1.2 Lower Respiratory Tract Infections Flashcards
Who commonly get LTRIs?
Very young
Od
When is there an increased incidence of LTRIs?
During winter
What is the 2nd commonest cause of death in the UK?
Pneumonia
What are the symptoms of asthma?
They can be variable
Often breathlessness
Pleuritic chest pain
Cough and infected sputum
Is a CXR abnormal in pneumonia?
Always abnormal
What is seen in a CXR of someone with pneumonia?
Pulmonary shadowing/consolidation
What does the added sound of crackling usually indicate?
Infection
What is bronchiectasis?
The dilation of bronchi producing sepsis in the chest
What are the symptoms of bronchiectasis?
Daily cough Daily copious purulent Sputum production Occasional haemoptysis Frequent chest infections
What are the signs of bronchiectasis?
Finger clubbing
Lung crackles on inspiration and expiratoin
Can bronchiectasis be cured?
No
How is empyema distinguished from a simple effusion?
The fluid can be collected and sampled and is found to be pus
Why does the infected fluid need to be drained and not treated with antibiotics?
Because antibiotics do not penetrate well into the pleural cavity
What investigations are done for bronchiectasis?
Sputum culture
Spirometry
CXR
High resolution CXR are the main diagnostic tests
What infects the fluid in empyema?
Micro-organisms
What is a lung abscess?
When the bacteria in the lung form a pocket of infected fluid
How is an abscess in the lung removed?
Long-term antibiotics
Sometimes the abscess must be drained by a surgeon or radiologist
What are the hosts defences of the lower respiratory tract?
Alveolar macrophages
Mucociliary escalator
Cough reflex
What are the aetiological classifications of pneumonia?
Community Hospital acquired Pneumonia in the Immunocompromised Atypical Aspiration Recurrent
What is lobar pneumonia?
A form of pneumonia that affects a large and continuous area of the lobe of a lung
What are some of the complications of LTRIs?
Pleurisy
Pleural Effusion
Empyema
What are some of the common micro-organism causes of LRTIs?
Streptococcus pneumonia
Staphylcoccus aureus
What are some of the uncommon micro-organism causes of LRTIs?
Legionella pneumophila
Klebsiella pneumoniae
Pseudomonas aeruginosa
Bacteroides and other anaerobes
What are some of the rare micro-organism causes of LRTIs?
Haemophilus influenzae
Escherichia coli
What % of pneumonias does streptococcus pneumonia account for?
50%
Who gets streptococcus pneumonia?
All ages
What are the features of streptococcus pneumonia?
Abrupt onset High pyrexia/rigors Pleuritic chest pain Cough with purulent (green) sputum Hypotension and cyanosis Septicaemia
What is shown in the CXR of streptococcus pneumonia?
Clasically lobar
Often patchy shadowing
What is the treatment for streptococcus pneumonia?
IV benzyl penicillin, amoxicillin, oral ampi
If the person is allergic to penicillin what antiobiotics should be used?
Macrolide
Clarithromycin
What is the treatment for empyema?
Chest drain
IV antibiotics
What organisms are more likely to result in cavitating pneumonia?
Staph. aureus
Pseudomonas
Anaerobes
What are the causes of bronchiectasis?
Idiopathic Immotile Cilia Syndrome CF Childhood infections such as measles ABPA
What is the treatment for bronchiectasis?
Chest physiotherapy
Prompt treatment of infections with appropriate antibiotics
May require inhaled therapy including beta2 agonist and inhaled corticosteroid
What % of community diagnosed pneumonia require hospitlisation?
Between 22 and 42%
How would you describe the sputum in pneumonia?
Rusty
What does CURB65 stand for?
C = confusion U= blood urea>7 Respiratory rate >30 B = diastolic blood pressure <60 65 = age>65
What are the main features of bronchiectasis?
Dilated and damaged bronchi
What are examples of LRTIs?
Acute bronchitis Exacerbation of COPD Pneumonia Empyema Lung Abscess Bronchiectasis
What is the UK incidence of pneumonia?
Between 5 and 11 per 1000 of the adult population
What are the symptoms of pneumonia?
Malaise Fever Chest pain (pleuritic) Cough Purulent Sputum Dyspnoea
What are the signs of pneumonia?
Pyrexia Tachpnoea Central cyanosis Dullness on percussion of affected lobe(s) Bronchial breath sounds Inspiratory crepitations Increased vocal resonance
What is tachpnoea?
Abnormally rapid breathing
What is the investigation for pneumonia?
Serum biochemistry and full blood count CXR Blood cultures Throat swab Sputum microscopy and culture
What bacteria can cause pneumonia?
Strep pneumoniae H. Influenzae Legionella Staph aureus Mycoplasma pneumoniae Chlamydia psittaci
What treatment is given to pneumonia patients?
Oxygen
I.V fluids
CPAP
Intubation and ventilation
What are the potential complications of pneumonia?
Septicaemia Acute kidney injury Empyema Lung abscess Haemolytic anaemia ARDS
What does ARDS stand for?
Acute respiratory distress syndrome
How is empyema diagnosed?
By pleural aspiration (draining the fluid and testing)
What is the treatment for empyema?
Chest drain
I.V antibiotics
What are the causes of bronchiectasis?
Idiopathic Immotile Cilia Syndrome Cystic Fibrosis Childhood infections e.g measles ABPA - allergic Bronchopulmonary aspergillosis
What are the symptoms of bronchiectasis?
Chronic cough
Daily sputum production
What are the sometimes symptoms of bronchiectasis?
Wheezing Dyspnoea Tiredness Flitting chest pains Haemoptysis
What is the treatment for bronchiectasis?
Chest physiotherapy
Prompt treatment of infections with appropriate antibiotics
May require inhaled therapy including beta 2 agonist and inhaled corticosteroid
