chest infection

Question 1

list URTI

Answer 1

rhinitis
sinusitis
pharyngitis
tonsillitis (Quinsy)
laryngitis

Question 2

list LRTI

Answer 2

laryngo-trachea-bronchitis (LTB)
bronchiolitis
pneumonitis (may or may not be infection)

Question 3

what is empyema

Answer 3

plural infection. plural space fills with fluid/pus

Question 4

what is bronchiectasis

Answer 4

recurring damaged airways susceptible to infection

Question 5

what is difficult to differentiate between when looking at exacerbations

Answer 5

infectious or inflammatory response?

Question 6

source control important

Answer 6

consider the pathogen, host and severity

outcome = pathogen and host

Question 7

basic microbiology

Answer 7

respitatory microbiology: commensal organism vs respiratory pathogen

Question 8

basic antibiotic biology

Answer 8

consider spectrum, route of administration, bioavailabilty, duration

consider goal of treatment - cure, control, maintenance, ‘immune-modulation’

cant sterilise the lungs

mechanisms -> understand bactericidal and bacteriostatic

Question 9

basic immunology

Answer 9

local defences, innate and adaptive

innate: phagocytosis, complement, CRP (measure / acute phase response)

adaptive (cell-mediated and humoral response)

Question 10

sepsis

Answer 10

a life-threatening organ dysfunction caused by a dysregulated host response to infection

pathogen x host = outcome

sepsis wins! if someone has it, it is your main concern

MAP <65mmHg, lactate >2mmol/l

hypotension despite fluid resuscitation, requiring vasopressors

Question 11

treatments for URTI

Answer 11

supportive mainly

consider underlying diagnosis - allergy, polyps, immunity

Question 12

treatments for LRTI

Answer 12

supportive, maybe need antibiotics

consider related morbidity - URT, LRT, asthma, chronic cough

make back-up plan - consider CXR, antibiotics, referral

Question 13

pneumonia

Answer 13

have to abnormality of XR
AB’s -even if likely virus

consider underlying diagnosis

Question 14

empyema

Answer 14

AB’s
drain
supportive
definitive treatment = surgery

Question 15

bronchiectasis

Answer 15

airway clearance! (drain pus)
then AB’s
long term management plan

Question 16

lung abscess, cavitation

Answer 16

AB’s
treatment defined by pathogen/cause
surgery

Question 17

X-ray can show

Answer 17

LRTI:

• mucus plugging (pneumonia)
• pneumonia (e.g. right or left lower lobe)

Question 18

aspergillosis pneumonia (has had pneumonia, got emphysema and bronchiectasis)

Answer 18

aspergilloma is a growth (fungus ball) that develops in an area of past lung disease or lung scarring such as TB or lung abscess. SOB, cough (blood, lumps, mucus), wheeze, pyrexia)

Question 19

granulomatous polyangiitis (GPA)

Answer 19

inflammation not infection

steroids and cytotoxic drug

Question 20

community acquired pneumonia

Answer 20

viral, bacterial (step, H.inf), or co-infection

cough, phlegm, SOB, fever

consider clinical features and radiology and CURB65 (reflects 30day mortality)

Question 21

how long should you give AB’s?

Answer 21

don’t know

depends on pathogen (some take days to kill), disease and host response

Question 22

how long is treatment for pneumonia, deep seated infection, empyema, cavitation?

Answer 22

pneumonia - 5-7days; 3 days may be sufficient (pneumococcus)

deep seated infection - 14days

empyema - 4-6weeks

cavitation - pyogenic >6weeks, TB 6months, NTM 18months

Question 23

hospital acquired pneumonia

Answer 23

different pathogens different outcomes

Question 24

what has the biggest impact?

Answer 24

vaccination

Question 25

differential diagnosis of pneumonia

Answer 25

• organising pneumonia
• bronchoalveolar carcinoma (BAC)
• vasculitis

Question 26

summary

Answer 26

consider the severity of the infection, the cause of the infection and the best treatment strategy for that person

use resources widely - blood tests, sputum, review in hospital, CXR…sputum, CT PET, 16s rRNA sequencing

consider a range of alternative explanations in pneumonia - the DD

work with colleagues for both the individual and the wider community

Question 27

future directions

Answer 27

rapid diagnostics, rapid drug sensitivities, improved community support, immunomodulatory therapy, biomarkers to assess response, sequencing