Chronic Lung Infections Flashcards
d: cachexia
weakness and wasting of the body muscles due to severe chronic illness
give some reasons for developing chronic pulmonary infection
Immunodeficiency -Congenital - Acquired Immunosuppression -Drugs -Malignancy Abnormal innate host defence -Damaged bronchial mucosa -Abnormal cillia -Abnormal secretions Repeated insult -Aspiration -Indwelling material
name some types of immunodeficiency
Immunoglobulin deficiency
IgA Deficiency
Hypogammaglobulinaemia: rarer, increased risk of acute, and chronic infections
CVID: commonest cause of immunodeficiency, recurrent infections
Specific Polysaccharide Antibody Deficiency (SPAD), streptococcal infections Hypo-splenism Immune paresis Myeloma, lymphoma, metastatic malignancy HIV
name some forms of immunosuppression
Steroids Azathioprine Methotrexate Cyclophosphamide Monoclonal antibodies Infliximab, etanercept: TNFa Rituximab: CD20 Leflunamide Chemotherapy
how may the bronchial mucosa become damaged?
smoking
recent pneumonia
malignacy
why may cilia be abnormal?
kartenager’s syndrome
Youngs Syndrome
why may you have abnormal secretions?
CF
Channelopathies
d: situs inversus
all the organs are the other way round
what causes situs inversus?
abnormal cilial function
What are symptoms of recurrent aspiration?
NG feeding
Poor Swallow
Pharyngeal Pouch
Give some egs of indwelling material?
NG tube in the wrong place…
Chest drain
Inhaled foreign body (peanut, chicken bone, piece of coal, cockroach…)
Name some Chronic Infections
Intrapulmonary abscess Empyema Chronic Bronchial Sepsis Bronchiectasis Cystic Fibrosis and other oddities
what type of necrosis is a lung abscess?
liquefactive
Name symptoms of an intrapulmonary abscess
unwilling to do exercise/lazy Weight loss common Lethargy, tiredness, weakness Cough ± sputum High mortality if not treated Usually a preceding illness of some sort -Pneumonic infection -Post viral -Foreign body
name some preceding illnesses for intrapleural abscess
pneumonia
aspiration pneumonia
hypogammaglobulinaemia
what pathogens cause abscesses?
Bacteria Streptococcus Staphylococcus (Particularly post ‘flu) E-Coli Gram Negatives Fungi Aspergillus
Name some causes of septic emboli
Right sided endocarditis
Infected DVT
Septicaemia
Intravenous drug users
Name the organisms that typical cause empyema
- Gram +ve (strep milleri, Staph aureus)
- Gram –ve (Ecoli, Pseudomonas, Haem Influenzae, Klebsiella)
aerobic/anaerobic organisms frequently cause empyema
aerobic
How would you diagnose empyema
Clinical suspicion The slow to resolve pneumonia Don’t forget the lateral chest film CXR Persisting effusion, particularly if loculations visible USS The preferred investigation Simple, bedside test Targetted sampling CT Differentiation between Empyema and Abscess
what other treatments are given in empyema?
IV antibiotics
amoxicillin and metronidazole
Oral antibiotics
co-amoxiclav
d:bronchiectasis
Localised, irreversible dilation of the bronchial tree
Involved bronchi are dilated, inflamed and easily collapsible
Airflow obstruction
Impaired clearance of secretions
Name some of the pathophysiology of bronchiectasis
Bronchial obstruction Cystic Fibrosis Young’s Syndrome Kartanager’s Syndrome ABPA Immunodeficiency Rheumatoid Arthritis Bronchopulmonary sequestration Mounier-Khun Syndrome Yellow Nail Syndrome Traction bronchiectasis associated with pulmonary fibrosis
Clinical presentations of chronic bronchial sepsis
All the hallmarks of bronchiectasis
No bronchiectasis on the HRCT
Confirmed positive sputum results
Often younger patients, mainly women, often involved in childcare
Others are older, usually with COPD, or airways disease
Same work-up as bronchiectasis
Remember the sinuses - reservoir of infection
treatment of chronic bronchial sepsis
Stop smoking ‘Flu vaccine Pneumococcal vaccine Reactive antibiotics Send sputum sample Give antibiotics appropriate to most recent positive culture
what has been shown to reduce exacerbation rates in bronchiectasis?
low dose macrolide antibiotics
How do you treat acute exacerbations of bronchiectasis?
2 weeks of antibiotics appropriate to the most recent positive sputum sample
Send sputum every time
Alter antibiotics if the sputum culture shows resistant organisms
Aggressively eradicate Pseudomonas Aeriginosa
