19 - Infection in Older Ps Flashcards
What is temporal arteritis?
Temporal arteritis (giant cell arteritis) is where the arteries, particularly those at the side of the head (the temples), become inflamed.
The main symptoms are:
* frequent, severe headaches
* pain or tenderness at the side of your head (temples) or on the scalp
* jaw pain while eating or talking
* vision problems, such as double vision or loss of vision in 1 or both eyes
More general symptoms are also common – for example, flu-like symptoms, unintentional weight loss, depression and tiredness.
Some people with temporal arteritis also develop polymyalgia rheumatica (PMR). This causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.
What is the Rx for temporal arteritis?
How is diagnosis confirmed?
High dose prednisolone
US for confirmation
What percentage of elderly Ps have asymptomatic bacteriuria?
20% Fs over 80
50% of nursing home
Why is it important not to treat asymptomatic bacteriuria?
Which infections are common in the elderly?
Sepsis
Pneumonia
UTI
Influenza
Herpes zoster
How are immune defence mechanisms altered in the elderly?
How do Ns change as we age?
Reduced recruitment to side of inflammation and reduced effective phagocytosis
How do B-cell responses change as we age?
Get more non-specific ABs rather than specific ABs produced.
Also get more ABs against self
How does the cellular environment change as we age?
Pro-inflammatory cytokines increase = low grade inflammation all the time - means cells have worse response to acute infection.
Also exacerbates conditions with inflammatory aetiology.
How do T-cell responses change as we age?
Reduction in the diversity of their repertoire - number doesn’t change but they are less diverse - so less able to respond to new pathogens.
How do elderly Ps often present with infection?
Atypically
- Delirium
- Lethargy
- Falls
- Anorexia
- Immobility
Apart from chest or urine infection - where else should you consider infection in a P?
Pressure sores
Intra-abdominal abscess
Biliary infections
Soft tissue infections - inc septic arthritis
What can make it challenging to diagnose infection in elderly Ps?
What are the sepsis 6?
What is ESBL infection?
Extended spectrum β lactamase pathogens - resistent to all penicillins - need to use carbapenem or meropenem for this.
How is vaccination affected as we age?
The vaccination response is attenuated by immune senesence as we age.
Why is AI disease slightly increased in the elderly?
Get auto-antibodies more frequently
and inc ANA
Why do cancer rates also increase as we age?
