pneumonia

An acute lower respiratory tract infection associated with fever and other abnormal chest symptoms and signs

Causes/Factors

• Community acquired (CAP) - most common streptococcus pneumoniae. Occurring outside of hospital or within 48hr of admission

CURB-65 - one point for each

• Confusion - AMTS $\le$ 8
• Urea - >7 mmol/L
• RR - $\ge$ 30
• Blood pressure < 90 systolic or <60 diastolic
• Age $\ge$ 65 (soft score)

0-1 - low risk home management - 500mg amoxicillin TDS for 5 days 2 - intermediate risk - short in-patient stay $\ge$ 3 - high risk - severe pneumonia

Risk of death with CURB-65

Score	Risk of death at 30 days
0	0.7%
1	3.2%
2	13.0%
3	17.0%
4	41.5%
5	57.0%

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• Hospital acquired (HAP) - after 48hs from admission

• Ventilator associated (VAP)

• Asp iration Pneumonia

• Immunocompromised patient - patients recurrently coming with a CAP is an indicator of HIV - esp if organism is weird

Symptoms

• Fever
• Rigors
• Anorexia
• Dyspnoea
• Productive cough
• Pleural pain

Signs

• Pyrexia
• Cyanosis
• Confusion - may be only sign in elderly patients
• Tachypnoea
• Tachycardia
• Hypotension
• Hypoxia
• Bronchial breathing (harsh breath sounds) and crackles heard

Diagnostic Tests

• CXR: showing consolidation

• Blood/sputum culture

• Bronchoscopy if risk of infection for bloods

• U&Es - hyponatremia Pneumonia $\to$ legionella. Can also use urinary antigen very sensitive and specific for legionella

• Pet history - parrots $\to$ Chlymidia pneumonitis

• Weird rash $\to$ Mycoplasma

Management

ABCDE

• Fluids
• Oxygen
• Antibiotics
• Assisted ventilation

Complications/red Flags

• Type 1 Respiratory Failure ($Pa{O}_2<8kPa$)
• Hypotension ← vasodilation/dehydration ← Sepsis
• Atrial Fibrillation - common in elderly, usually resolves with treatment
• Pleural Effusion - inflammation of pleura leading to fluid build up
• Empyema - pus in pleural space, should be drained with chest drain
• Lung Abscess
• Pericarditis and myocarditis
• Jaundice - usually cholestatic - may be due to Sepsis or secondary to antibiotic treatment (esp. flucloxacillin and Co-amoxiclav)