Community acquired pneumonia Year 4 Internal Medicine Notes

Community acquired pneumonia Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / INFECTIOUS -- ● Objectives: ● Define​ ​Pneumonia​ ​and​ ​be​ ​familiar​ ​with​ ​the​ ​possible​ ​causative​ ​agents. ● Explain​ ​different​ ​types​ ​of​ ​pneumonia​ ​with​ ​special​ ​emphasis​ ​on​ ​the​ ​causative\norganisms​ ​for​ ​each. ● Familiarize​ ​with​ ​the​ ​diagnostic​ ​tools​ ​and​ ​for​ ​pneumonia. ● Identify​ ​which​ ​patient​ ​can​ ​be​ ​managed​ ​as​ ​outpatient. \n[​ ​Color​ ​index​ ​:​ ​ ​Important​ ​ ​ ​ ​Notes​ ​ ​ ​Extra​ ​] ● Resources: ● 435​ ​slides [​ ​ ​ ​ ​Editing​ ​file​ ​ ​ ​ ​ ​ ​ ​ ​ ​Feedback​ ​ ​ ​ ​ ​ ​ ​ ​ ​Share​ ​your​ ​notes​ ​ ​ ​ ​ ​ ​ ​ ​ ​Shared​ ​notes​ ​ ​ ​ ​ ​ ​ ​Twitter​ ​ ​ ​ ​]\n\n● Done​ ​by:​ ​Fahad​ ​AlAbdullatif​ ​&​ ​Sara​ ​AlEnezy ● Team​ ​sub-leader:​ ​Dalal​ ​AlHuzaimi ● Team​ ​leaders:​ ​Khawla​ ​AlAmmari​ ​&​ ​Fahad​ ​AlAbdullatif ● Revised​ ​by: \n\n● Pneumonia​:\n- Pneumonia​ ​is​ ​an​ ​inflammatory​ ​condition​ ​of​ ​the​ ​lung​ ​characterized​ ​by\ninflammation​ ​of​ ​the​ ​parenchyma​ ​of​ ​the​ ​lung​ ​(alveoli)​ ​where​ ​abnormal\nalveolar​ ​filling​ ​with​ ​fluid​ ​causing​ ​air​ ​space​ ​disease​ ​(consolidation​ ​and\nexudation).\n- Clinically it usually presents as an ​acute illness with ​cough, purulent\nsputum and fever together with physical signs or radiological changes\ncompatible​ ​with​ ​consolidation​ ​of​ ​the​ ​lung.\n\n● Epidemiology:\n❖ Unclear​ ​as​ ​population-based​ ​statistics​ ​on​ ​the​ ​condition​ ​alone​ ​are​ ​few.1\n❖ Pneumonia​ ​&​ ​influenza​ ​=​ ​6th​​ ​ ​leading​ ​causes​ ​of​ ​death​ ​in​ ​the​ ​world.\n❖ Single​ ​most​ ​common​ ​cause​ ​of​ ​infection-related​ ​mortality.\n❖ Age-adjusted​ ​death​ ​rate​ ​=​ ​22​ ​patient​ ​per​ ​100,000​ ​population​ ​per​ ​year.\n❖ Mortality​ ​rate:​ ​1-5%​ ​out-patients,​ ​12%​ ​In-patients,​ ​40%​ ​ICU.\n❖ Death​ ​rates​ ​increase​ ​with​ ​comorbidity​ ​and​ ​age.\n❖ Affects​ ​race​ ​and​ ​sex​ ​equally​.\n\n● Pathogenesis:\nPrimary​ ​Inhalation Aspiration \nEntry​ ​of​ ​colonized​ ​material​ ​from​ ​the​ ​oropharynx2​ ​or\nstomach​ ​into​ ​the​ ​lower​ ​respiratory​ ​tract: When organisms ​bypass ​normal respiratory defense mechanisms ​(e.g cilia, coughing, nose hair, ❖ Secretions. humidification of respiratory tract) ​or when the ❖ Food​ ​or​ ​drink. patient inhales organisms that colonize the upper ❖ Stomach​ ​contents. respiratory tract or respiratory support equipment (intubation)​. Most​ ​common​ ​causative​ ​organisms:\n➔ Nasopharynx:​ ​Streptococcus​ ​Pneumoniae. Most​ ​common​ ​causative​ ​organisms: ➔ Stomach3:​ r​ eservoir​ ​of​ ​GNR4​ ​anaerobes​ ​that​ ​can\n➔ TB. ascend,​ ​colonizing​ ​the​ ​respiratory​ ​tract.