Chronic Pulmonary Infection Flashcards
Immunoglobulin deficiency
IgA Deficiency
Hypogammaglobulinaemia
CVID
Specific Polysaccharide Antibody Deficiency
Other immunodeficiencies
Hypo-splenism
Immune paresis (Myeloma, lymphoma etc)
HIV
Therapies causing immuosuppression
Steroids Azathioprine Methotrexate Cyclophosphamide Monoclonal antibodies Infliximab, etanercept, rituximab, leflunamide Chemotherapy
Defective innate host defences
Damaged bronchial mucosa
Abnormal cilia
Abnormal secretions
Causes of damaged bronchial mucosa
Smoking
Recent pneumonia, or viral infection
Malignancy
Causes of abnormal cilia
Kartenager’s Syndrome
Youngs Syndrome
Causes of abnormal secretions
Cystic Fibrosis
Channelopathies
Risk factors for developing chronic pulmonary infection
Immunodeficiency
Immunosuppression
Abnormal host defences
Repeated insult
Forms of chronic infection
Intrapulmonary abscess Empyema Chronic bronchial sepsis Bronchiectasis Cystic fibrosis
Features of intrapulmonary abscess
Indolent presentation Weight loss Lethargy Cough High mortality if untreated Usually a preceding illness
Pathogens that cause abscesses (from pneumonia)
Streptococcus Staphylococcus E-coli Gram negatives Aspergillus
Septic emboli in injecting drug users
Inject into groin
DVT
Infection
PE + abscesses
Empyema
Pus in the pleural space
Simple parapneumonic effusion
Clear fluid
pH>7.2
LDH < 1000
Glucose >2.2
Complicated parapneumonic effusion
pH <7.2
LDH > 1000
Glucose <2.2
Requires chest tube drainage or becomes empyema
Bacteriology of empyema
Aerobic organisms most frequently Gram Positive (Strep Milleri, Staph Aureus) Gram Negatives (E-Coli, Pseudomonas, Haemophilus Influenzae, Kelbsiellae)
Bronchiectasis
Localised, irreversible dilation of the bronchial tree
Involved bronchi are dilated, inflamed and easily collapsible
Airflow obstruction
Impaired clearance of secretions
Presentation of bronchiectasis
Recurrent “chest infections”
Recurrent antibiotics
No response/ short lived response to antibiotics
Persistent sputum production
Clinical bronchiectasis
Cough with sputum production
Chest pain
Recurrent LRTIs
Radiological bronchiectasis
High resolution CT scan
Pathophysiology of bronchiectasis
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%
Chronic bronchial sepsis
All the hallmarks of bronchiectasis but none on the HRCT
Positive sputum results
Treatment of bronchiectasis
Stop smoking Flu vaccine Pneumococcal vaccine Reactive antibiotics Prophylactic antibiotics Nebulised gentamicin, colomycin, pulsed IV abx, alternating antibiotics Low dose macrolide antibiotics Clarithromycin, azithromycin
Mortality rate from abscess
10%
Mortality rate from empyema
20%
