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