Pneumonia
Acute
Recurrent
Fevers
Dyspnoea
Cough
CXR
Viral
Rx
Benpen if immunised (Strep)
Cefotaxime (Hi, Moroxella, pen resistant S. pneumo) if severe or <1y
Complications
Parapneumonic Effusion (Pleural effusion related to pneumonia) (Augemtin / Timentin)
Pneumatocele: thin walled cyst (Staph)
Abscess: thick walled cyst with air fluid level (Staph)
SIADH
Recurrent
- Inhaled foreign body
- Immunodeficiency
Fevers
Dyspnoea
Cough
CXR
- Consolidation (replacement of air with fluid)
- Collapse (volume loss: look for shift of structures e.g. mediastinum, fissure, event of diaphragm)
- Round(ish) pneumonia (look for air brochograms)
- small round, ?thin calcific rim (hydatid)
- See complications below as well
Viral
- Influenza (Oseltamivir)
- Often confection with staph > add staph cover
- HSV, VZV (Aciclovir)
- CMV (Ganciclovir)
- Strep pneumonia most common (penicillin)
- Strep progenies (GAS)
- Staph aureus (vanc if MRSA)
- Hib (unimmunised)
- Hi non-typeable
- Moroxella
- Mycoplasma (headache no coryza, SJS, haemolytic anaemia), Chlamydia (staccato cough, conjunctivitis), Legionella (Azithromycin)
- Pertussis (azithro) (unimmunised: catarrhal (coryza) > paroxysmal > convalescent phases (atypical less severe if vaccinated), lymphocytosis)
- Pseudomonas (Gent/Tazocin/Mero/Cipro)
- Meliodosis (NT)
- TB (likes high VQ i.e. apex) Rx Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, (Streptomycin for Ethan if meningitis) check for HIV
- Aspiration (Augmentin)
- Pneumocystis (Bactrim: nb normal exam with hypoxia!) T-cell probs: HIV, Tacrolimus...
- Aspergillosis (voriconazole): spreads locally to ribs / spine and metastasised to brain
- Candidiasis (Amphotericin/fluconozole) (rare, from metastasis of yeastaemia rather than primary pneumonia)
- Hydatid cysts
Rx
Benpen if immunised (Strep)
Cefotaxime (Hi, Moroxella, pen resistant S. pneumo) if severe or <1y
Complications
Parapneumonic Effusion (Pleural effusion related to pneumonia) (Augemtin / Timentin)
- Usually sterile
- Complicated parapneumonic effusion
- Loculated: septa preventing free flow of fluid
- Empyema: when bacteria colonise and pus is formed
- Strep pneumo, Strep pyogenes, Staph aureus
- If less than ¼th of hemithorax treat as pneumonia PO if well IV if unwell
- If >1/4th > US to establish if loculated
- NO locales > IVABs and Chest drain
- If loculated > ?trial of fibrinolytic therapy chesterfields drain OR straight to VATS and Chest drain
Pneumatocele: thin walled cyst (Staph)
Abscess: thick walled cyst with air fluid level (Staph)
SIADH