| What is acute bronchitis? | It is an infection involving large airways (bronchi) without evidence of pneumonia and COPD, occurs with viruses and some bacteria, usually self-limited |
| What is pneumonia? | Infection of pulmonary parenchyma, divided into community acquired (CAP) and nosocomial (could be hospital acquire (HAP) or ventilator acquired (VAP)) |
| Talk about the epidemiology of pneumonia? | CAP is most common encountered condition in clinical practice and is the second cause of hospitalization and most common infectious cause of death |
| What are the risk factors for developing CAP? | Old age, chronic comorbidities (COPD, diabetes, heart disease), Viral illness, smoking, alcohol, Immunocomprimised. |
| What are the most common microbiological causes of pneumonia? | Strep pneumonia, respiratory viruses |
| What are the pneumoniogenic bacteria? | S.pneumonia, haemophilus influenza, Moraxella cattarrhalis, Staph aureus (typical)
Atypical: Legionella, mycoplasma pneumonia, chlamydia pneumonia |
| What respiratory viruses cause pneumonia? | Influenza A and B, Rhinoviruses, Parainfluenza virus, Adenovirus |
| What is the current situation regarding bacterial/ viral detection causing pneumonia? | Pneumococcus is declining, but still the nb one cause
rarely do we identify the pathogen causing pneumonia (50% of the time)
There is also antimicrobial resistance patterns and risk factors to be known in order to know the selection for empiric CAP antibiotic tx. |
| How is the pathogenesis of pneumonia? | Transmission by droplets and to a lesser extent aerosols (legionella)
Pathogens colonize nasopharyx and reach alveoli by microaspiration, when inoculum size is sufficient immune defense is impaired resulting in an infection.
then replication and inflammation occurs damaging parenchyma causing pnuemonia |
| What is the clinical presentation of pneumonia? | Vary from mild cough and fever to sepsis and respiratory failure.
Most common respiratory symptoms are cough (dry or with sputum), dyspnea, and pleuritic chest pain
General symptoms are fever, chills, fatigue and hypotension |
| What is the physical exam findings for pneumonia? | tachypnea, increased work of breathing, crackels in bronchi
Tectile fremitus, egophony and dullness percussion |
| How do we diagnose pneumonia? | Clinically compatible symptoms with X ray finding of infiltrates (PA imaging), we see consolidations/ cavitations
We also use CT scan for immunocomprimised pt and pt with normal X ray
We can also perform labs CBC, CRP and BUN levels
Maybe blood and sputum culture, urinary Ag, PCR (viruses) |
| How do we assess the severity of pneumonia? | Use one of the scores, either pneumonia severity index or CURB-65 |
| What is CURB-65 assessment table? | . |
| When do we treat pneumonia? | Pt with oxygen saturation <92%, intermediate scores (CURB>1 / PSI>III) unable to take oral drugs with impaired cognition should be hospitalized
Respiratory failure pt should be ventilated and ones with sepsis enter the ICU |
| What is the treatment for pneumonia? | First Abx dose is <4 hours - least possible time to get the dose (depends on severity of condition)
Macrolide if resistance <20 percent , if >25 beta lactam w/ macrolide or doxycyclin/ only give fluoroquinolone (if no suspicion of MRSA or pseudomonas
If pseudomonas sus (antipseudomonas beta lactam and quinolone
ICU pt both beta lactam and fluorquinolone for 5-7 days and stop when pt is afebrile and improving for 2 days
Chest radiography required after 4-6 weeks for pt >50 years smokers |
