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CR2 > 26 - Lower Respiratory Tract Infections > Flashcards

26 - Lower Respiratory Tract Infections Flashcards

1
Q

What is pneumonia

A

Pneunoitis + consolidation + exudation due to infection

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2
Q

Respiratory symptoms of pneumonia

A

Cough + Pleural pain, dysponea, tachypnoea

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3
Q

Systemic symptoms of pneumonia

A

Sweating, fevers, rigors, shivers, aches and pains

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4
Q

Types of pneumonia

A

Hospital/community acquired

Atypical/typical

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5
Q

Hospital acquired pneumonia bacteria

A 
Gram neg - multi drug resistant
= Pseudomonas Aeruginosa
= Enterobacter
= Klebsiella
= Moraxella catarrhalis
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6
Q

When do you get HAP

A

48-72 hours after being admitted

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7
Q

Predesposing factors for HAP

A

Abnormal conscious state, intubation, ventilation, surgery, immunosuppression

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8
Q

Symptoms of CAP

A

Sudden onset of chills –> Fever –> Pleuritic chest pain+ productive cough

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9
Q

Chest X-ray in CAP

A

Lobar consolidation (due to strep pneumonia)

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10
Q

Most likely cause of CAP

A

S. pneumoniae

ALL GRAM POS

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11
Q

CAP Typical pathogens

A 
	Streptococcus pneumoniae – most common
	Haemophilus influenzae
	Moraxella catarrhalis 
	(Staphylococcus aureus post influenza)
	Group A streptococcus (Upper RTI)
•	streptococcus pyogenes
	ONLY GET THIS IN CAP NOT HAP
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12
Q

CAP Atypical pathogens

A 
Mycoplasma pneumoniae (15-20%)
Chlamydophilia pneumoniae (5%)
C.psittaci (2-5%)
Legionella pneumophillia (5%)
Coxiella burnetii (1%)
Pneumocystis carinii/PCP <1%
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13
Q

Mycoplasma pneumoniae

A

• Droplet transmission
• Epidemics
• Occurs in the young
• CXR shows patchy bilateral bronchopneumonia
o S. AUREUS causes a bilateral CAVITATING bronchopneumonia

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14
Q

Chlamydophila pneumoniae

A
  • Intracellular pathogen

* Implicated as potential pathogen / co-pathogen in coronary artery disease and cerebrovascular disease

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15
Q

C.psittaci

A

• Zoonosis acquired from birds

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16
Q

Legionella Pneumophilia

A
  • Preferred habitat – WARM WATER
  • Large outbreaks associated with cooling towers/spas/air cond.
  • History – exposure to cooling towers
17
Q

Clinical features of Legionella pneumophilia

A

multi-system disease with confusion, muscle aches, pneumonia, renal failure, liver involvement + diarrhoea

18
Q

Lab features of legionella pneumophilia

A

o CXR - Patchy interstitial involvement or consolidation
o Hyponatraemia often present
o Urea frequently raised
o Liver function tests abnormal

19
Q

Coxiella burnetii

A
  • Causes Q FEVER

* Transmitted via infected animals through milk, excreta

20
Q

 Pneumocystis carinii/PCP

A
  • Important cause of pneumonia in the severely immunocompromised ie HIV
  • Presents with non productive cough
  • Treat with co trimoxazole or pentamidine by slow iv for 2-3 weeks
21
Q

What is atypical pneumonia

A

Pneumonia not due to sprep pneumoniae
Doesn’t respond to conventional b-lactam therapy
More insidious
Difficult to culture
= Non-productive cough, fever, headache, chest x-ray more abnormal than suggested by clinical examination
 inflammation restricted to alveolar septa and interstitial tissues - essentially interstitial pneumonitis
 bilateral - patchy CXR
 typical- unilateral

22
Q

Complications of pneumonia

A 
Pleural effusion
Empyema thoracis
Lung abcess
= Single - psudomonas
= Multiple - staphylococcus aureus
23
Q

Diagnosing pneumonia

A

Hx + clinical
Chest examination
Sputum
Serodiagnosis

24
Q

How to determine severity of pneumonia

A

CURB 65 score

25
Q

What does CURB 65 stand for

A 
C - confusion
U - urea >7mmol
R - resp rate >30
B - BP <90mmhg
65 - age >65
26
Q

Treatment of mild, moderate, severe pneumonia

A

o Mild – amoxicillin
o Moderate – add clarithromycin
o Severe – as above + co-amoxiclav

27
Q

Treatment of HAP

A

Tazocin

28
Q

Treatment of pneumonia due to Legionella

A

fluoroquinolone

29
Q

Tx pneumonia due to chlamydophila

A

tetracycline

30
Q

Tx of pneumonia due to PCP

A

High dose co-trimoxazole

CR2 (34 decks)

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