Pneumonia & Pleural Disease

Pneumonia & Pleural Disease

Community-Acquired Pneumonia (CAP)

• Common organisms: *Streptococcus pneumoniae* (most common), *Haemophilus influenzae*, *Mycoplasma pneumoniae*, *Legionella*
• CXR: lobar consolidation (typical) vs patchy bilateral infiltrates (atypical)

CURB-65 Score (1 point each)

• Confusion (new)
• Urea >7 mmol/L
• Respiratory rate ÔëÑ30/min
• BP systolic <90 or diastolic Ôëñ60
• 65: age ÔëÑ65
• Score 0–1: home treatment; 2: hospital; ÔëÑ3: ITU consideration

CAP Antibiotic Therapy (BTS guidelines)

• Mild (CURB-65 0–1): amoxicillin 500 mg TDS PO ├ù 5 days
• Moderate (CURB-65 2): amoxicillin + clarithromycin
• Severe (CURB-65 ÔëÑ3): co-amoxiclav + clarithromycin IV
• Atypical cover (Mycoplasma/Legionella): macrolide or doxycycline

Pleural Effusion

• Transudate (protein <25 g/L): LVF, cirrhosis, nephrotic syndrome, hypothyroidism
• Exudate (protein >35 g/L): infection, malignancy, PE, RA, TB
• Light's criteria (any one = exudate): pleural/serum protein >0.5; pleural/serum LDH >0.6; pleural LDH >2/3 upper serum normal

Pneumothorax

• Primary spontaneous: tall thin young males, no lung disease
• Secondary: underlying lung disease (COPD, asthma, CF)
• Tension: tracheal deviation away, absent breath sounds, haemodynamic compromise → immediate needle decompression (2nd ICS, MCL) then chest drain