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Respiratory > Chronic Pulmonary Infection > Flashcards

Chronic Pulmonary Infection Flashcards

1
Q

How is chronic pulmonary infection diagnosed?

A 
Shadow on CXR 
Weight loss 
Persistent sputum production 
Chest pain 
Increased SOB
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2
Q

What can be the differential diagnosis if pulmonary infection is suspected?

A 
Lung cancer 
Intrapulmonary abscess
Emypema 
Bronchiectasis 
CF
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3
Q

What are the risk factors for developing chronic pulmonary infections?

A

Abnormal host response
Abnormal innate host defence
Repeated insult

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4
Q

What is abnormal host response?

A

Immunnodeficiency: Congenital, acquired
Immunosuppression: Drugs, malignancy

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5
Q

What is abnormal innate host defence?

A

Damaged bronchial mucosa
Abnormal cillia
Abnormal secretions

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6
Q

What is repeated insult?

A

Aspiration

Indwelling material

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7
Q

What is immunodeficiency?

A

Immunoglobulin deficiency
Hypo-splenism
Immune paresis
HIV

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8
Q

What are the different types of immunoglobulin deficiency?

A

IgA deficiency: common, increased risk of acute infections, rarely chronic infections
Hypogammaglobulinaemia: rarer, increased risk of acute and chronic infections
CVID: commenest cause of immunodeficiency, recurrent infections
Specific Polysaccharide Antibody Deficiency SPAD

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9
Q

What are the different types of immune paresis?

A

Myeloma
Lymphoma
Metastatic malignancy

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10
Q

What can cause immunosuppression?

A 
Steroids 
Azathioprine
Methotrexate
Cyclophosphamide 
Monoclonal antibodies: Infliximab
Rituximab 
Chemotherapy
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11
Q

What can cause damaged bronchial mucosa?

A

Smoking
Recent pneumonia or viral infection
Malignancy

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12
Q

What can cause abnormal cilia?

A

Kartenager’s Syndrome

Youngs Syndrome

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13
Q

What can cause abnormal secretions?

A

CF

Channelopathies

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14
Q

What can cause recurrent aspirations?

A

NG feeding
Poor swallow
Pahyngeal pouch

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15
Q

What can cause indewlling of material?

A

NG tube in the wrong place
Chest drain
Inhaled foreign body (peanut, chicken bone ect)

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16
Q

What are different forms of chronic infection?

A 
Intrapulmonary abscess
Empyema 
Chronic Bronchial Sepsis
Bronchiectasis
CF or other oddities
17
Q

What are the signs and symptoms of intrapulmonary abscess?

A 
Indolent presentation 
Weight loss common
Lethargy, tiredness, weakness
Cough - can be with or without sputum
High mortality if not treated 
Usually a preceding illness of some sort
18
Q

What can be the preceding illness that leads to intrapulmonary abscess?

A

Pneumonia: Flu - Staph pneumonia - cavitating pneumonia - abscess
Aspiration pneumonia: vomiting, lowered conscious level, pharyngel pouch
Poor host immune response: Hypogammaglobulinaemia

19
Q

What pathogens can cause intrapulmonary abseccess?

A

Bacteria: Streptococcus, Staphylococcus, E-coli, Gram negatives
Fungi: Aspergillus

20
Q

What can cause a septic emboli?

A

Right sided endocarditis
Infected DVT
Septicaemia
IV drug users (PWID) - inject into groin, DVT, infection, PE + abscesses

21
Q

What is an empyema?

A

Pus in the pleural space
57% of all patients with pneumonia develop pleural fluid
Remainder are primary empyema - often iatrogenic, many idiopathic
High mortality - 20% of all patients with empyema die

22
Q

What are the characteristics of a simple parapneumonic effusion?

A

Clear fluid
pH > 7.2
LDH < 1000
Glucose > 2.2

23
Q

What does LDH measure?

A

Tissue damage

24
Q

What are the characteristics of a complicated parapneumonic effusion?

A

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

25
Q

What are the characteristics of am empyema?

A

Frank pus

26
Q

What is the bacteriology of an empyema?

A

Aerobic organisms most frequently
Gram positives: Strep milleri, staph aureus (usually post-operative or nosocmial in immunocompromised individuals)
Gram negatives: E-coli, pseudomonas, haemophilus influenzae, kelbsiellae
Anaerobes in 13% of cases - usually in severe pneumonia or poor dental hygiene

27
Q

How is an empyema diagnosed?

A

Clinical suspicion: slow to resolve pneumonia with lateral CXR
CXR: persisting effusion
USS: simple bedside test, targetted sampling
CT: Differentiation between empyema and abscess

28
Q

What does a CXR look like in empyma?

A

Look for D sign

Better CXR increase sensitivity and specificity

29
Q

How can empyema’s be treated?

A

USS guided drainage
IV antibiotics - broad spectrum, amoxicillin and metrondioazole
Oral antibiotics - directed towards cultured bacteria for at least 14 days

30
Q

What is bronchiectasis?

A

The localised, irreversible dilation of the bronchial tree
Involved bronchi are dilated, inflamed and easily collapsed
This causes airflow obstruction and impaired clearance of secretions

31
Q

What is the presentation of bronchiectasis?

A

Recurrent chest infections
Recurrent antibiotics prescriptions but no response to antibiotics or a short lived response to antibiotics
Persistent sputum production

32
Q

How is bronchiectasis diagnosed?

A

Clinical - cough production of sputum, chest pain, recurrent LRTIs
Radiological - HRCT

33
Q

What can cause bronchiectasis?

A 
Bronchial obstruction 
CF
Young's syndrome 
Kartanger's syndrome 
ABPA
Immunodeficiency
Rheumatoid arthritis
Bronchopulmonary sequestration 
Mounier-Khun syndrome 
Yellow nail syndrome
Traction bronchiectasis associated with pulmonary fibrosis
34
Q

What is chronic bronchial sepsis?

A

Has all the hallmarks of bronchiectasis but no findings on the HRCT. Confirmed positive sputum results, often in younger patients, mainly women, often in involved in childcare
Others are older, usually with COPD or airways disease
Same work up as bronchiectasis
The sinuses are resovoirs of infections

35
Q

What are treatment options for bronchiectasis?

A

Stop smoking
Flu vaccine
Pneumococcal vaccine
Reactive antibiotics - send sputum sample, give antibiotics appropriate to most recent positive culture

36
Q

What is the treatment when the patient with bronchiectasis is colonised with bacteria?

A

Prophylactic antibiotics
Nebulised gentamicin, colomycin
Pulsed IV antibiotics
Alternating oral antibiotics

37
Q

What is the prognosis for patients with bronchiectasis?

A

Recurrent infections
Abscesses and empyema
Colonisation

38
Q

What are some complications of CF?

A 
Bronchiectasis - cystic saccular 
Tenacious sputum 
Biliary obstruction and obstructive hepatitis 
Pancreatic dysfunction 
Psychological issues for all

Respiratory (24 decks)

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