Pneumonia

Legionella pneumonia

* needs a specific environment to survive in ( it's fastidious). The organism is transmitted when it becomes airborne and enters the patients lungs as an aerosol.

Chyamydia pneumoniae:

- a cause of pnuemonia in adults - it has been detected in schools, military instituions, and families. - It is associated with meningoencephalitis, myocarditis, endcarditis, cornonary artery disease and Guillain-Barre syndrome

The major pathologic or structural changes associated with pneumonia are as follows:

- inflammation of the alveoli -Alveolar consolidation -Atelectasis b/c of mucus plugging ( eg. aspiration pneumonia).

A patient with severe pneumonia can be expected to have the following:

1. chest pain 2. tachycardia 3. hemoptysis 4. cyanosis

Staphylococcal pneumonia

1.) Staph aureus which is responsible for most staph infections in humans & 2.) staph epi, which are part of the normal skin flora. Staph pneumonia often follows a predisposing virus infection and is seen most often in children and immunosuppressed adults. S. aureus is commonly transmitted by aerosol from a cough or sneeze of an infected individual and indirectl via contact with contaminated floors, bedding, clothes, and the like. ( FOMITES)... Staphylococci are a common cause of hospital-acquired pneumoniaand are becoming increasingly antibiotic resistant.

Mycoplasma pneumonia (aka walking pneumonia) is a part of atypical organisms

A common cause of mild pneumoniae. A common symptom is a cough that tends to come in violent attacks, producing only a small amount of white mucus. Chills and fever are early symptoms. Some patients experience nausea or vomiting. M. pneumoniae is most frequently seen in people younger than 40 years of age during the late summer and early fall months. This type of pneumoniae spreads easily in areas where people congregate.

Streptococcal pneumonia

Accounts for more than 80% of all the bacterial pneumonia. Most strains of S. pneumonia are sensitive to penicillin and its derivatives. S. pneumonia also commonly cultured from the sputum of patients having an acute exacerbation of chronic bronchitis.

Viral causes ( most common cause)

Approximately half of all pneumonia are caused by viruses. Viral pneumonia tends to start with flulike signs and symptoms. The early symptoms are a dry ( nonproductive) cough, headache, fever, muscle pain, and fatigue. Viral pneumonia always carries the risk of development of a secondary bacterial pneumonia. Approximately 90% of acute upper respiratory tract infections and 50% of lower respiratory tract infections are caused by pneumonia in young children, peaking between the ages of 2 and 3.

When auscultating over an area of pneumonia, what breath sound can be expected?

Bronchial

Chlamydia psittaci ( Psittacosis)

C. psittaci is a small gram negative bacterium in the respiratory tract and feces of a variety of birds. C. psittaci is transmitted from birds to humans by aerosol or direct contact.

Severe Acute Respiratory Syndrome ( SARS)

Coronaviruses are a group of viruses that have a halo or corona-like appearance when observed under an electron microscope. Known forms of coronavirus cause common colds and upper respiratory tract infections. SARS is highly contagious on close personal contact with infected individuals. SARS might be transmitted through the air or from objects that have become contaminated. 10% to 20% of SARS patients require mechanical ventilation. Death from SARS is rare.

Initially, pneumonia often mimics a common cold or flu ( the signs & symptoms develope quickly).

For example, the patient suddenly experiences chills, shivering, high fever, sweating, chest pain ( pleurisy- sharp, pinpoint pain), and a dry and nonproductive cough.

Aspiration Pneumonitis

In the absence of a secondary bacteral infection, the inflammation usually becomes clincially insignificant in approximately 72 hours. Mendelson's syndrome is usually confined to aspiration pneumonitis in pregnant women.

Chest findings ( all from consolidation)

Increased tactile and vocal fremitus, dull percusion note, bronchial breath sounds, crackles and rhonchi, pleural friction rub ( if process extends to pleural surface), whispered pectoriloquy

Influenza virus

Influenza A & B are the most common causes of viral respiratory tract infections. Influenza viruses have an incubation period of 1 to 3 days and usually cause upper respiratory tract infections.

