Chest Infection Flashcards
List of respiratory tract host defences.
What age category is pneumonia most common in?
Very old and very young – immune system less prepared to take on infections
Major cause of death in children under 5 - especially in low socio-economic classes
How does the type of respiratory infection change throughout the year?
What are the common bacterial causes of pneumonia?
Streptococcus pneumoniae(most common bacterial cause)
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
What are the common bacterial causes of atypical pneumonia?
Legionella pneumophila
Mycoplasma pneumoniae
Coxiella burnetti
Chlamydia pneumoniae and psittaci
How do chest infections present?
- Fever
- Cough
- Sputum production
- Breathlessness
- Chest pain – due to the inflammation in the pleural space
- Confusion – elderly and specific types of pneumonia (legionella) – confusion that does not correlate with levels of hypoxia
What investigations should be performed if someone is presenting with severe Covid-19 infection?
- Covid-19 PCR
- Urea and electrolytes, full blood count and C-reactive protein – look at systemic effects
- Blood cultures
- Arterial blood gas
- Chest X-ray
Covid pneumonitis – X-ray – swelling, infiltration of immune cells, fluid build-up
What treatment should be given to patients with Covid-pneumonitis?
- Oxygen therapy - aim for oxygen saturation 94-96%
- Glucocorticoid e.g. dexamethasone - reduce the immune response – anti-inflammatory
Other alternatives
1. Anti-virals e.g. Remdesivir
2. IL-6 inhibitors e.g. Tocilizumab
3. JAK inhibitors e.g. Baracitinib
What investigations should be performed if someone is suspected of having pneumonia?
- Nasopharyngeal swab for Sars-Cov2
- Urea and electrolytes, full blood count and C-reactive protein – look at systemic effects
- Blood cultures
- Arterial blood gas
- Chest X-ray
How does pneumonia normally present - think X-ray and breath sounds?
- X-ray - Lung consolidation - normally in lower lobes
- Crackles - fluid
- Bronchial breathing
What is the CURB65 score used for?
CURB65 score – developed to figure out how sick people are with pneumonia – scoring of pneumonia – stratification of patients
CURB65: One point for each feature
1. C-confusion
2. U-urea >7 mmol/L
3. R-respiratory rate 30 breaths per minute
4. B-blood pressure (systolic < 90 mmHg, diastolic < 60 mmHg)
5. Age > 65 years
Interpreation of score - shown in image
How do you treat pneumonia?
- Oxygen start 40% via a face mask
- Antibiotics against bacteria - gram positive or negative – start with a general antibiotic moving on to more specific options when the culprit has been identified
- Thromboprophylaxis – high risk of DVT or PE
- Review from intensive care
What is Pneumocystis jirovecii?
- It is a fungus, specific for humans - Airborne spread
- Many of us may have asymptomatic colonisation
- Common in patients - Lung infection in those who are immunosuppressed
- Common cause of pneumonia in HIV infected patients in the 80’s and 90’s
How is Pneumocystis jirovecii diagnosed?
- Get Sputum
- Induced sputum - Give hypertonic saline nebulizer and physiotherapist then obtains a sample - less invasive than the bronchoscopy
- Bronchoscopy - Test for presence
- Microscopy-silver stain
- PCR for microbial DNA
X-ray - Diffuse ground glass opacification
What is the treatment for Pneumocystis jirovecii infection?
- High dose intravenous cotrimoxazole (antibiotic) and corticosteroids
- Prophylaxis for those at risk with oral cotrimoxazole
