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Respiratory > 8. Lower Respiratory Tract Infection And Pneumonia > Flashcards

8. Lower Respiratory Tract Infection And Pneumonia Flashcards

1
Q

What are the common microbiota of the respiratory tract?

A

Viridans streptococci, neisseria spp., anaerobes candida sp

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2
Q

What are some less common microbiota of the respiratory tract?

A

Streptococcus pneumoniae, streptococcus pyogenes, haemophilus influenzae

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3
Q

What are the defences of the respiratory tract?

A
  • Muco-ciliary clearance mechanisms: nasal hairs, ciliated columnar epithelium
  • Cough and sneezing reflex
  • Respiratory mucosal immune system: lymphoid follicles of the pharynx and tonsils, alveolar macrophages, secretory IgA and IgG
  • Alveolar microbiota
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4
Q

What is the course of a typical infection in the lungs?

A
  1. Alveolar macrophage fails to stop pathogen
  2. Cytokines to recruit more macrophages
  3. Inflammation leads to increased permeability
  4. More WBC/proteins to aid macrophages
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5
Q

What causes dysregulation?

A

Pathogen
Host factors
Drugs

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6
Q

What are some host factors?

A 
Age >65
Smoking, alcohol, drugs
Chronic lung diseases
Aspiration
Immunocompromised 
Metabolic - malnutrition, hypoxamia, acidosis
Co-infection with virus
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7
Q

What are some common upper respiratory tract infections?

A 
Rhinitis (cold)
Pharyngitis
Epiglottitis
Laryngitis
Tracheitis 
Sinusitis
Otitis media
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8
Q

What are some lower respiratory tract infections?

A 
Bronchitis
Pneumonia
Bronchioles is
Bronchiectasis
Empyema 
Lung abscess
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9
Q

What is acute bronchitis?

A

Inflammation of medium sized airways

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10
Q

What are the symptoms of acute bronchitis?

A 
Cough
Fever
Increased sputum production
Increased SOB
CXR normal
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11
Q

What organisms can cause acute bronchitis?

A

S. pneumoniae
H. influenzae
M. catarrhalis

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12
Q

What is the treatment for acute bronchitis?

A

Bronchodilation
Physiotherapy
Antibiotics if bacterial

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13
Q

What are some common lower respiratory tract infections?

A

Community acquired pneumonia
Hospital acquired pneumonia
Ventilated acquired pneumonia

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14
Q

What is the pathology in pneumonia?

A

Acute inflammatory response
Exudation of fibrin-rich fluid
Neutrophil infiltration
Macrophage infiltration

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15
Q

What are the typical organisms that cause most CAP?

A 
Strep. pneumoniae
Haemophillus influenzae
Moraxella catarrhalis
Staph aureus and MRSA
Klebsiella pneumonia
Group A streptococcus pyogenes
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16
Q

What are some of the atypical organisms that cause pneumonia?

A

Mycoplasma
Legionella - contaminated water
Chlamydophila pneumoniae
Chlamydophila psittaci - exposure to birds

17
Q

What are the clinical findings in CAP/

A 
Cough
Dyspnoea
Pleurisy
Fever
Tachycardia 
Organ dysfunction
Crackles
18
Q

What is present on imaging in CAP?

A

Consolidations
Infiltrates
Cavitations

19
Q

How do you assess severity of CAP?

A

CURB-65 - confusion, urea >7, respiratory rate >30, BP <90 and <60, >65 years
Score 2 maybe admit
Score 2-5 manage as severe

20
Q

What investigations should be done in CAP?

A 
FBC
U and E
C reactive protein
Arterial blood gases
CXR
21
Q

What are the microbiological investigations done in CAP?

A 
Sputum
Blood untrue
Broncho alveolar lavage fluid
Nose and throat swabs
Urine
Serum
22
Q

How do you manage CAP?

A

Mild - treat empirically
Moderate - investigations (blood cultures, sputum, urinary streptococcal antigen)
Severe - moderate + bronchoscopic specimens

23
Q

What are the differential diagnoses for CAP?

A 
Heart failure and pulmonary oedema
PE
Atelectasis
Aspiration
Drug reactions
Lung cancer
Interstitial lung disease
24
Q

What is the treatment for CAP?

A

Antibiotics - 5-7 days for mild, 7-10 for severe
Mild-moderate: amoxicillin or doxycycline or erythromycin
Moderate-severe: needing admission, co-amoxiclav and clarithromycin/doxycycline

25
Q

What are some complications of pneumonia?

A

Empyema, lung abscess, bacteraemia

26
Q

What is the aetiology of HAP?

A 
Staphylococcus aureus
MRSA
Enterobacteriaciae
Pseudomonas spp
Fungi (candida sp)
27
Q

What is the first line and second line treatment for HAP?

A

First line: co-amoxiclav

Second line/ITU: piperacillin/tazobactam or meropenem

28
Q

What is aspiration pneumonia?

A

Aspiration of exogenous material or endogenous secretions into respiratory tract
Common in patients with neurological dysphagia, epilepsy, alcoholics, drowning

29
Q

How do you treat aspiration pneumonia?

A

Mild - no treatment

Moderate to severe - co-amoxiclav

30
Q

How can you prevent pneumonia?

A

Immunisation - flu vaccine, pneumococcal vaccine
Chemoprophylaxis - oral penicillin/erythromycin
Smoking advice

Respiratory (23 decks)

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