Pseudomonas aeruginosa ( Bacillus Pyocyaneous):

P. aeruginosa frequently is cultured from the respiratory tract of chronically ill, tracheostomized patients and is a leading cause of hospital-acquired pneumonia. B/c the pseudomonas organism thrives in dampness, it is frequently cultured from contaminated respiratory therapy equipment. The sputum from patients with Pseudomonas infections is frequently green & sweet smelling.

Pneumocystis carinii Pneumonia

P. jiroveci is an opportunistic, often fatal, form of pneumonia seen in profoundly immunosuppressed patients. Pneumocystis normally can be found in the lungs of humans, but it does not cause disease in healthy hosts, only in individuals whose immune systems are critically impaired. Seen in AIDS patients.

Your patient has been hospitalized for 2 weeks and has a tracheostomy tube. Her secretions have a sweet smell and are green in color. What is the most likely organism causing her infection?

Pseudomonas aeruginosa

Respiratory Synctial Virus (RSV)

RSV is most often seen in children less than 12 months of age and in older adults with underlying disease. Almost all children will be infected with RSV by their 2nd birthday.

Rickettsiae:

Rickettsiae rickettsii (Rocky Mountain Spotted fever), Rickettsiae prowazekii (typhus), and Rickettsiae burnetti also called Coxiella burnetti ( Q fever) which is extremely resistant to heat and light. Q fever is an influenza-like illness. Transmitted by arthropods ( lice, fleas, ticks, mites). May also be transmitted by cattle, sheep and goats and possibly in raw milk.

Gram positive organisms:

Steptococcal pneumonia & Staphylococcus pneumonia

Pneumonia & influenza are especially life threatening in individuals whose lungs are already damaged by COPD, asthma, or smoking.

The risk of death from pneumonia or influenza is also higher among people with heart disease, diabetes, or a weakened immune system.

Who are at high risk for silent aspiration?

Tracheostomized patients. Perhaps 55%-70% of intubated or tracheostomized patients aspirate.

Pneumonia involving the entire lobe of the lung is called lobar pneumonia.

When both lungs are involved, the condition is called double pneumonia. Walking pneumonia ( mild case of pneumonia, sometimes patients are told they have walking pneumonia, when they are infected with mycoplasma pneumoniae).

Community Acquired Pneumonia

a lower respiratory tact infection that is acquired outside of the hospital or during the first 48 hours of hospitalization. The most common cause of CAP is streptococcus.

Bacterial penuemonia often occurs after

an individual has had an upper respiratory infection such as a cold or the flu. Early signs & symptoms include shaking chills, shaking, a high fever, sweating, chest pain, an increased respiratory rate, and cough that produce yellow & green sputum.

A patient with the common cold and associated chest infection would be treated with all of the following EXCEPT:

antibiotic

A 75-year-old patient has had a stroke leaving him with dysphagia. What type of pneumonia is he at risk of developing?

aspiration

Major causes of anaerobic lung infections:

aspiration of oropharyngeal secrections and gastric fluids.

Silent aspiration

aspiration that doesn't evoke clinically observable adverse symptoms such as coughing, choking, and immediate respiratory distress. Some patients have silent aspiration after a stroke. Evidence also suggests that some sequelae of stroke include layngopharyngeal sensory deficits with no subjective or objective evidence of dysphagia, such as choking, gagging, or cough.

Causes of bacteria include:

bacteria, viruses, fungi, tuberculosis, anaerobic organisms, apiration, and the inhilation of irritating chemcials such as chlorine.

Thoracentesis:

can be used to treat pleural effusion. Fluid samples may be examined for: color, odor, RBC count, protein, glucose, LDH, amylase, pH, wright's stain, gram stain, acid-fast bacillus stain,; aerobic, anaerobic, TB, and fungal cultures; cytology.

