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

2. 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

3. Pneumonia

5. 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 38.011518130/7594% ORA

6. In-patient vs Out-Patient?

7. PORT score

11. http://www.mdcalc.com/

12. CURB-65

14. Do they work?

16. What tests?

17. Which bugs?

18. Which drugs? outpatient

19. Which drugs? inpatient

20. Which drugs? ICU

21. Drugs and special populations

22. So, when do I worry about the extra coverage?

23. Time to antibiotics

24. Length of antibiotics?

25. Other things to think about...

26. 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) 38.28326105/6493% ORA

27. VS

31. What’s different about HCAP?

32. What makes a patient riskier?

33. 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

34. Para-Pneumonic Effusions

35. 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 36.510520145/8291% ORA

36. What is it?

37. When should it be suspected?

38. How to image?

40. To treat or not to treat?

41. So, I poked it, does that help?

42. When does the pH lie?

43. If I need to drain, does tube size matter?

44. TB

45. 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 37.511522120/8292% ORA

46. Primary TB vs Reactivated TB

48. So, what am I looking for?

49. Complications of TB

50. Extra Pulmonary Complications Neuro GU MSKCardiacRenal GI

51. Where is the money? CXR!

52. Primary TB Ranke Ghon Tuburculoma Milliary

53. Post Primary TB

54. All that cavitates...

55. Treatment!

56. Questions?