15- pneumonia pt.3

• Strept pneumo

  • Sputum: rusted color
  • High fever, pleuritic chest pain
  • Acute onset, preceded by flu-like symptoms
  • Urine antigen test
  • WBC > 15 (90% polymorphic leukocytosis)
  • High ESR & CRP
  • +ve blood cultures indicate severe disease with higher mortality
  • Associated with herpes labialis
• Mycoplasma

  • Mild disease in young patient
  • X-ray does not correlate to the clinical picture (patient signs and symptoms are mild while x-ray looks very bad)
  • Prominent extra-pulmonary features (headache, malaise, myalgia)
  • Hemolytic anemia (cold agglutinins; thrombocytopenia)
  • Erythema multiforme
  • Hepatitis
  • Meningoencephalitis
  • Myocarditis and pericarditis
  • Serology: high IgM
  • WBC usually normal
• Legionella

  • More severe disease with need for early intensive care
  • Inhaling water-mist bacteria
  • Headache and neurological symptoms
  • GI involvement, hepatitis, high CK
  • More common in young, males, smokers
  • Urinary antigen
  • Lymphopenia with no marked leukocytosis
  • Hyponatremia
  • Hypoalbuminemia
  • High liver enzymes
• Risk factors for pneumonia

  • Alcohol: klebsiella or TB
  • Smoking/COPD: Hemophilus influenzae, Moraxella, Strept pneumo
  • Aspiration: gram –ve
  • Abscess: fungal, atypical, TB, MRSA
  • Cavitation: staph aureus, klebsiella, anaerobes, TB
  • Staph aureus: recent influenza
  • Chlamydophila pneumonia: hoarseness