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Pneumonia, Empyema, and TB Meira Louis Margriet Greidanus.

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Pneumonia, Empyema, and TB Meira Louis Margriet Greidanus
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Page 1: Pneumonia, Empyema, and TB Meira Louis Margriet Greidanus.

Pneumonia, Empyema, and TB

Meira LouisMargriet Greidanus

Page 2: Pneumonia, Empyema, and TB Meira Louis Margriet Greidanus.

Format for Today

• Group work x 30 minutes (3 groups)• Cases as a large group– Case I: Community Acquired Pneumonia– Case II: Health Care Associated Pneumonia– Case III: Para-pneumonic effusion– Case IV: TB

• Questions

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Pneumonia

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Case I

43 year old male, previously healthy- Cough x 6 days, productive of green sputum- Febrile x 4 days- Now feeling progressively more SOB- No home meds, no allergies

38.0 115 18 130/75 94% ORA

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In-patient vs Out-Patient?

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PORT score

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http://www.mdcalc.com/

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CURB-65

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Do they work?

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What tests?

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Which bugs?

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Which drugs? outpatient

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Which drugs? inpatient

Same as outpatient with

comorbidities!

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Which drugs? ICU

Same as outpatient with

comorbidities!

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Drugs and special populations

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So, when do I worry about the extra coverage?

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Time to antibiotics

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5Length of antibiotics?

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Other things to think about...

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Case II

63 yo male, history of COPD, DM, HTN, CHF- Cough x 3 days, productive of yellow sputum- Febrile x 4 days- Now feeling progressively more SOB- Meds: Lasix, ASA, ramipril, insulin- Hospitalized x 5 days for COPD (6 weeks ago)

38.2 83 26 105/64 93% ORA

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VS

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What’s different about HCAP?

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What makes a patient riskier?

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• An antipseudomonal cephalosporin or β-lactam (cefepime, ceftazidime, pip-tazo)

• Plus a fluoroquinolone (ciprofloxacin, levofloxacin) • Plus an agent active against MRSA (linezolid or vancomycin)

Empiric Antibiotics for HCAP?

=fluoroquinolone or azithromycin

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Para-Pneumonic Effusions

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Case III

45yo female, mild HTN, hyperlipidemia- Unwell x few weeks, episodic fevers, cough- Sent in by GP to r/o PE as completed full

course of Azithromycin with no improvement.- Progressive SOB and chest pain

36.5 105 20 145/82 91% ORA

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What is it?

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When should it be suspected?

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How to image?

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To treat or not to treat?

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So, I poked it, does that help?

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When does the pH lie?

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If I need to drain, does tube size matter?

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TB

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Case IV

29yo male, previously healthy- Recently returned from India after 6 month

visit (immigrated several years ago)- Unwell x few weeks, episodic fevers, weight

loss- Completed course of Levofloxacin, no change

37.5 115 22 120/82 92% ORA

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Primary TB vs Reactivated TB

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10

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So, what am I looking for?

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Complications of TB

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Extra Pulmonary Complications

Neuro

GU

MSK

Cardiac

Renal

GI

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Where is the money? CXR!

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Primary TB

Ranke

Ghon

Tuburculoma

Milliary

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Post Primary TB

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All that cavitates...

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Treatment!

PIRES

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Questions?


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