pneumonia

• What is pneumonia?

  Infection of the lung tissue
• What is the main cause of pneumonia?

  Lower respiratory tract infection (LRTI) by bacteria
• How is pneumonia classified?

  By CAP, HAP, ventilator-acquired, aspiration
• What are the types of pneumonia classification?

  • CAP (Community-acquired pneumonia)
  • HAP (Hospital-acquired pneumonia)
  • Ventilator-acquired pneumonia
  • Aspiration pneumonia
• What is aspiration pneumonia associated with?

  Aspiration of food or fluid
• Who is commonly affected by aspiration pneumonia?

  Stroke and dementia patients
• What are common features of pneumonia?

  Fever, productive cough, sputum production
• What are the clinical features of pneumonia?

  • Fever
  • Productive cough
  • Sputum production
  • Basal crackles on auscultation
  • Lobar consolidation on CXR
  • Pleuritic chest pain worse on inspiration
• What does a chest X-ray (CXR) show in pneumonia?

  Lobar consolidation
• What is pleuritic chest pain?

  Pain that worsens on inspiration
• What could be the cause if pneumonia doesn't improve with antibiotics?

  Empyema
• What investigations are done for empyema?

  Pleural aspirates for culture and microscopy
• How is empyema treated?

  With a chest drain
• What is the CURB-65 score used for?

  To decide on inpatient or outpatient treatment for CAP
• What does CURB-65 stand for?

  Confusion, Urea, Resp rate, BP, Age
• What is the scoring system for CURB-65?

  • 0-1: Low risk = home-based care
  • 2: Intermediate risk = consider hospital-based care
  • ≥3: Inpatient care with possible ICU admission
• What are the main causes of typical pneumonia?

  Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus
• What is a specific feature of typical pneumonia caused by Staphylococcus aureus?

  Pneumonia develops after influenza

  multilobe involvement & cavitation
• What is atypical pneumonia?

  Cannot be cultured in a normal way

  can't be detected w/ gram staining
• What is the treatment for atypical pneumonia?

  Macrolides, fluoroquinolones, tetracyclines
• How does Legionella pneumophila develop pneumonia?

  Exposure to water, staying in hotels
• What are the signs of Legionella pneumophila infection?

  Low sodium and lymphocytes
• How is Legionella managed?

  With macrolides or tetracyclines
• What is a specific feature of Mycoplasma pneumonia?

  Erythema multiforme
• What are the atypical features of Mycoplasma pneumonia?

  Young adult, dry cough, bilateral patchy consolidation
• What is Chlamydophila pneumonia associated with?

  Mild to moderate pneumonia
• What are the signs of Chlamydophila pneumonia?

  Wheezing
• Who is commonly affected by Chlamydophila pneumonia?

  School-age children
• How do people contract Coxiella burnetti (Q fever)?

  Exposure to animal bodily fluids
• How do people contract Chlamydia psittaci bacteria?

  Contact with infected birds
• What type of pneumonia is Jirovecii pneumonia?

  Fungal pneumonia
• What is a risk factor for Jirovecii pneumonia?

  HIV with CD4 <200
• What is the presentation of Jirovecii pneumonia?

  HIV + dry cough + exertional dyspnoea
• What investigations are done for Jirovecii pneumonia?

  CXR and bronchoscopy with bronchoalveolar lavage
• What prophylactic management is given for Jirovecii pneumonia?

  Co-trimoxazole
• What are the investigations for pneumonia?

  CXR, blood culture, sputum culture
• What does CXR show in pneumonia investigations?

  Consolidations
• What is the management of low severity CAP?

  5-day course of amoxicillin
• What is the management of moderate or severe CAP?

  7-10 day course with dual antibiotics

  moderate: amoxicillin & clarithromycin

  severe: co-amoxiclav & clarithromycin
• What is the management of non-severe HAP?

  1. oral co-amoxiclav (1st line)

  2. oral doxycycline (penicillin allergy)