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?

<p>Severe headache (B)</p> Signup and view all the answers

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

<p>Antibiotics and respiratory support (C)</p> Signup and view all the answers

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

<p>Oxygen saturation levels (B)</p> Signup and view all the answers

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

<p>CT scan of the abdomen (B)</p> Signup and view all the answers

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

<p>Repeat chest X-ray and cultures (D)</p> Signup and view all the answers

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

<p>Streptococcus pneumoniae (A)</p> Signup and view all the answers

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

<p>Schedule a follow-up chest X-ray (D)</p> Signup and view all the answers

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

<p>0.1-1% (B)</p> Signup and view all the answers

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

<p>Pulmonary edema (B)</p> Signup and view all the answers

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

<p>Mucociliary transport (B)</p> Signup and view all the answers

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

<p>Nosocomial pneumonia (B)</p> Signup and view all the answers

What percentage of pneumonia cases lead to hospital admissions?

<p>40% (D)</p> Signup and view all the answers

Which immune response type involves immunoglobulins and T lymphocytes?

<p>Adaptive immunity (C)</p> Signup and view all the answers

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

<p>Streptococcus pneumoniae (B)</p> Signup and view all the answers

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

<p>Diabetes Mellitus (C)</p> Signup and view all the answers

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

<p>Phagocytic cells (C)</p> Signup and view all the answers

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

<p>Adenovirus (D)</p> Signup and view all the answers

Flashcards

Pneumonia: Epidemiology

A common lower respiratory tract infection affecting 0.1-1% of adults yearly, more prevalent in older adults (over 40), during winter, and in individuals with specific health conditions.

What is Pneumonia?

An inflammation of the lungs caused by various microbes, including bacteria, viruses, fungi, and parasites.

How does Pneumonia develop?

Pneumonia caused by inhaling, aspirating (breathing in) or blood-borne microbes reaching the lungs.

Nosocomial Pneumonia

Pneumonia that develops in a hospital setting, usually in patients already hospitalized for other reasons.

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Community-Acquired Pneumonia

Pneumonia acquired in the community, not linked to a hospital stay.

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Pneumonia in Immunocompromised Individuals

Pneumonia that develops in individuals with weakened immune systems, making them more susceptible to infections.

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Aspiration Pneumonia

A type of pneumonia caused by inhaling food or other foreign substances into the lungs.

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Respiratory Host Defenses

A critical body defense against pneumonia, involving features like coughing, mucus movement, and specific immune cells.

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Common Microbes in Community-Acquired Pneumonia

Common causative agents of community-acquired pneumonia - usually bacteria.

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Microbes Commonly Found in Nosocomial Pneumonia

Common causative agents of nosocomial pneumonia - usually bacteria.

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Pneumonia

A serious lung infection caused by bacteria, viruses, or fungi, often following a viral infection.

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Streptococcus pneumoniae

A common cause of community-acquired pneumonia, often affecting people with weakened immune systems.

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Staphylococcus aureus

A type of bacteria that is often associated with healthcare-associated pneumonia.

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Pseudomonas aeruginosa

A bacterial species that can cause pneumonia in patients with cystic fibrosis or other lung conditions.

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Community-acquired pneumonia (CAP)

This type of pneumonia is acquired outside of a hospital setting.

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Hospital-acquired pneumonia (HAP)

This type of pneumonia occurs 48 hours or more after hospital admission.

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CURB-65

A score used to assess pneumonia severity and guide treatment decisions.

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Pneumonia Severity Index

An evaluation tool used to determine the likelihood of complications in pneumonia patients.

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Dyspnea

A common pneumonia symptom that refers to shortness of breath.

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Tachycardia

A rapid heart rate, often associated with pneumonia.

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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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