Pneumonia

• What is pneumonia?

  Pneumonia is an infection of the lung tissue causing inflammation in the alveolar space.
• How can pneumonia be identified on a chest x-ray?

  Pneumonia can be seen as a consolidation on a chest x-ray.
• What does acute bronchitis refer to?

  Acute bronchitis refers to infection and inflammation in the bronchi and bronchioles.
• How are pneumonia and acute bronchitis classified in terms of respiratory tract infections?

  Both pneumonia and acute bronchitis are classed as lower respiratory tract infections.
• What type of infections are upper respiratory tract infections usually associated with?

  Upper respiratory tract infections are usually viral.
• What is the general rule regarding the probability of bacterial infection in the respiratory tract?

  The lower down the respiratory tract, the higher the probability of bacterial infection, as opposed to viral.
• How can pneumonia be classified based on where the infection was acquired?

  • Community-acquired pneumonia (CAP)
  • Hospital-acquired pneumonia (HAP)
  • Ventilator-acquired pneumonia (VAP)
  • Aspiration pneumonia
• What is community-acquired pneumonia (CAP)?

  Community-acquired pneumonia (CAP) develops in the community.
• What is hospital-acquired pneumonia (HAP)?

  Hospital-acquired pneumonia (HAP) develops after more than 48 hours in a hospital.
• What is ventilator-acquired pneumonia (VAP)?

  Ventilator-acquired pneumonia (VAP) develops in intubated patients in the intensive care unit.
• What is aspiration pneumonia?

  Aspiration pneumonia is when the infection develops due to the aspiration of food or fluids.
• What type of bacteria is aspiration pneumonia associated with?

  Aspiration pneumonia is associated with anaerobic bacteria.
• What are the presenting symptoms of pneumonia?

  • Cough
  • Sputum production
  • Shortness of breath
  • Fever
  • Feeling generally unwell
  • Haemoptysis (coughing up blood)
  • Pleuritic chest pain
  • Delirium (acute confusion)
• What are the characteristic chest signs of pneumonia?

  • Bronchial breath sounds
  • Focal coarse crackles
  • Dullness to percussion
• What can derangements in basic observations indicate in pneumonia patients?

  They can indicate sepsis secondary to pneumonia.
• What are the signs of sepsis secondary to pneumonia?

  • Tachypnoea (raised respiratory rate)
  • Tachycardia (raised heart rate)
  • Hypoxia (low oxygen)
  • Hypotension (shock)
  • Fever
  • Confusion
• What scoring systems are recommended for severity assessment of pneumonia?

  • CRB-65 scoring system (out of hospital)
  • CURB-65 scoring system (in hospital)
• What does a CRB-65 score of more than 0 suggest?

  It suggests considering hospital assessment.
• What does the CURB-65 score predict?

  The CURB-65 score predicts mortality.
• What does a CURB-65 score of 0/1 indicate?

  A CURB-65 score of 0/1 indicates low risk (under 3%).
• What should be considered for a CURB-65 score of 2?

  Consider hospital admission for a CURB-65 score of 2.
• What should be considered for a CURB-65 score of 3 or more?

  Consider intensive care for a CURB-65 score of 3 or more.
• What are the top causes of typical bacterial pneumonia?

  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
  • Methicillin-resistant Staphylococcus aureus (MRSA)
• What is the most common cause of typical bacterial pneumonia?

  Streptococcus pneumoniae is the most common cause.
• In which patients is Moraxella catarrhalis a common cause of pneumonia?

  Moraxella catarrhalis is common in immunocompromised patients or those with chronic pulmonary disease.
• In which patients is Pseudomonas aeruginosa a common cause of pneumonia?

  Pseudomonas aeruginosa is common in patients with cystic fibrosis or bronchiectasis.
• In which patients is Staphylococcus aureus a common cause of pneumonia?

  Staphylococcus aureus is common in patients with cystic fibrosis.
• In which patients is Methicillin-resistant Staphylococcus aureus (MRSA) a common cause of pneumonia?

  MRSA is common in hospital-acquired infections.
• What is atypical pneumonia caused by?

  Atypical pneumonia is caused by organisms that cannot be cultured in the normal way or detected using a gram stain.
• Why is treatment with penicillin ineffective for atypical pneumonia?

  Treatment with penicillin is ineffective for atypical pneumonia.
• What types of antibiotics are used to treat atypical pneumonia?

  Atypical pneumonia is treated with macrolides, fluoroquinolones, and tetracyclines.
• What organism typically causes Legionnaires’ disease?

  Legionella pneumophila typically causes Legionnaires’ disease.
• How is Legionella pneumophila typically contracted?

  Legionella pneumophila is typically contracted by inhaling infected water from infected water systems.
• What syndrome can Legionella pneumophila cause?

  Legionella pneumophila can cause a syndrome of inappropriate ADH (SIADH), resulting in hyponatraemia.
• What is a typical presentation of a patient with Legionnaires’ disease?

  The typical exam patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia.
• What test can be used as an initial screening for Legionella pneumophila?

  A urine antigen test can be used as an initial screening test for Legionella pneumophila.