates decreased air entry during respiratory examination?

Decreased percussion note (correct)

Tachypnea

Crackles

Bronchial breathing

What characteristic symptom is least likely to be seen in a patient with lower respiratory infections?

Severe headache Signup and view all the answers

What is the primary treatment approach for a patient diagnosed with pneumonia?

Antibiotics and respiratory support Signup and view all the answers

Which feature is NOT assessed in the CURB-65 scoring system?

Oxygen saturation levels Signup and view all the answers

Which investigation is least relevant in the initial diagnosis of pneumonia?

CT scan of the abdomen Signup and view all the answers

What should be considered if a patient's condition is not improving after treatment for pneumonia?

Repeat chest X-ray and cultures Signup and view all the answers

Which of the following microorganisms is commonly associated with community-acquired pneumonia?

Streptococcus pneumoniae Signup and view all the answers

What is the recommended follow-up action after a patient is discharged post-pneumonia treatment?

Schedule a follow-up chest X-ray Signup and view all the answers

What is the annual incidence of pneumonia in the adult population?

0.1-1% Signup and view all the answers

What is a common complication associated with untreated or improperly treated pneumonia?

Pulmonary edema Signup and view all the answers

Which anatomical factor is significant in the respiratory host defenses against pneumonia?

Mucociliary transport Signup and view all the answers

Which type of pneumonia is characterized by occurring more than 48 hours after hospital admission?

Nosocomial pneumonia Signup and view all the answers

What percentage of pneumonia cases lead to hospital admissions?

40% Signup and view all the answers

Which immune response type involves immunoglobulins and T lymphocytes?

Adaptive immunity Signup and view all the answers

What is a common cause of pneumonia due to its inhalation or aspiration route?

Streptococcus pneumoniae Signup and view all the answers

Which of the following is not a listed co-morbidity associated with pneumonia risk factors?

Diabetes Mellitus Signup and view all the answers

What is the primary immune component involved in the innate response to pneumonia?

Phagocytic cells Signup and view all the answers

Which viral organism is commonly associated with community-acquired pneumonia?

Adenovirus Signup and view all the answers

Study Notes

Pneumonia

A common lower respiratory tract infection, affecting 0.1-1% of adults annually.
Predominant in children under 5 and adults over 40.
Winter is the typical season for this infection.
40% of patients require hospital admission; 5-12% result in hospital mortality.
Common underlying co-morbidities include smoking, alcohol abuse, immunosuppression, chronic lung disease (COPD, asthma, ILD, bronchiectasis), and other conditions (neurological, renal, cardiovascular, liver).
Causes: Microbial (bacteria, viruses, fungi, parasites) infection + host inflammatory response leading to consolidation and impaired alveolar function.
Infections can occur through inhalation, aspiration, or hematogenous spread (bloodstream).

Types of Pneumonia

Community-acquired pneumonia (CAP)
Nosocomial pneumonia
Aspiration pneumonia
Pneumonia in the immunocompromised

Respiratory Host Defenses

Anatomical factors:
- Cough
- Mucociliary transport
Innate immunity:
- Antimicrobial peptides (e.g., lysozymes, lactoferrin, defensins, collectins)
- Phagocytic and inflammatory cells
Adaptive immunity:
- Immunoglobulins (Ig)
- T lymphocytes

Microbial Etiology

Common organisms (CAP):
- Streptococcus pneumoniae
- Haemophilus influenzae
- Influenza virus
- Adenovirus
- Mycoplasma pneumoniae
- Moraxella catarrhalis
- Chlamydia pneumoniae
- Legionella pneumophilia
- Staphylococcus aureus
Common organisms (Nosocomial):
- Staphylococcus aureus
- Pseudomonas aeruginosa
- Bacteroides
- E. coli, Klebsiella, Proteus
- Serratia marcescens
- Acinetobacter spp.
- Viruses

Clinical Features

History:
- Productive cough
- Breathlessness
- Pleuritic chest pain
- Fever
- Systemic features (other symptoms)
Examination:
- Tachypnea
- Tachycardia
- Impaired air entry
- Diminished percussion note
- Increased vocal resonance
- Bronchial breath sounds
- Crackles/rales

Management 1

Diagnosis:
- Short history of acute lower respiratory infection
- New focal chest signs
- New radiographic shadowing (consolidation)
Severity assessment:
- CURB-65
- Pneumonia Severity Index
- Presence of complications

Management 2 (CURB-65 scoring system)

CURB-65 scoring system to determine severity:
- Confusion
- BUN (Blood urea nitrogen) > 30
- Respiratory rate > 30
- Blood Pressure Systolic < 90 or Diastolic < 60
- Age > 65
Treatment based on SCORE:
- CURB 0-1 : Home
- CURB 2: Short hospital stay
- CURB 3-4 : Medical ward
- CURB 5: ICU care

Management 3 (Investigations and Treatment)

Investigations:
- Vital signs (sO2, BP, HR, RR)
- Chest X-ray (CXR)
- Blood tests (FBC, U/E, LFTs, CRP, ABG)
- Microbiological investigations (sputum, blood culture, viral swabs, specific serology)
Treatment:
- Oxygen
- Fluids
- Antibiotics
- Respiratory support
- Monitoring

Not Improving Patient

Causes of failure to improve:
- CRP > 50% on day 4
- Slow response to treatment
- Incorrect/missed diagnosis
- Secondary complication (pulmonary/extrapulmonary)
- Inappropriate or unexpected pathogen
- Impaired immunity
- Underlying issues (immunodeficiency/chronic lung disease)
Management strategies:
- Consider alternate diagnosis
- Repeat CXR/cultures
- Consider bronchoscopy/pleural fluid sampling
- Escalate antibiotics

After Discharge

Follow-up:
CXR follow-up: Assess for lung cancer, especially in smokers >60 years (17% risk)
Vaccinations:
- Annual influenza vaccine
- Pneumococcal vaccine

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Description

Explore the various aspects of pneumonia, a prevalent respiratory infection impacting different age groups. This quiz covers types of pneumonia, common causes, and the respiratory host defenses involved. Test your knowledge on this essential health topic and understand its implications.