Pneumonia, Empyema, and TB Meira Louis MargrietGreidanus
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
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
Which drugs? inpatient Same as outpatient with comorbidities!
Which drugs? ICU Same as outpatient with comorbidities!
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
Empiric Antibiotics for HCAP? • An antipseudomonal cephalosporin or β-lactam (cefepime, ceftazidime, pip-tazo) • Plus a fluoroquinolone (ciprofloxacin, levofloxacin) • Plus an agent active against MRSA (linezolid or vancomycin) = fluoroquinolone or azithromycin
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 withno improvement. • Progressive SOB and chest pain 36.5 105 20 145/82 91% ORA
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
Extra Pulmonary Complications Neuro Cardiac Renal MSK GI GU