\n➔ Viruses.\n➔ Legionella. ​ ​Normally​ ​the​ ​patient​ ​will​ ​cough​ ​to​ ​remove​ ​the​ ​pathogen/fluids\nfrom​ ​respiratory​ ​tract,​ ​but​ ​if​ ​the​ ​patient​ ​becomes​ ​unconscious,\nor​ ​he​ ​is​ ​having​ ​seizures​ ​he​ ​will​ ​not​ ​be​ ​able​ ​to​ ​cough. \nHematogenous​ ​spread Direct​ ​Extension Originate from a distant source and reach the lungs via​ ​the​ ​bloodstream. E.g: Staphylococcus Aureus (septic emboli) usually happens to endocarditis patients when a heart valve Direct​ ​trauma. shoots a septic emboli (full of bacteria) that travels through the bloodstream reaching the lung causing pneumonia.\n\n 1\n​ ​They​ ​lumped​ ​up​ ​pneumonia​ ​and​ ​influenza​ ​together​ ​in​ ​statistics​ ​that​ ​is​ ​why​ ​it​ ​is​ ​unclear.\n2\n​ ​Majority​ ​of​ ​the​ ​organisms​ ​that​ ​cause​ ​CAP​ ​are​ ​normal​ ​inhabitants​ ​of​ ​the​ ​pharynx,​ ​this​ ​happens​ ​in​ ​the​ ​presence​ ​of\ntracheo-esophageal​ ​fistula​ ​or​ ​during​ ​sleep​ ​“impaired​ ​consciousness.\n3\nproduce​ ​an​ ​extremely​ ​severe​ ​and​ ​sometimes​ ​fatal​ ​illness​ ​owing​ ​to​ ​the​ ​intense​ ​destructiveness​ ​of​ ​gastric​ ​acid.\n4\n​ ​Gram​ ​negative​ ​rods. \n\n● Types​ ​of​ ​Pneumonia​: \nCommunity​ ​Acquired​ ​Pneumonia​ ​(CAP) Hospital-Acquired​ ​Pneumonia​ ​ ​(HAP) \nOccurs​ ​in​ ​the​ ​community​ ​or​ ​within​ ​the​ ​first​ ​48 New​ ​episode​ ​of​ ​pneumonia​ ​occurring​ ​at​ ​least​ ​2​ ​days\nTiming hours​ ​of​ ​hospitalization​. (​ ​ ​48​ ​hours​)​ ​after​ ​hospital​ ​admission. \n➔ Healthcare-associated​ ​pneumonia​ ​(HCAP)\n➔ Typical. Develops​ ​within​ ​48​ ​hours​ ​of​ ​admission​ ​in​ ​patients​ ​with:\n➔ Atypical. It’s​ ​still​ ​not​ ​CAP​ ​as​ ​you​ ​have​ ​to​ ​be​ ​exposed​ ​to​ ​one​ ​of​ ​the\nrisk​ ​factors​ ​below.\n- CAP​ ​usually​ ​caused​ ​by​ ​a​ ​single\norganism ❖ Hospitalization​ ​in​ ​any​ ​hospital​ ​or​ ​acute​ ​care\nfor​ ​ ​ ​2​ ​days​ ​in​ ​the​ ​past​ ​90​ ​days.\n- Even​ ​with​ ​extensive​ ​diagnostic​ ​testing,\nTypes ❖ Residence​ ​in​ ​Nursing​ ​Home​ ​or​ ​LTC5​ ​facility.\nmost​ ​investigators​ ​cannot​ ​identify​ ​a\n❖ Chronic​ ​dialysis​ ​within​ ​30​ ​days.\nspecific​ ​etiology​ ​for​ ​CAP​ ​in​ ​≥​ ​50%​ ​of\n❖ Home​ ​IV​ ​therapy​ ​in​ ​the​ ​past​ ​30​ ​days.\npatients.\n❖ Home​ ​wound​ ​care​ ​in​ ​the​