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Year 1
Respiratory
Pneumonia
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Megan Vann
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Organisms
Year 1 > Respiratory > Pneumonia
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Pneumonia is a
lower
respiratory tract infection of the lung tissue that causes
inflammation
in the
alveolar
space
Types of pneumonia:
CAP - can be primary or secondary to underlying cause
HAP - in hospital for more than
48
hours
Ventilator
acquired
Aspiration
pneumonia
Presentation of pneumonia:
cough
productive of
sputum
Dyspnoea
Fever
Haemoptysis
Pleuritic
chest pain
Delirium
- can be only sign in
elderly
Chest signs characteristic of pneumonia:
Reduced
expansion
Bronchial
breath sounds
Course
crackles
Dullness to
percussion
Wheeze
- particularly in those with associated respiratory conditions
Streptococcus
Pneumoniae
is the most common causative pathogen of pneumonia
Urinary antigen tests are needed for causes of atypical pneumonia:
Legionella
Chlamydia
Mycoplasm
Not treatable with
penicillin
CURB-65 score for CAP:
·
Confusion
present (abbreviated mental test score <8/10)
· Urea level >
7mmol
/L
· Respiratory rate >
30
/min
· Blood pressure systolic <
90
mmHg or diastolic <
60
mmhg
· Age >
65
Patients with a CURB-65 score of 0 or 1 can usually be treated in
primary
care with no
investigation
Investigations for pneumonia:
CXR - lobular
consolidation
and pleural
effusion
FBC and CRP - raised
WCC
and inflammation
U&Es -
urea
for CURB-65 and
AKI
Sputum
culture
Blood
culture
if pyrexical
Urine
antigen
tests
Treatment of CAP:
Oral first line -
amoxicillin
, clarithromycin and doxycycline
High severity/ IV first line -
co-amoxiclav
and clarithromycin
Treatment of HAP:
Oral first line -
co-amoxiclav
Severe -
IV Taz
Patients diagnosed with pneumonia will need a follow up in
6
weeks +/- a chest
x-ray
Complications of pneumonia:
Respiratory
failure
- common
AF
Pleural
effusion
that can lead to
empyema
Pericarditis
Septic
shock
Lung
abscesses
Post infective
bronchiectasis
Pneumonia = inflammation of the lung
parenchyma
with the normal
air-filled
lungs becoming filled with infective liquid
Risk factors:
Age
- infants and those over 65
Smoking
Alcohol
Pre-existing
respiratory
conditions
Hospitalisation
Proton
pump inhibitors
Poor
oral
hygiene
Legionella
and
pneumococcal
urinary antigen: this should be requested in those with moderate or
high-severity
CAP or where other
risk
factors exist.
Vaccinations available:
Pneumococcal
haemophilus
influenza type
b
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