Chronic Pulmonary Infection

Question 1

Immunoglobulin deficiency

Answer 1

IgA Deficiency
Hypogammaglobulinaemia
CVID
Specific Polysaccharide Antibody Deficiency

Question 2

Other immunodeficiencies

Answer 2

Hypo-splenism
Immune paresis (Myeloma, lymphoma etc)
HIV

Question 3

Therapies causing immuosuppression

Answer 3

Steroids
Azathioprine
Methotrexate
Cyclophosphamide
Monoclonal antibodies 
 Infliximab, etanercept, rituximab, leflunamide
Chemotherapy

Question 4

Defective innate host defences

Answer 4

Damaged bronchial mucosa
Abnormal cilia
Abnormal secretions

Question 5

Causes of damaged bronchial mucosa

Answer 5

Smoking
Recent pneumonia, or viral infection
Malignancy

Question 6

Causes of abnormal cilia

Answer 6

Kartenager’s Syndrome

Youngs Syndrome

Question 7

Causes of abnormal secretions

Answer 7

Cystic Fibrosis

Channelopathies

Question 8

Risk factors for developing chronic pulmonary infection

Answer 8

Immunodeficiency
Immunosuppression
Abnormal host defences
Repeated insult

Question 9

Forms of chronic infection

Answer 9

Intrapulmonary abscess
Empyema
Chronic bronchial sepsis
Bronchiectasis
Cystic fibrosis

Question 10

Features of intrapulmonary abscess

Answer 10

Indolent presentation
Weight loss
Lethargy
Cough
High mortality if untreated
Usually a preceding illness

Question 11

Pathogens that cause abscesses (from pneumonia)

Answer 11

Streptococcus
Staphylococcus
E-coli
Gram negatives
Aspergillus

Question 12

Septic emboli in injecting drug users

Answer 12

Inject into groin
DVT
Infection
PE + abscesses

Question 13

Empyema

Answer 13

Pus in the pleural space

Question 14

Simple parapneumonic effusion

Answer 14

Clear fluid
pH>7.2
LDH < 1000
Glucose >2.2

Question 15

Complicated parapneumonic effusion

Answer 15

pH <7.2
LDH > 1000
Glucose <2.2
Requires chest tube drainage or becomes empyema

Question 16

Bacteriology of empyema

Answer 16

Aerobic organisms most frequently
Gram Positive (Strep Milleri, Staph Aureus)
Gram Negatives (E-Coli, Pseudomonas, Haemophilus Influenzae, Kelbsiellae)

Question 17

Bronchiectasis

Answer 17

Localised, irreversible dilation of the bronchial tree
Involved bronchi are dilated, inflamed and easily collapsible
Airflow obstruction
Impaired clearance of secretions

Question 18

Presentation of bronchiectasis

Answer 18

Recurrent “chest infections”
Recurrent antibiotics
No response/ short lived response to antibiotics
Persistent sputum production

Question 19

Clinical bronchiectasis

Answer 19

Cough with sputum production
Chest pain
Recurrent LRTIs

Question 20

Radiological bronchiectasis

Answer 20

High resolution CT scan

Question 21

Pathophysiology of bronchiectasis

Answer 21

Bronchial obstruction
Cystic fibrosis
Young's syndrome
Kartanager's syndrom
ABPA
Immunodeficiency
Rheumatoid arthritis
Bronchopulmonary sequestration
Mounier-Khun Syndrome
Yellow nail syndrome
Traction bronchiectasis associated with pulmonary fibrosis
Idiopathic >50%

Question 22

Chronic bronchial sepsis

Answer 22

All the hallmarks of bronchiectasis but none on the HRCT

Positive sputum results

Question 23

Treatment of bronchiectasis

Answer 23

Stop smoking
Flu vaccine
Pneumococcal vaccine
Reactive antibiotics
Prophylactic antibiotics
 Nebulised gentamicin, colomycin, pulsed IV abx, 
 alternating antibiotics
Low dose macrolide antibiotics
 Clarithromycin, azithromycin

Question 24

Mortality rate from abscess

Answer 24

10%

Question 25

Mortality rate from empyema

Answer 25

20%