Id 6 - Bacterial Pneumonia

Front 1

Upper respiratory tract definition

Back 1

Mouth down to larynx or trachea

Front 2

Lower respiratory tract definition

Back 2

Pneumonia or bronchitis

Front 3

Pneumonia - definition

Back 3

Infection of pulmonary parenchyma

Front 4

Pneumonitis - definition

Back 4

Inflammation of pulmonary parenchyma

Front 5

Types of pneumonia

Back 5

Community-acquired
Ventilator-acquired
Hospital-acquired

Front 6

Definition of hospital-acquired pneumonia

Back 6

Onset of symptoms 48 hours or more after admission

Front 7

Normal mouth flora

Back 7

Strep viridans
Anaerobes

Front 8

Normal nose flora

Back 8

Staph aureus
Strep pneumoniae
Haemophilus
Moraxella

Front 9

Exogenous respiratory viruses

Back 9

Strep pneumoniae
Haemophilus influenza
Strep pyogenes
Neisseria meningitidis

Front 10

Upper airway host defenses

Back 10

Nose hairs filter out big particles
Turbulence moves particles to mucosa
Cilia, mucus, and saliva expel particles
IgA - antibacterial and antiviral

Front 11

Conducting airway host defenses

Back 11

Epiglottic reflex
Cough reflex - expels particles from trachea and major bronchi
Sharp angles and deposition onto mucus
Mucociliary escalator - contains lactoferrin, IgA, and lysozyme
Lymphoid cells - BALT, tonsils, submucosal

Front 12

Alveolar host defense

Back 12

Microbicidal fluids - surfactant, fibronectin, Ig, complement
Macrophages - alveolar, interstitial, dendritic cells, intravascular

Front 13

Immune response

Back 13

Opsonization by complement and Ig
Phagocytosis by neutrophils and alveolar macrophages

Front 14

Classic - fever, productive cough, pleuritic chest pain
Fatigue, anorexia, sweats, chills

Back 14

Pneumonia

Front 15

Pneumonia - signs

Back 15

Fever
Tachypnea
Rales
Pulmonary infiltrate confined to one lobe

Front 16

Pneumonia - risk factors

Back 16

Disruption of anatomic or mechanical barriers - smoking, CHF, COPD
Increased exposure to pathogens
Immune deficiency - very young or old, HIV, diabetes
Iatrogenic - bronchoscopy, sedation, medical immunosuppression

Front 17

Other types of pneumonia

Back 17

Elderly - nonspecific complains, delirium, dyspnea
Aspiration pneumonia - associated with poor dentition, mouth flora
Atypical - more gradual onset, diffuse infiltrates
Post-obstructive - distal to bronchial obstruction, usually cancer, recurrent unless obstruction is relieved

Front 18

Pneumonia - organisms (birth to 3 weeks)

Back 18

Group B strep
Listeria
Gram negatives

Front 19

Pneumonia - organisms (3 weeks to 3 months)

Back 19

Strep pneumo
Bordatella
Staph aureus
Chlamydia

Front 20

Pneumonia - organisms (3 months to 5 years)

Back 20

Strep pneumo
Haemophilus
Mycoplasma

Front 21

Pneumonia - organisms (5-15 years)

Back 21

Strep pneumo
Mycoplasma
Chlamydia

Front 22

Pneumonia - organisms (adults)

Back 22

Strep pneumo
Moraxella
Haemophilus
Staph aureus recently
Gram negatives - klebsiella, nosocomial

Front 23

Gram positive diplococcus
Alpha hemolytic
Colonizes nasopharynx

Back 23

Strep pneumo

Front 24

Strep pneumo - bad prognostic indicators

Back 24

Multilobar disease
Age
Associated comorbidities

Front 25

Strep pneumo - virulence factors

Back 25

Polysaccharide capsule
Damage mostly from host immune response

Front 26

Strep pneumo - treatment

Back 26

Penicillin
Ceftriaxone
Quinolones

Front 27

Gram negative coccobacillus
Associated with chronic lung disease
Serotypes A-F

Back 27

Haemophilus influenza

Front 28

Gram negative diplococcus
Colonizes nasopharyngeal mucosa
Spread to middle ear, sinuses, and lower tract

Back 28

Moraxella catarrhalis

Front 29

Gram positive coccus
Associated with skin and soft tissue infections
Severe necrotizing pneumonia in kids and adolescents

Back 29

Staph aureus

Front 30

Staph aureus - treatment

Back 30

Empirically with vancomycin

Front 31

Pneumonia - complications

Back 31

Pleural effusion - usually resolves by itself
Empyema - infected effusion, needs to be drained

Front 32

Pneumonia - diagnosis

Back 32

History
Physical
Blood and sputum culture
HIV test
CBC
Arterial blood gas and test for etiologic agents if hospitalized
Chest x-ray for effusions and diagnosis

Front 33

Pneumonia - supportive care

Back 33

IV fluids and vasopressors to support BP
Supplemental oxygen or mechanical ventilation

Front 34

Pneumonia - antibiotics

Back 34

Outpatient - macrolide, doxycycline, fluoroquinolone with enhanced strep pneumo activity
Ward - macrolide with either ceftriaxone, cefoxatime, or penicillin-beta lactamase combination
Pathogen-directed

Front 35

Pneumonia - prevention

Back 35

Hand hygiene
Active immunization - strep pneumo, haemophilus influenza type B
Avoid exposures that thwart respiratory defenses

Front 36

Hospital-acquired pneumonia - properties

Back 36

Onset 48-72 hours after admission
Predominantly gram negatives
Increased risk of drug resistance

Front 37

Hospital-acquired pneumonia - organisms

Back 37

Enterobacteriaceae - E coli, klebsiella, enterobacter
Pseudomonas
Staph aureus
Acinetobacter
CAP organisms

Front 38

Hospital-acquired pneumonia - treatment

Back 38

Early broad spectrum empiric antibiotics

Front 39

Hospital-acquired pneumonia - prevention

Back 39

Handwashing
Aspiration precautions
Careful washing of respiratory equipment
Flu vaccination in health care workers