Chronic Pulmonary Infection Flashcards
What are some examples of immunodeficiencies that result in increased risk of acute infections?
CVID - commonest cause of immunodeficiency, low production of antibodies. Recurrent infection.
Immunoglobin deficiiencies such as
IgA deficiency: This is common. IgA is usually first line defence.
Hypogammaglobulinaemia: is rare and means the body produces no antibodies. Increases risk of both chronic and acute infection
What is the commonest cause of immunodeficiency?
CVID - common variable immunodefciency disease. This is where there is low production of antibodies, particularily IgA, IgM and IgG. Causes recurrent infections.
What does SPAD stand for and what is it?
Specific Polysaccharide Antibody Defciency
Deficiency in making IgG antibodies for bacteria that have polysaccharide wall.
Significance of hyposplenism with regards to immunodeficiency?
Spleen “white pulp” rich in T lymphocytes and B lynphocytes. Humoral and adaptive immune response affected if spleen absent/ not functioning.
What is immune paresis?
When antibodies are grossly abnormal/ non functional. Examples are myeloma (cancer of plasma cells), lymphoma (cancer of lymphocytes) or metastatic malignancy to organs/lymph of immune system.
What is HIV?
Human immunosupression virus, virus infects immune system.
What are some iatrogenic causes of immunosuppression?
-Steroids
-Chemotherapy
-Monoclonal antibodies, used in organ transplants (infliximab binds to TNFa, Rituximab binds to CD20 - prevents division and differentiation of plasma cells)
Azathioprine - immunosupressant that prevents DNA replication and other cellular processes
Chemotherapy agents - methotrexate and cyclophosphamide
Why would the innate hose defence be damaged?
Damaged bronchial mucosa due to smoking, recent flue or pneumonia, malignancy
Repeated insult such as NG feeding, NG tube in the wrong place, inhaled foreign body..
What is kartagener’s syndrome?
Rare congenital condition known as primary ciliary dyskinesia. Inefficent or unsynchronized ciliary beating
What is Young’s syndrome?
- rhinosinusitis: inflammation of sinuses
- bronchiectasis: dilated bronchi with lost muscle and elasticity, clearance doesn’t work properly
What’s the difference between an abscess and empyema?
Abscess is collection of pus WITHIN the lung that results in cavitation. Empyema is collection of pus in the intrapleural space.
What is the clinical presentation of an intrapulmonary abscess?
Slow presentation
Lethargy, tiredness and weakness
Cough with or without sputum
History: preceding illness (post viral/foreign body inhalation/ pneumonia)
What are some common causes of pulmonary abscesses?
Septic emboli from endocarditis, infected DVT or IV drug users
Preceding illness such as pneumonia (becomes cavitating pneumonia) or aspiration pneumonia, or poor host immune response
What are some common causes of empyema?
Over half of patients pneumonia. Remaineder “primary empyema” iatrogenic or idiopathic
What raises clinical suspicion for empyema?
Slow to resolve pneumonia
CXR: persisting effusion with loculations (pockets of pus in lungs), do lateral CXR
Ultrasound preferred investigation
