Acute bronchitis, influenza and TB Flashcards
What is bronchitis
inflammation of the large airways of the lungs
Common causes of bronchitis
VIRUS
- influenza A and B
- parainfluenza
- RSV
- coronavirus
- rhinovirus
- adenovirus
Clinical manifestations of acute bronchitis
- persistent cough for 1 to 3 weeks
- with or without sputum
- low grade fever
- wheezing, mild dyspnea
- rhonchi that clears with cough
- chest pain
Why do you do a CXR if bronchitis is suspected
to rule out pneumonia
Indications for a chest xray with bronchitis
- tachycardia/tachypnea
- fever
- hypoxia
- dementia
- rales,egophany, tactile fremitus
- MS change in pts >75
When is bronchitis suspected in a patient
persistent cough for at least 5 days
What is procalcitonin
blood test used to detect a bacterial infection
What procalcitonin levels would you consider using antibiotics
> 0.25 mcg/L
OTC cough med for bronchitis
- Dextromethorphan (cough suppressant)
- guaifenesin (expectorant)
Management of bronchitis
- patient education
- bronchodilators
- antitussives
Perscription cough medications for bronchitis
- robitussin AC (guaifenesin with codiene)
- tessalon pearles (benzonatate)
High risk populations for the flu
- pregnant women
- children
- > 65
- comorbities
How is influenza subtyped
surface hemagglutinin (H) and neuraminidase (N) antigens
How many different H antigens are there? N?
16 H
9 N
What three subtypes affect humans
H1, H2, H3, N1, N2
Antigenic shifts
major changes in the glycooproteins of H and N
What are antigenic shifts responsible for
pandemics and epidemics
Antigenic drifts
result from point mutations in the RNA gene segments
Clinical manifestation of influenza
- sudden onset
- headache
- fever
- myalgia
- cough
- sore throat
Rapid influenza antigen testing
- differentiates between types A and B
- nasopharyngeal swab
Immunifuorescence
- respiratory swab
- direct and indirect staining
- depends on laboratory expertise
- not often used
Reverse transcriptase polymerase chain reaction (RT-PCR)
- most sensitive and specific
- differentiates between types and subtypes
- get specimen through nasal swab, bronchial lavage, throat swab
Neuraminidase inhibitors for influenza
- zanaminvir
- oseltamivir
- peramivir
Adamantane agents for influenza
- amantadine
- rimantadine
*no longer recommended
What type of flu vaccine is recommended in patients >65
high dose vaccine
Where are the highest rates of TB
sub-Sarharan africa, india, and islands of southeast asia and micronesia
Factors associated with risk of transmission of TB
- presence of active untreated pulmonary or laryngeal disease
- presence of cavitary disease
- presence of sputum positive for m. tuberculosis AFB
High risk procedures for TB transmission
- intubation
- bronchoscopy
- sputum induction
- chest PT
- administration of aerosolized drugs
- irrigation of TB abscess
- autopsy
Four stages of TB
- immediate clearance of the organism
- primary disease
- latent infection
- reactivation disease
Clinical manifestation of primary disease
- fever
- fatigue
- arthralgia
- cough
- pharyngitis
Clinical manifestation of reactivation disease
- weight loss
- night sweats
- anorexia
- pleuritic or retrosternal chest pain
When is a PPD test considered positive in a healthy person
> 15 mm
Diagnosis of active disease in TB
Sputum (ABF stain or mycobacterial culture)
When to do a chest xray with TB
- suspected active TB
- positive PPD
- positive IGRA
Where is TB typically found
in the upper lobes
What are the goal of TB treatment
- eradication
- prevent transmission
- prevent relapse
- prevent development of drug resistance
Medication management for TB
- isoniazid
- rifampin
- pyrazinamide
- ethambutol
- +/- streptomycin
*all given simultaneously
Intensive phase of TB treatment
- give all 4 drugs
- lasts 2 months
- give meds on empty stomach
- monitor LFTs
Continuation phase of TB treatment
- give isoniazid and rifampin
- 4 months
- until 2 consecutive negative cultures
Management of latent TB
- isoniazid x9 months
- rifampin x4 months
Multi-drug resistant TB
resistant to at least isoniazid and rifampin
Extensively drug resistant TB
resistant to at least isoniazid, rifampin and at least on of the three injectable second line durgs (capromycin, kanamycin, amikacin)
