Pneumonia D2 Part2.pdf.pdf

Pneumococcal pneumonia n Segmental – lobar distribution n Bronchopneumonia: infants, young children, elderly, immobile pts, cardiac failure n Upper respiratory infection – several days before n High fever – chills ( a single episode of true rigor in 1/3 of pts.) ...

Pneumococcal pneumonia n Segmental – lobar distribution n Bronchopneumonia: infants, young children, elderly, immobile pts, cardiac failure n Upper respiratory infection – several days before n High fever – chills ( a single episode of true rigor in 1/3 of pts.) Pneumococcal pneumonia n Cough 90 %, sputum (bloody) n Pleuritic chest pain n PE findings due to consolidation n WBC ­ (15.000 – 30.000 with left shift) n Gram stained sputum: PNL’s, predominance of Gram(+) bullet- shaped diplococci n Blood cultures (+) in 15-25 % Pneumococcal pneumonia n Treatment n Complications n Penicillin n Pleural effusion (% 10-20) n Cephalosporins n Empyema n Macrolides n Meningitis n New quinolones n Endocarditis n Prevention: Conjugate (PCV13) and polysaccharide vaccines (PPSV23) Legionella pneumophila n Legionnaires’ disease: n 2-10 day incubation period n Pneumonia and involvement of other organ systems n Pontiac fever: n 5-66 hours incubation period n Fever without pneumonia and organ involvement Legionnaires’ disease n Common modes of spread n Contaminated potable water n Contaminated heat-exchange apparatus n Sporadic cases: late summer – early fall n No person to person transmission n More common in elderely, COPD, renal failure, DM, smokers, imm-suppresed pts in legionnaires disease we will not see respond to penecilin or cephaolocprin Legionnaires’ disease n Severity: mild grippe ® severe multisystem disease affecting lungs, liver, kidney, GI tract, CNS n Clinical clues: n Very high fever with repeated rigors n Lack of preceeding upper respiratory symptoms n Diarrhea n Unexplained impairment of mental function n Hematuria n Abnormal liver function n Negative routine bacteriologic cultures n Failure to respond to therapy with pen. and ceph. Legionnaires’ disease n Diagnosis: n Direct immunofluorescence n Serology n Urine antigen test n Therapy: n Macrolides + rifampin n Quinolones n Tetracycline Mycoplasma pneumoniae n Pharyngitis, tracheobronchitis, pneumonia n Cold agglutinins (H2O2 effect) - % 50 n Children – young adults (5-20 y) n Incubation period 2-3 weeks Mycoplasma n Clinical characteristics n Onset – insidious n Fever – mild n Severe, disabling, paroxysmal cough – usually nonproductive n Auscultation findings – not impressive n Patchy infiltration Mycoplasma n Complications: n Pulmonary – spread of infection within the lung pleural effusions n Extrapulmonary (2-10 %) n Stevens-Johnson synd. n Raynaud’s phenomenon n Hemolysis n Neurologic, cardiovascular, musculoskelatal (rare) Mycoplasma n Clinical course and diagnosis n Self limited – pneumonia 4-6 weeks n Relaps 5-10 % n Young adult patient n Gram stain – mild inflammation – no bacterial organisms n Cold agglutinins ( > 1:32 – 2. And 3.weeks of illness) n Spesific serology (IgM, 4 fold increase IgG) n Therapy: Macrolides, Quinolones, Tetracycline Varicella PCP Hospital acquired pneumonia n Gram-negative bacilli n P. aeruginosa n Acinetobacter spp. n Enterobacter spp. n K. pneumoniae n S. aureus n The increasing prevalence of MRSA Abscess