Term
| Defense Mechanisms Against Pneumonia |
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Definition
- Nasal Hair/Mucus Producing Cells: initial mechanical barrier
- Current Flora: prevents colonization
- Epiglottis: physical barrier when swallowing
- Trachea/Bronchioles: ciliated columnar epithelial cells interspersed with mucus-secreting cells
- Alveoli: alveolar lining contains surfactant, fibronectin, IgG, Iron-binding proteins, immune and phagocytic cells
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Term
| Risk Factors for Pneumonia |
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Definition
- Increased aspiration risk (alcohol, seizures, stroke, MS/neurologic disorders)
- Reduced mucociliary transport of debris (smoking, cold, elderly, cystic fibrosis)
- Decreased macrophage activity (alcoholism, elderly, immunosuppression)
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Term
| Pathogen-Specific Risk Factors for Pneumonia |
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Definition
- MRSA (prisoners, homeless, children in daycare)
- Legionella (DM, cancer, HIV, smoking)
- Resistant Strep. pneumoniae (beta lactam in past 3 months, elderly, immunosuppression, alcoholism)
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Term
| Clinical Presentation of Pneumonia |
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Definition
- New Cough that is productive
Watery, scant (atypicals)
Rust colored (Strep. pneumoniae)
Red jelly (Klebsiella)
Foul smelling, putrid (anaerobes)
2. Increased sputum production/change in consistency
3. Fever or hypothermia
4. Chills
5. Fatigue, myalgias, abdominal pain, anorexia, headache
6. Dyspnea
7. Rigors
8. Sweats
9. Pleuritic chest pain |
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Term
| If someone had pneumonia, a Physical Exam would show: |
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Definition
- Dullness to percussion of the chest
- Crackles or rales
- Bronchial breath sounds
- Tactile fremitus
- Egophony
- Tachypnea
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Term
| A CBC for someone that had pneumonia would show: |
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Definition
- Elevated WBCs
- Elevated Bands with Left Shift (more immature WBCs)
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Term
| What is required to have a good sputum sample whe diagnosing someone with pneumonia? |
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Definition
- < 10 epithelial cells
- > 25 WBCs (neutrophils)
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Term
| When diagnosing someone based on Gram Stains/Cultures, you would check: |
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Definition
- Sputum
- Blood
- Urine Antigen (rapid and simple)
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Term
| Limitations with Gram Stains/Culture Samples |
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Definition
- No good sputum sample/can't get one
- Some bacteria don't gram stain/slow growers
- Time to get results
- Usually can't get a culture before you start antibiotics
- Contamination with normal flora
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Term
| Typical Pathogens that cause Pneumonia |
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Definition
- Mycoplasma pneumoniae
- Streptococcus pneumoniae
- Haemophilus influenzae
- Chlamydia pneumoniae
- Legionella pneumoniae
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Term
| For outpatient treatment of pneumonia, if patient does not have comorbidities, you treat with: |
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Definition
1st Line: Macrolides (azithromycin, clarithromycin, erythromycin)
2nd Line: Doxycycline
3rd Line: Ketolide
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Term
| For outpatient treatment of pneumonia, if the patient develops a high resistance to macrolides, then what would you use? |
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Definition
| Respiratory Fluoroquinolones (moxifloxacin, gemifloxacin, levofloxacin) even if they don't have comorbidities |
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Term
| For outpatient treatment of pneumonia, if patient has comorbidities, you treat with: |
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Definition
1st Line: Resp. Fluoroquinolones (moxifloxacin, gemifloxacin, levofloxacin)
OR
Beta Lactam + Macrolide
2nd Line: Doxycycline
3rd Line: Ketolide |
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Term
| For outpatient treatment of pneumonia, if patient has comorbidities, what is the preferred beta lactam, including dose and schedule? |
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Definition
Amoxicillin 1 g TID
OR
Augmentin 2 g BID |
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Term
| For inpatient treatment of pneumonia, if the patient is not admitted to the ICU, what should they be treated with? |
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Definition
Resp. Fluoroquinolone
OR
Beta Lactam (ceftriaxone, cefotaxime, ampicillin) + Macrolide |
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Term
| For inpatient treatment of pneumonia, if the patient is admitted to the ICU, what should they be treated with? |
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Definition
| Beta Lactam (cefotaxime, ceftriaxone, ampicillin-sulbactam) + either azithromycin or a fluoroquinolone |
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Term
| For inpatient treatment of pneumonia, if the patient is not admitted to the ICU, what should they be treated with if they have PCN allergy? |
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Definition
| Resp. Fluoroquinolone (Moxifloxacin, gemifloxacin, levofloxacin) |
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Term
| For inpatient treatment of pneumonia, if the patient is admitted to the ICU, what should they be treated with if they have a PCN allergy? |
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Definition
| Resp. Fluoroquinolone + Aztreonam |
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Term
| What are the preferred beta lactams for pseudomonal pneumonia? |
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Definition
- Piperacillin-Tazobactam
- Cefepime
- Imipenem
- Meropenem
