Pneumonia, Empyema, and TB Meira Louis Margriet Greidanus.

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Presentation transcript:

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

Pneumonia

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 /7594% ORA

In-patient vs Out-Patient?

PORT score

CURB-65

Do they work?

What tests?

Which bugs?

Which drugs? outpatient

Which drugs? inpatient

Which drugs? ICU

Drugs and special populations

So, when do I worry about the extra coverage?

Time to antibiotics

Length of antibiotics?

Other things to think about...

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) /6493% ORA

VS

What’s different about HCAP?

What makes a patient riskier?

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

Para-Pneumonic Effusions

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 /8291% ORA

What is it?

When should it be suspected?

How to image?

To treat or not to treat?

So, I poked it, does that help?

When does the pH lie?

If I need to drain, does tube size matter?

TB

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 /8292% ORA

Primary TB vs Reactivated TB

So, what am I looking for?

Complications of TB

Extra Pulmonary Complications Neuro GU MSKCardiacRenal GI

Where is the money? CXR!

Primary TB Ranke Ghon Tuburculoma Milliary

Post Primary TB

All that cavitates...

Treatment!

Questions?