Chronic Pulmonary Infection

Question 1

What are the different forms of chronic pulmonary infection?

Answer 1

• intrapulmonary abscess
• empyema
• chronic bronchial sepsis
• bronchiectasis
• cystic fibrosis & other oddities

Question 2

What are the risk factors for developing chronic pulmonary infection?

Answer 2

1. Abnormal Host Response
   
   • immunodeficiency
   • immunosuppression
2. Abnormal Innate Host Defence
3. Repeated Insult

Question 3

List the immunodeficiency problems people with chronic pulmonary infection may suffer from?

Answer 3

• immunoglobin deficiency
• hypo-splenism
• immune paresis
• HIV

Question 4

Describe the types of immunoglobulin deficiency people with chronic pulmonary infection may suffer from?

Answer 4

IgA Deficiency
      -common, increased 
       risk of acute 
       infections, rarely 
       chronic infections
Hypogammaglobulinaemia
        -rarer 
        -increased risk of acute & chronic infections
CVID
        -commonest cause of immunodeficiency
        -recurrent infections
Specific Polysaccharide Antibody Deficiency

Question 5

What is immune paresis related (?) to?

Answer 5

Myeloma
Lymphoma
Metastatic malignancy

Question 6

What can cause immune suppression?

Answer 6

Increasingly common therapies e.g.

• steroids
• azathioprine
• methotrexate
• cyclophosphamide
• monoclonal antibodies
  - infliximab, etanercept: TNFa
  - rituximab: CD20
  - leflunamide
• chemotherapy

Question 7

Why do you need to be aware of therapies that can cause immune suppression?

Answer 7

It could be the reason for their chronic pulmonary infections!

Question 8

What is meant by ‘defective innate host defense’?

Answer 8

1) Damaged Bronchial Mucosa
- smoking
- recent pneumonia, or viral infection
- malignancy
2) Abnormal Cillia
- Kartenager’s Syndrome
- Youngs Syndrome
3) Abnormal Secretions
- Cystic fibrosis
- Channelopathies

Question 9

You know ‘repeated insult’ can contribute to chronic pulmonary infections but what does this actually mean?

Answer 9

1. RECURRENT ASPIRATION
   - NG feeding
   - Poor swallow
   - Pharyngeal
   pouch
2. INDWELLING MATERIAL
   - NG tube in
   wrong place
   - Chest drain
   - Inhaled foreign
   body (peanut,
   chicken bone,
   piece of coal,
   cockroach…)

Question 10

What are the symptoms of intrapulmonary abscess?

Answer 10

-indolent presentation
-weight loss common
-lethargy, tiredness, weakness
-cough & sputum
-high mortality if not treated
-usually a preceding illness of some sort e.g.
#pneumonic
infection
#post viral
#foreign body