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Term
| If pseudomonas is suspected to be the cause of pneumonia and the patient has a PCN allergy, what could you use? |
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Definition
- Aztreonam
- Aminoglycoside
- Antipneumococcal Fluoroquinolone (Ciprofloxacin, Levofloxacin)
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Term
| If patient acquried CA-MRSA that causes pneumonia, what should you treat it with? |
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Definition
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Term
Targeted Therapy
Strep. pneumoniae
PCN Non-Resistant |
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Definition
Preferred: PCN G, Amoxicillin
Alt: Macrolide, cephalosporins, clindamycin, vancomycin, linezolid, high dose amoxicillin |
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Term
Targeted Therapy
Strep. pneumoniae
PCN Resistant |
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Definition
Agents chosen on basis of susceptibility
If MIC < 4, high dose amoxicillin |
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Term
Targeted Therapy
H. influenzae
Non-Beta Lactmase Producing |
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Definition
Preferred: Amoxicillin
Alt: Fluoroquinolone, doxycycline, azithromycin, clarithromycin |
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Term
Targeted Therapy
H. influenzae
Beta Lactmase Producing |
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Definition
Preferred: 2nd/3rd Gen. Cephalosporins, amoxicillin-clavulanate
Alt: Fluoroquinolone, doxycycline, azithromycin, clarithromycin |
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Term
Targeted Therapy
Mycoplasma/Chlamydophila pneumoniae
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Definition
Preferred: Macrolide, tetracycline
Alt: Fluoroquinolone |
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Term
Targeted Therapy
Legionella spp. |
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Definition
Preferred: Azithromycin, Fluoroquinolones
Alt: Doxycycline |
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Term
Targeted Therapy
Chlamydophila psittaci |
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Definition
Preferred: TCN
Alt: Macrolide |
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Term
Targeted Therapy
Coxiella burnetti |
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Definition
Preferred: Tetracycline
Alt: Macrolide |
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Term
Targeted Therapy
Francisella tularensis |
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Definition
Preferred: Doxycycline
Alt: Gentamicin, Fluoroquinolone |
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Term
Targeted Therapy
Yersinia pestis |
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Definition
Preferred: Streptomycin, gentamicin
Alt: Doxycycline, Fluoroquinolone |
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Term
Targeted Therapy
Enterobacteriaceae |
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Definition
Preferred: 3rd gen. Cephalosporins, Carbepenems
Alt: Beta Lactam/Beta Lactamase Inhibitors, Fluoroquinolones |
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Term
Targeted Therapy
Histoplasmosis/Blastomycosis |
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Definition
Preferred: Itraconazole
Alt: Amphotericin B
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Term
Targeted Therapy
Mycobacterium tuberculosis |
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Definition
Preferred: Isoniazid + Rifampin + Ethambutoll + Pyrazinamide
Alt: Guideline-directed |
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Term
| Duration of Treatment for CAP |
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Definition
- Typically 10-14 days, minimun of 5 (10-14 days for immunosuppressed or Legionella infection)
- Should be afebrile for 48-72 hrs
- Should have no more than one CAP-associated sign of clinical instability before discontinuing therapy
- Longer duration needed if initial therapy was not active against identified pathogen or if course infection was complicated (meningitis, endocarditis)
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Term
| Hemagluttinin's role in influenza infection |
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Definition
| Attaches to sialic acid receptor on host cell to allow virus to enter cell |
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Term
| Neuraminidase's role in influenza infection |
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Definition
| Allows release of new viral particles from host cells by catalyzing the cleavage of linkages to sialic acid |
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Term
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Definition
- Small changes in hemagluttinin and/or neuraminidase molecules
- Responsible for seasonal epidemics
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Term
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Definition
- Virus acquires a new hemagluttinin and/or neuraminidase via genetic reassortment rather than point mutations
- H1N1 (swine flu)
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Term
| Disease-Specific Pathogens for Pneumonia: Alcoholism |
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Definition
- Strep. pneumoniae
- Oral anaerobes
- Klebsiella pneumoniae
- Acinetobacter spp.
- Mycobacterium tuberculosis
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Term
| Disease-Specific Pathogens for Pneumonia: COPD and/or Smoking |
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Definition
- H. influenzae
- P. aeruginosa
- Legionella spp.
- S. pneumoniae
- Moraxella catarrhalis
- Chlamydophila pneumoniae
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Term
| Disease-Specific Pathogens for Pneumonia: Aspiration |
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Definition
- G- Enteric Pathogens
- Oral anaerobes
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Term
| Disease-Specific Pathogens for Pneumonia: IV Drug Use |
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Definition
- S. aureus
- Anaerobes
- Mycobacterium tuberculosis
- S. pneumoniae
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