chest infection Flashcards
list URTI
rhinitis sinusitis pharyngitis tonsillitis (Quinsy) laryngitis
list LRTI
laryngo-trachea-bronchitis (LTB)
bronchiolitis
pneumonitis (may or may not be infection)
what is empyema
plural infection. plural space fills with fluid/pus
what is bronchiectasis
recurring damaged airways susceptible to infection
what is difficult to differentiate between when looking at exacerbations
infectious or inflammatory response?
source control important
consider the pathogen, host and severity
outcome = pathogen and host
basic microbiology
respitatory microbiology: commensal organism vs respiratory pathogen
basic antibiotic biology
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
basic immunology
local defences, innate and adaptive
innate: phagocytosis, complement, CRP (measure / acute phase response)
adaptive (cell-mediated and humoral response)
sepsis
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
treatments for URTI
supportive mainly
consider underlying diagnosis - allergy, polyps, immunity
treatments for LRTI
supportive, maybe need antibiotics
consider related morbidity - URT, LRT, asthma, chronic cough
make back-up plan - consider CXR, antibiotics, referral
pneumonia
have to abnormality of XR
AB’s -even if likely virus
consider underlying diagnosis
empyema
AB’s
drain
supportive
definitive treatment = surgery
bronchiectasis
airway clearance! (drain pus)
then AB’s
long term management plan
lung abscess, cavitation
AB’s
treatment defined by pathogen/cause
surgery
X-ray can show
LRTI:
- mucus plugging (pneumonia)
- pneumonia (e.g. right or left lower lobe)
aspergillosis pneumonia (has had pneumonia, got emphysema and bronchiectasis)
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)
granulomatous polyangiitis (GPA)
inflammation not infection
steroids and cytotoxic drug
community acquired pneumonia
viral, bacterial (step, H.inf), or co-infection
cough, phlegm, SOB, fever
consider clinical features and radiology and CURB65 (reflects 30day mortality)
how long should you give AB’s?
don’t know
depends on pathogen (some take days to kill), disease and host response
how long is treatment for pneumonia, deep seated infection, empyema, cavitation?
pneumonia - 5-7days; 3 days may be sufficient (pneumococcus)
deep seated infection - 14days
empyema - 4-6weeks
cavitation - pyogenic >6weeks, TB 6months, NTM 18months
hospital acquired pneumonia
different pathogens different outcomes
what has the biggest impact?
vaccination
differential diagnosis of pneumonia
- organising pneumonia
- bronchoalveolar carcinoma (BAC)
- vasculitis
summary
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
future directions
rapid diagnostics, rapid drug sensitivities, improved community support, immunomodulatory therapy, biomarkers to assess response, sequencing
