5. Lower Respiratory Tract Infections Flashcards
Sx of CAP
Cough and breathlessnnes, pleuritic pain , new sputum production (54%), haemoptysis(15%)
Confusion, abd pain, GI upset, myalgia and headache
Signs of CAP
Pyrexia, rigors, tachyc, hypoT, tachypneoa
COARSE inspiratory crackles, reduced expansion, bronchial breathing, pleural rub on pneum side, abd tenderness
Def of CAP
Sx and signs consistent with LRTI, new CXR shadowing (eg. may have loss of definition of heart border), and no other explanation
How to differentiate between Middle and Lower lobe pneumonia
If lower lobe, hemidiaphragm will not be clear
What bacteria can cause lung abscess commonly
Staph aureus
How to assess pneumonia severity
CURB65
Confusion
Urea>7
SBP <90 or DBP<60
Age >65
1 or less is low severity
If CURB =2, how to treat
Usually only oral antibiotics
Ix for Moderate vs severe pneumonia
Blood cultures and sputum, pneumococcal urine antigen test for both (consider ONLY for moderate )
Ix for legionella only is suspected in mod pneumonia ( urine antigen and sputum ) vs Ix for legionella and atypical and viral pathogens
Common source of mild CAP and how to treat
Strep pneumoniae, just treat with oral amox
Mod severity CAP Tx
Oral amox + clarithromycin
(IV benzyl may be fiven instead of amox if oral not possible)
What is the use of clarithromycin in CAP
For atypical organisms
High severity CAP Tx
IV co amox + clarithro, add levofloxacin if legionella
How to treat parapneumonic effusion
With abx
What is empyema
Infxn and pockets in pleural space
When would chest drain be considered for Empyema
Pleural fluid acidosis
+ve bacteriology from pleural space
frank pus
Empyema charcteristics
High protein (>30) and LDH (>1000),usually have loculations, high neurophil, low glucose (<2.2) and ph <7.2
Org in pri vs sec empyema
Strep, anaerobes, staph aureus, gram -ve aerobes
vs
MRSA, Gram -ve aerobes like e coli, pseudomonas, kleb more common, s aureus and anaerobes
Mx of empyema
Fluids, LMWH, ICD if meets criteria, Abx mainly coamox, but may use metro and cephs.
If failure to respond then decorticate and put abx, or if too frail then rib resection + permanent ICD
If flu like Sx and then CAP, what org is likely
Staph aureus
What is PCP assoc with
Immunocompromised
What is legionella assoc with
Water, travel overseas
What is bronchiectasis
Permanently dilated airways– chronic cough and sputum production, recurrent chest infections
Sx of bronchiectasis
Fatigue, chest pain, cough
Most common causes (2) of bronchiectasis
No cause, then past infection
Possible causes of bronchiectasis that should be investigated
Allergic bronchopulmonary aspergillosis, common variable immunodefeciency and CF
Most common pathogen in bronchiectasis and what other causes
H influenzae, then pseudomonas
Ix for bronchiectasis and observation on imaging
Chest CT
Sputum culture, once a year and at exac start
Dense opacification of lung fields due to chronic bronchietastic change on CXR
what does signnet ring sign suuggest
Bronchiectasis- bronchus bigger than vessel
What variables are considered in bronchiectasis severity index scoring
Age, low BMI (< 18.5), >3 lobes involved or cystic bronchiectasis, FEV1
What is bronchiectasis a risk factor for
Coronary heart disease and stroke, independent of past smoking
Tx for bronchiectasis exacerbation, and what the requirements for tx
Abx - - acute detioration, worsening local sx, and or systemic upset
Non-medical treatment for bronchiectasis
physiotherapy
What disease is DNAse used for
CF
long term treatment for bronchiectasis
SAB2 agonist if airways obstruction , anti cholinergic also possible
LABA if significant breathlessness and response to SA
similar to COPD
Macrolides side effect and when is it used
GI, CV, hearing impairment
To reduce exac in high risk pts
What are the high risk groups to target abx
BSI or >= 3 Exac per year
Target froup for LT inhaled ABXs and which Abx are these
Chrminic PA or R, intolerance or lack of effect with macrolides
Gent or colomycin
What resp condition is a risk factor for TB
Silicosis
Sx of TB
Progressive Sx ( weeks/ months)
Weigh loss + night sweats
Cough
Possibly productive + haemoptysis
Anorexia
General malaise
Which lobe predominance does TB have
Upper Lobe
Features of active TB on chest radiograph
Soft nodular shadowing, consolidation, infiltration, cavitation, miliary modules, pleural effusion, tuberculoma
First Ix for TB
Tuberculin skin test
What are the TB specific antigens, are they present in BCH
ESAT 6 and CFP 10.
When should INFg assay be performed
If Mantoux is +ve
What samples should be done for pulmonary Tb and what test are done, what stain is used
Sputum x 3, induced sputum x3, BAL +- TBB
smear, culture (TB+ routine)and histopatholgy
Ziehl neelsen stain used
should pulm tb pts be isolated in -ve pressure room
yes
tx for TB and when shpuld it be extended
Rifampicin (R) 6mo
Isoniazaid (H) 6mo + pyridoxine
Pyrazinamide 2mo
ethambutol 2mo
extend if TB meningitis, extensive TB, miliary TB
when should oral steroids be used in TB
extensive tb, meningitis, pericarditis, ureteric, and Pleural effusion
Treatment for latent TB
6mo R/H or 3mo R+H
Contact tracing for TB and precautions
Household and close contacts >8h
Should screen all close contacts- TST, CXR, med assessment of concerns
What is considered HAP
Over 48 hrs in hospital
What are the common causes of HAP and how should HAP be treated
Pseudomonas and MRS
Use coamox
Should Gram-ve or Gram+ve be done for HAP first
Gram -ve then Gram +ve
