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MCC of PNA in kids 6wks-18yrs
- Viruses (RSV)
- Mycoplasma
- Chlamydia Pneumoniae
- Strep pneumoniae
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MCC of PNA in adults 18-40 yrs
- Mycoplasma
- C. Pneumoniae
- S. Pneumoniae
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MCC of PNA in adults 40-65 yrs
- Strep. Pneumoniae
- H. Influenza
- Anaerobs
- Viruses
- Mycoplasma
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MCC of PNA in elderly
- S. pneumoniae
- Viruses
- Anaerobes
- H. Influenza
- Gram + Rods
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PNA work up for
1 Legionella
2 Chlamydia Pneumo
3 Mycoplasma
4 strep Pneumo
5 Viral
- 1: Legionella urine antigen test
- 2: chlamydia serologic testing, cuture, PCR
- 3: Mycoplasma, serum cold agglutinis and serum Mycoplasma antigen
- 4: Urine pneumococcal Ag test, culture
- 5: nasopharyngeal aspirate, rapid tests, DFA, viral culture
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Out-pt comm-acquired PNA, pts <65 yrs of age, otherwise healthy
Likely cause and Tx
- S. pneumo
- Mycoplasma
- C. Pneumo
- H. influenza
- viral
- Macrolide: azithromycin
- Doxycycline
- Flouroquinolones
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Pts >65 yrs or with comorbidity:
COPD, CHF, DM, Renal Failure, Liver Dz, EtOH abuse
Most common pathogens and Tx
- Strep pneumo
- H. influenza
- Aerobic GNR: E.coli, Enterobacter, Klebsiella
- Staph Aureus
- Legionella
- Viruses
- TX:
- Macrolide (azithromycin)* or
- Fluoroquinolones
- *Consider adding 2nd Gen Cephalosporin or B-lactam to macrolide
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Comm-Acquired PNA requiring admission
pathogens and Tx
- Strep Pneumo
- H. infu
- Anaerobes
- Aerobic GNRs
- Legionella
- Chlamydia
- TX:
- Extended spect Cephalosporin
- B-lactam/B-lactamase inhibitor or
- fluoroquinolone
- add macrolide if atypical organisims suspected
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Comm-acquired PNA needing ICU care
pathogens and Tx
- Strep pneumo
- H. Influ
- Anaerobes
- Aerobic GNRs
- Mycoplasma
- Legionella
- Psudomonas
- TX:
- Fluoroquinolone or 3rd Gen Ceph or
- B-lactam/B-lactamase inhibitor + macrolide
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Hospital acquired PNA
Pathogens and TX
- GNR's (includes Pseudomonas and Acinetobactor)
- Staph Aureus
- Legionella
- Mixed Flora
- TX:
- 3rd Gen Ceph or
- B-lactam with antipseudomonal activity or
- Carbepenem
- Might add aminoglycoside or Fluoroquinolones for coverage of resistant organisms (pseudomonas)
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PNA d/t MRSA, Tx
Add Vanc or linezolid; broader gram neg coverage
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Tx of active and Latent TB
- report all cases to local and state health departments
- Respirator Isolation
- Active TB: 4-drug tx, INH, Pyrazinamide, rifampin, ethambutol x 2mos
- followed by 4 mos of INH+Rifampin
- Latent TB:
- +PPD w/o symptoms - INH x 9mos
- alternative - INH x 6mos or rifampin x 4mos
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What should also be given to patients on INH therapy?
- Vit B6 (Pyridoxine)
- helps to minimize the peripheral neuropathy caused by INH
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Causes of Acute Pharyngitis
Viral>Bacterial (90% of adults)
Bacterial: GAS, N. gonorrhea, Corynebacteria, Mycoplasma
Viral: Rhinovirus, Coronavirus, Adenovirus, HSV, EBV, CMV, Flu virus, coxsackie, acute HIV
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Centor's Criteria for Strep Pharyngitis
- 3 of 4 criteria required
- Fever
- Sore throat
- pharyngeal exudate
- Lack of Cough***
Others: cevical lymphadenopathy, palatal petechiae, HA, Vomiting, scarlatiniform rash
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Dx and Tx of Strep pharyngitis
Dx: 3/4 Centor Criteria and +Rapid GAS antigen test
Tx: Penicillin x 10 days
Alternatives: Cephalosporins, amoxicillin, azythromycin
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Complications of Strep Pharyngitis
Nonsupprative: Acute Rheumatic Fever and Poststrep GN
- Supporative: cervical lymphadenopathy, mastoiditis, sinusitis, OM, retropharyngeal or peritonsillar abscess and
- Lemierre's syndrome: thrombophebitis of jugular vein d/t Fusobacterium
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Gold Standard Dx of Sinusitis
- Sinus tap and bacterial culture (not usually done)
- Middle meatus endoscopy and cultures is gaining popularity
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Tx for Sinusitis
- Since most are d/t virus and self limiting...
- symptomatic: decongestants, antihistamines, pain relief
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Tx for Acute Bacterial Sinusitis
Augmentin: amoxil/clavulanate 500mg PO TID x 10 days
Alternatives: clarithromycin, azythromycin, TMP-SMX, Fluoroquinolone or 2nd gen ceph
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Tx for Chronic Sinusitis
Adjuvant therapy with intranasal corticosteroids, decongestants, antihistamines
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