Pneumonia is a common respiratory illness and a leading cause of morbidity and mortality worldwide, especially in young children and elderly individuals. It is a common presentation in clinical practice, and medical professionals need to be familiar with its management, including the use of antibiotics, and supportive care.
Steroids used in both covid-19 and Pneumocystis Jiroveci causing interstitial pneumonia.
Commonest cause of pneumonia in AIDS positive patient is Pneumococcus not Pneumocystis jivovecio
Organism Specific Approach for Pneumonia
Alcoholism= S. pneumonia, Klebsiella Pneumoniae, oral anaerobes.
Klebsiella pneumonia in alcoholics causes Necrotizing Pneumonia that results in a feature of red currant Jelly sputum.
Oral anaerobes in alcoholics cause Necrotizing Pneumonia that results in lung abscess. Chest X-ray showing air fluid level S/O Lung abscess
Impaired airway defence seen in alcohol/drug intoxication, dementia, stroke, etc., cause of pneumonia is Oral anaerobes
Rx of oral anaerobes causing Pneumonia is clindamycin
1. Red currant Jelly stool in 9-month baby S/O intussusception 2. Multiple air fluid level in X-ray abdomen S/O Intestinal obstruction
COPD: H. influenzae
Lung abscess: oral Anaerobes? Primary.
CA-MRSA ? Secondary to setting of foreign body, Tumor, Infection.
Hotel stay / cruise : Legionella Pneumophila. (due to inhalation of water droplets)
Infected Humans: SARS - COV 2
Birds: H. capsulatum, C.pittaci
Rabbits: F. tularensis.
Tularemia is caused by the bacterium Francisella tularensis.
Hunter after killing a rabbit develops Eschar/ ulcer and regional lymph node swelling.
Ulceroglandular fever: The most common form of tularemia and usually occurs following a tick bite or after handing of an infected animal. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
Sheep: Coxiella Brunetti / Q fever
Coxiella Brunetti cause atypical pneumonia and Endocarditis as well.
Rx of Atypical Pneumonia: Macrolides.
Confusion (defined as a Mental Test Score of ≤8, or disorientation in person, place, or time )
Uremia: BUN >7 mmol/L ( ~19 mg / dL)
Respiratory rate: ≥30 breaths / minute
Blood pressure: systolic <90 mm Hg or diastolic ≤60 mm Hg
Age ≥65 years
BUN = UREA/2.14
E.g., BUN= 10, UREA = BUN x 2.14 = 10 x 2.14 = 21.4 mg/dl
Urea = BUN x 0.35
E.g., BUN= 10, Urea = 10 x 0.35 = 3.5 mmol/L
Treatment options based on CURB -65 Score
Group 1; mortality low (1.5%)
Low risk; consider home treatment
Group 2; mortality intermediate (9.2%)
Consider hospital-supervised treatment (either short – stay inpatient or hospital – supervised outpatient)
Group 3; mortality high (22%)
Manage in hospital as severe pneumonia; consider admission to
For group 1: OPD management is done
For group 2: IPD management is done. E,g., 70 yrs old patient with elevated BUN RX: IV Augmentin with macrolides
For group 3: ICU management is done
If only age is >/= 65 and rest are normal. Treatment is based on health condition of patient the treating doctor can decide the type of management.
If age along with another deranged parameter is given. Then admit patient and give parenteral antibiotics
Beta lactam+ macrolide or respiratory fluroquinolones (levofloxacin, moxifloxacin, Gemifloxacin)
If recent hospitalization/ respiratory isolation
Add coverage for MRSA: Vancomycin/ linezolid & for pseudomonas: Piperacillin-Tazobactum
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