As the respiratory therapist, you have given supplemental oxygen to a patient with pneumonia. What would cause the patient to be hypoxemic?

capillary shunting and alveolar consolidation

Aspiration pneumonia results in all of the following anatomic alterations EXCEPT:

destruction of the alveolar-capillary membrane ( that would be emphysema)

Hospital Acquired Pneumonia ( nosocomial pneumonia)

develops 48 hours or longer after admission to the hospital. Accounts for more than 15% of all respiratory infections.

What term applies to the filling of alveolar spaces as a result of pneumonia?

effusion

Radiologic findings- chest radiograph

increased density ( consolidation and atelectasis), air bronchograms, pleural effusion.

Cytomegalovirus (CMV)

infection commonly coexists with P. carinii infection

Haemophilus influenza ( gram negative):

inhabitant of human pharyngeal flora.There are six types, designated A to F, but only type B is commonly pathogenic. Pneumonia caused by H Influenza type B is seen most often in children aged 1 month to 6 years old. H. Influenzae type B is almost always the cause of acute epiglottitis.

E. Coli:

normal inhabitant of the intestinal tract. sometimes the cause of nosocomial infections. Someones not washing their hands...

Normal swallowing mechanisms:

oral prepatory, oral, pharyngeal, esophageal

Klebsiella pneumoniae ( Friedlander's Bacillus) ( gram negative):

organisms have long been associated with lobar pneumonia, particularly in older men than 40 years and in chronic alcoholics of both genders. It's a normal inhabitant of the human gastrointestinal tract. K. pneumoniae is a common nosocomial disease.

Oxygen therapy protocol:

oxygen therapy is used to treat hypoxemia, decrease WOB, and decrease myocardial work. Hypoxemia caused by capillary shunting is at least partially refractory to oxygen therapy. Get some oxygen to the normal part of the lungs.

Avian influena A ( bird flu, H5N1)

people with bird flu may develop life threatening complications, such as viral pneumonia and ARDS ( the most common cause of bird flu-related deaths).

Ventilator Acquired Pneumonia (VAP)

pneumonia that develops more than 48 hours to 72 hours after endotracheal intubation.

Aspiration pneumonia

pulmonary result of entry of material from the stomach or upper respiratory tract into the lower airways. - toxic injury to the lung ( such as that caused by gastric acid) - obstruction ( by a foreign body or fluids) - Infection

Aspiration is the presumed cause of nearly all cases of anaerobic pulmonary infections.

studies suggest that anaerobic bacteria are the most common causative agents of lung abscesses; they are also commonly isolated in cases of empyema. ( puss in the pleural space).If the aspirate's pH is relatively high ( greater than 5.9), the initial injury is rapidly reversible. Higher the pH, the better.

Varicella ( chickenpox)

the mortality rate of varciella pneumonia is about 20%

Dysphagia

the result of an abnormal swallow that can involve the oral, pharyngeal and esophageal phases. Prone to aspirate.

Pneumonia, or pneumonitis with consolidation is...

the result of an inflammatory process that primarily affects the gas exchange area of the lung. In response to the inflammation, fluid ( serum) and some red blood cells from adjacent pulmonary capillaries pour into the alveoli.

Moraxella catarrhalis

the third most common cause of acute exacerbation of chronic bronchitis.

GERD

three times more prevalent in patients with asthma than in other patients. it is an unrecognized cause of asthma. GERD does cause chronic cough in 10-20% of patietns.

Parainfluenza virus:

types 1,2,3,4A and 4B. Types 1,2,and 3 are the major causes of infections in humans. Type 1 is considered a croup type of virus. Type 2 & 3 are associated with severe infections. Parainfluenza viruses are transmitted by aerosol droplets and by direct person to person contact. The parainfluenza viruses are known for their ability to spread rapidly among members of the same family. & closed end spaces with a lot of people.

If the infection is overwhelming, the alveoli become filled with fluid, RBC's, polymorphonuclear leukocytes, and macrophages.

when this occurs, the lungs are said to be consolidated. Atelectasis is often associated with patients who have apiration pneumonia.