Case 24: Community Acquired Pneumonia

What is the most common etiology of cough?
Upper respiratory tract infection

What is the gold standard for the diagnosis of pneumonia?
Demonstration of an infiltrate on chest x-ray

What is the defintion of pneumonia?
Infection of the lung parenchyma. This can be caused by bacteria, viruses, fungi, or parasites.

What is the defintion of pneumonitis?
Inflammation of the lung parenchyma due to non-infectious etiologies

What is the most common mechanism for a pneumonia infection?
Upper respiratory infection with aspiration

What organism most commonly causes community acquired pneumonia?
Strep pneumoniae

What are the three most common causes of ear infections, sinus infections, and pneumonia?
Strep pneumo, haemophilus influenzae, and moraxella catarrhalis

What are some of the organisms that can cause atypical or interstitial pneumonia?
Rickettsia, viruses, mycoplasma pneumonia, chlamydia pneumoniae, and legionella pneumophila

What are some of the risk factors that lead to the development of health care associated pneumonia?
Intubation, nasogastric tube feeding, pre-existing lung disease, and multisystem failure

What are some of the organisms that in addition to the organisms that cause community acquired pneumonia, can cause HCAP?
Klebsiella, Pseudomonas, and Acinetobacter

What are some ofthe common symptoms that occur in a patient with pneumonia?
Productive cough, fever, pleuritic chest pain, and dyspnea

What is the classic presentation for Staph aureus pneumonia?
Post influenza pneumonia

What is the classic presentation for legionella pneumonia?
Pneumonia in an elderly male smoker that is associated with abdominal symptoms such as diarrhea

What is the typical location of a pneumonia that is caused by the aspiration of gastric contents?
Right lower lobe pneumonia

What is the classic appearance and presentation of PJP pneumonia?
PJP causes ground glass infiltrate in an immunosuppressed individual with a CD4 count less than 200.

Which types of pneumonia can be identified with antigen testing?
Mycoplasma and legionella

Which type of pneumonia can be detected with a urine antigen test?
Legionella

What is CURB-65
A method to determine if a patient with pneumonia requires hospitalization. C stands for confusion, U stands for urea greater than 19 mg/dL, R stands for respiratory rate greater than 30, B stands for blood pressure, less than 90 systolic or 60 diastolic, , and 65 stands for greater than 65 years of age

A score greater than what on CURB-65 should indicate hospitalization?
A score of 3 or higher

What additional index can be used to assess the severity of pneumonia?
Pneumonia Severity Index

What is the epiric treatment for community acquired pneumonia?
A macrolide such as clarithromycin or azithromycin

What is an alternative therapy in areas with a high degree of resistance?
A new respiratory fluoroquinolone such as levofloxacin or moxifloxacin, or the combination of a beta lactam and a macrolide.

For hospitalized patients, what IV treatments are recommended for the treatment of community acquired pneumonia?
IV beta lactam or an IV macrolide

In an outpatient setting, how long after the initial visit should the follow up visit be made?
3-4 days after the initial visit

How long should the person be treated for in an uncomplicated Strep pneumo pneumonia?
Until the patient has been afebrile for 14 hours

What are some of the possible complications of pneumonia?
Bacteremia, pleural effusion, and empyema formation

What are the recommendations for vaccination with the pneumococcal vaccine?
Vaccination is recommended for everyone over the age of 65, with possible revaccination after 5 years. In addition those with chronic pulmonary diseases, cigarette smokers, and immunocompromised individuals should be vaccinated sooner.

What is the treatment of choice for pneumonias caused by staph?
Erythromycin

What is the treatment of choice of pneumonias caused by legionella?
Erythromycin

What is the treatment of choice for pneumonias caused by Haemophilus influenza?
Cefuroxime

Community Acquired pneumonia (CAP) definition – no contact with hospital setting – vary by age and comorbidites ____% of the time the cause of CAP is left unknown 30-40% of the time the cause of CAP is left unknown WE …

What are the most common etiologies of Outpatient CAP? Streptococcus pneumonia, Mycoplasma pneumonia, Haemophilus pneumonia, Chlamidophila pneumonia, respiratory viruses. What is the drug of choice for CAP in outpatients? Macrolides: Azithromycin (Z-pack), or Clarithromycin (Biaxin 250-500mg Q 12h ~ Biaxin …

Causes of pneumonia Most common mechanism of infection = aspiration of organisms colonizing the oropharynx. Inhalation of infected aerosols. Hematogenous dissemination (uncommon) History findings Cough (productive or non-productive), fever, shaking chills, pleuritic chest pain (pain is worsened on deep inspiration), …

what is the most common cause of pneumonia? strep pneumonia what can cause atypical pneumonia? mycoplasma, respiratory viruses, chlamydia pneumonia (influenza, rsv, adenovirus, parainfluenza virus) WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY …

False (4th) True or False: Pneumonia is the 3rd leading cause of death in the US. True True or False: Pneumonia is the most common cause of death from infectious disease in the US. WE WILL WRITE A CUSTOM ESSAY …

Compromises to respiratory defence that increase risk of lower respiratory tract infections – 5 main types – 10 examples 1) Swallowing – Alcohol – Muscle weakness – Stroke 2) Ciliary function – Smoking – Viral infection – Primary ciliary dyskinesia …

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