Bacterial RT Infections

Question 1

What is the mortality rate of bacterial RT infections?

Answer 1

8-14%

30% in ICU

Question 2

Who most commonly gets bacterial RT infections?

Answer 2

Extremes of age

Question 3

What is the pathogenesis of bacterial RT infections?

Answer 3

• Pathogens overcome the immune system due to:
  
  • Large innoculum
  • Increased virulence
  • Host defense defect

Question 4

What are the typical pathogens which cause bacterial RT infections?

Answer 4

• Moraxella catharralis
• Haeophilus influenzae
• Streptococcus pneumoniae

Question 5

What are the atypical pathogens which cause bacterial RT infections?

Answer 5

• Legionella. pneumoniae
• Chlamydia. pnaeumoniae
• Mycoplasma. pneumoniae

Question 6

What is the number one cause of community acquired pneumonia?

Answer 6

S. Pneumoniae

Question 7

What are the risk factors for S. Pneumoniae?

Answer 7

• Cancer
• Asthma
• Alcohol
• Smoking

Question 8

Describe the clinical symptoms of s. pneumniae?

Answer 8

• Abrupt Onset
  
  • Cough
  • Fever
  • Pleuritic chest pain

Question 9

What is pictured here?

Answer 9

Chest XR of someone with S. pnuemoniae RT infection

Question 10

What clinical findings would be present with s. pneumoniae infection?

Answer 10

• Dull percussions
• Coarse crepitations
• Increased vocal resonance

Question 11

Describe resistance of s. pneumoniae to penicillin?

Answer 11

• Asia
• North America
• Southern Europe

Question 12

What can S. Pneumoniae be treated with if the patient has a penicilin allergy?

Answer 12

• Macrolides
  
  • Clarithromycin
• Tetracyclines
  
  • Doxycycline

Question 13

When is a person most likely to become infection with Haemophilus influenzae?

Answer 13

• Older people
• Underlying lung disease

Question 14

Describe the clinical presentation of H. influence respiratory tract infection?

Answer 14

• Abrupt onset
  
  • Cough
  • Fever
  • Pleuritic chest pain

Question 15

Describe the clinical findings of H. influenzae respiratory tract infection?

Answer 15

• Dull percussions
• Coarse crepitations
• Increased vocal resonance

Question 16

What is the first line treatment for H. influenzae respiratory tract infections?

Answer 16

Amoxicillin

Question 17

What should someone with H. influenzae be treated with if there was a risk of beta lactamase?

Answer 17

• Co-amoxiclav
• Macrolides (clarithromycin)
• Tetracyclines (doxycicline)

Question 18

Describe mycoplasma pneumoniae?

Answer 18

• Smallest free living bacterium
• Lack of cell wall
• Difficult to grow

Question 19

Describe the spread of mycoplasma pneumoniae?

Answer 19

• Droplet spread (sneezing)
• Seasonal incidence
  
  • Autumn
  • Winter

Question 20

How is M. pneumoniae diagnosed?

Answer 20

• Serology
• PCR
  
  • sputum
  • throat swab

Question 21

How is L. pneumophila diagnosed?

Answer 21

• Culture
• Serology
• Urinary antigen test

Question 22

How should L. pneumophila be treated?

Answer 22

• Macrolides (clarithromycin)
• Quinolones (ciprofloxacin)
• Tetracyclines (doxycicline)

Question 23

What is it important to cover with a history in someone with pneumoniae?

Answer 23

• Symptoms
• Past medical history
• Epidemiology
  
  • travel
  • ill contacts
  • water exposure

Question 24

Name the categories of investigations into patients with pneumoniae?

Answer 24

• Blood tests
• Imaging
• Microbiology

Question 25

What blood tests should be performed on someone with pneumonia?

Answer 25

* FBC * U&Es * ABGs

Question 26

What microbiology tests should be performed on someone with pneumonia?

Answer 26

* Blood cultures * Sputum culture * Throat swab * Urine legionella antigen

Question 27

What imaging should be performed on someone with pneumonia?

Answer 27

* CXR * ECG

Question 28

How would someone with pneumonia be managed?

Answer 28

* Airway, breathing, circulation * Antibiotics? * Admission to hospital? * CURB65 * Sepsis? * Hypoxia?

Question 29

What is important about H. influenza?

Answer 29

The general population are vaccinated against it (Hib)

Question 30

What does Hib cause?

Answer 30

Epiglottitis

Question 31

Which H. Influenza strains cause pneumonia?

Answer 31

* All of them apart from Hib * (vaccine does not protect against pneumonia)

Question 32

Where does H. Influenza colonise? What does this mean for what it infects?

Answer 32

Colonises the upper RT Causes infections around about this area

Question 33

Name some infections which H. Influenza can cause due to colonised the upper RT?

Answer 33

* Sinusitis * Pneumonia * Otitis media * Conjuctivitis

Question 34

How will people present with M. pneumonia?

Answer 34

* Tired * Fever * Headache

Question 35

What is an atypical pneumonia?

Answer 35

* Very non-specific presentation * Chest x-ray will show lung consildation

Question 36

Name some complications of M. pneumonia?

Answer 36

* Guillain-Barre * Reactive arthritis * Haemolysis (cold)

Question 37

How can you be infected by legionella pneumophilia? What is a major factor which helps diagnose legionella?

Answer 37

* Contaminated water systems * Soil and compost Complete patient history

Question 38

Describe the presentation of legionella pneumophilia?

Answer 38

* Atypical presentation * Headache * Tiredness * Fever

Question 39

Describe the CURB65 scoring system?

Answer 39

* C - Confusion * U - Urea \> 7 * R - RR \>= 30 * B - BP, diastolic \<60 or systolic \<90 * 65 - Age over 65 years old Severe pneumonia if they have score \>2

Question 40

What defines severe pneumonia regardless of CURB65 score?

Answer 40

* Multilobar consolidation on CXR * and/or * Hypoxia on room air

Question 41

Describe the qSOFA criteria for sepsis?

Answer 41

* Altered mental status * Systolic BP \< 100 mmHg * RR \> 22 breaths/min

Question 42

What clinical assessments can be used with a patient who has pneumonia?

Answer 42

* CURB65 score * Sepsis qSOFA * Multilobar consolidation on CXR/Hypoxia on room air