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Productive cough, purulent sputum, dyspnoea Haemoptysis Febrile,…

- - - - Strep pneumoniae
        
        Moraxella catarrhalis
      - HIB
        
        Staph aureus
        
        Pseudomonas aeruginosa
    - - Mycoplasma pneumoniae
        
        Chlamydia pneumoniae
        
        Legionella spp.
  - - - URT
        
        sinusitis
        
        pharyngitis
        
        laryngitis
      - LRT
        
        Viral: influenza
        
        Bacterial: TB
        
        Fungal: aspergillus
        
        Exac of COPD/asthma
        
        Bronchiectasis
        
        Cystic fibrosis
        
        Postobstructive pnuemonia (bronchogenic carcinoma)
    - - Malignant
        
        Primary
        
        Lung cancer
        
        Mesothelioma
        
        Secondary
        
        Mets to lung (breast/colon/prostate)
      - Benign
    - - Wegner's granulomatosis
        
        Goodpasture's syndrome
        
        RA, SLE
    - - Sarcoidosis
        
        Amyloidosis
    - - Drug-induced
        
        Radiation
        
        Ventilation / intubation / aspiration pneumonia
    - - PE
        
        AVM
        
        Septic pulmonary emboli
- - - - What will you expect to see on CXR?
        
        Pulmonary cavity
        
        What are your differentials for a pulmonary cavity?
        
        CAVITY
        
        Cancer
        
        Autoimmune
        
        Vascular
        
        Infective
        
        Trauma
        
        Youth
        
        Cancer: cavitating pulmonary lesions MC SCC
        
        Autoimmune: rheumatoid nodules, granulomas from Wegner's
        
        Vascular: pulmonary emboli (bland or septic)
        
        Infective: abscess, TB
        
        Trauma: pneumatoceles
        
        Youth: congenital pulmonary airway malformation, pulmonary sequestration, bronchogenic cyst
        
        Multiple pulmonary cavities
        What organism could it be?
        
        PVL-positive staph aureus
        *(PVL = Panton-Valentine Leukocidin)
        
        Pulmonary cavity / cavitating lesion
        
        Air-fluid level
        
        Consolidation
        
        Thick wall (>5mm neoplasm)
        
        Aspergilloma (white-ball-within-cavity)
    - - What will lead you to diagnosis of Staph aureus pneumonia? (microbiological tests)
        
        Staph vs strep (both gram positives)
        
        Microscopy/gram stain: staph grapelike clusters, strep rows
        
        Catalase: staph (+)
        
        Culture
        
        Staph:
        
        HBA: b-haemolytic, golden-yellow pigment (golden staph)
        
        Mannitol: red → yellow
        
        Within staph spp.
        
        Coagulase
        staph aureus coagulase (+)
        epidermidis & saprophyticus (-)
- - - - Flucloxacillin
        
        IV, 2g, QID (q4-6h)
        
        Uncomplicated staph pneumonia: oral + IV = 14 days
        
        Complicated: >14 days
        
        severe cavitatory disease
        
        lung abscess
        
        bacteremia
        
        Penicillin hypersensitive: cephazolin IV 2g TDS (q8h)
    - - Vancomycin
        
        IV
        
        MAC
        
        glycopeptide
        
        bactericidal
        
        inhibits bacterial cell wall synthesis
        
        by preventing formation of peptidoglycan polymers
        
        S/E
        
        hypersensitivity
        
        red man syndrome
        
        nephro & ototoxicity
      - MRSA origins
        
        MEC gene acquisition
        On SCCmec
        Codes for PBP2a
        Decreased affinity for methicillin
    - - Linezolid
        
        IV BD (q12h)
    - - MSSA - Fluclox
        
        beta-lactamase resistant abx
      - MRSA - Vanc
        
        Fluclox inactive against MRSA
- - - - Strep viridans
        
        Type 3 pneumococcus