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Pneumonias

Pneumonias. Case History. What are the signs to diagnose severe pneumonia? Enumerate 4 organisms for community acquired pneumonia. Symptoms( 2 or 3 of the 4 cardinal symptoms missing ) . Signs (None of the signs in 50% patients with pneumonia Dx CXR). Diagnosis. Chest X ray

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Pneumonias

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  1. Pneumonias

  2. Case History • What are the signs to diagnose severe pneumonia? • Enumerate 4 organisms for community acquired pneumonia

  3. Symptoms( 2 or 3 of the 4 cardinal symptoms missing )

  4. Signs (None of the signs in 50% patients with pneumonia Dx CXR)

  5. Diagnosis • Chest X ray • Microbiological testing • Blood tests: WCC, ESR,CRP

  6. Chest X Ray • Indicated : severely ill patient + diagnostic doubt • Unreliable : study shows 8 out of 26 pneumonias diagnosed with high resolution CTs were not diagnosed by CXR. • Follow up CXR after 6 weeks : patients with increased risk of lung cancer , smokers > 40 years

  7. Microbiological testing • Specimens: sputum or nasopharynx • Common causes of pneumonia : Streptococcus pneumonia ( pneumococci) , Haemophilusinfluenzae, Mycoplasma pneumonia, Chlamydia pneumonia and Legionella pneumonia • PCR Analysis(1-2 days) , IgM testing(1-2 days) , Culture ( days)

  8. Common causes of pneumonia

  9. White cell count • Elevated : (usually ) pneumococcal pneumonia • Normal: (usually) pneumonias caused by viruses , M pneumonia and C pneumonia

  10. ESR • Elevated : all pneumonias regardless of aetiology • A few days b4 value exceeds the reference range

  11. CRP: elevated within 12 hours + increase reflects disease severity

  12. Treatment • Pneumonia severity index (PSI) US • CURB 65 • CRB 65

  13. Patient classificationusing the pneumonia severityindex (PSI)* PSI risk class l (lowest risk) Patient has none of the following: • Age >50 • History of • neoplastic disease • congestive cardiac failure • C erebrovascular • renal • liver disease (3) Clinical signs • altered mental state • pulse rate ≥125 bpm • respiratory rate ≥30 breaths/min • systolic blood pressure <90mmHg • temperature <35ºC or ≥40ºC.

  14. Patient classificationusing the pneumonia severityindex (PSI)* PSI risk classes ll–V Patients with any of the above characteristics are classified according to their PSI score, calculated according to the table on the left.

  15. Pneumonia Severity Index (1) Factor: age + nursing home resident (2) Coexisting illness: (3) Signs on examination: (4) Results of investigation:

  16. PSI: Factor + Coexisting illness

  17. PSI: Signs on examination

  18. PSI: Results of investigations

  19. Interpretation of PSI Risk score

  20. Treatment of CAP:PSI risk Class I (low risk) or class II - treatment outside hospital (1) Amoxycillin 500-1000mg orally tds for seven days (if penicillin allergy, use cefuroxime 500mg orally bd for seven days) (2) AND if Mycoplasma or Chlamydia are suspected change to, or add, either: • Oral doxycycline 200mg orally for the first dose, followed by 100mg daily for five days or alternatively • Roxithromycin 300mg orally daily for five days

  21. Treatment of CAP: PSI risk Class III and IV* — treatment in hospital Should be managed as inpatients using (1) IV penicillins (or ceftriaxone/cefotaxime) + oral agents such as doxycycline Or (2) clarithromycin or roxithromycinas per antibiotic guidelines

  22. Pneumonia in children

  23. Severity assessment —indicators for admission to hospital

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