Chronic Pulmonary Infection

Question 1

What are the risk factors for developing CPI?

Answer 1

Abnormal host response 
– Immunodeficiency - Congenital or Acquired 
– Immunosuppression - Drugs 
Malignancy 
Abnormal innate host defence 
– Damaged bronchial mucosa 
– Abnormal cillia
– Abnormal secretions 
Repeated insult 
– Aspiration 
– Indwelling material - ng tube in wrong place

Question 2

What are the signs for an Intrapulmonary Abscess?

Answer 2

Indolent presentation

Weight loss common

Lethargy, tiredness, weakness 
Cough ± sputum

High mortality if not treated 
Usually a preceding illness of some sort – Pneumonic infection, Post viral
, Foreign body

Question 3

What pathogens may cause an Intrapulmonary Abscess?

Answer 3

Bacteria
- Streptococcus

- Staphylococcus (Particularly post ‘flu) – E-Coli

- Gram Negatives 
Fungi

- Aspergillus

Question 4

What may cause a septic emboli?

Answer 4

Right sided endocarditis
Infected DVT

Septicaemia
drug users common

Question 5

What is Empyema?

Answer 5

Pus in the pleural space

Question 6

What pathogens may cause Empyema?

Answer 6

Aerobic organisms most frequently
Gram Positive
- Strep Milleri + Staph Aureus
Usually post operative or immunocomprimised
Gram Negatives
- E-Coli + Pseudomonas + Haemophilus Influenzae + Kelbsiellae
Anaerobes in 13 % of cases


Question 7

What would Empyema look like on a CXR? What other diagnostic tests are there?

Answer 7

CXR
–Persisting effusion, particularly if loculations visible
Ultrasound Scaning 
–The preferred investigation
CT
–Differentiation between Empyema and Abscess

Question 8

Describe Bronchiectasis?

Answer 8

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

Impaired clearance of secretions

Question 9

What are the clinical signs of Bronchiectasis?

Answer 9

• Cough productive of sputum
• Chest pain
• Recurrent LRTIs
• Little or no response to antibiotics

Question 10

How is Brochiectasis diagnosed?

Answer 10

HRTC scan

Question 11

What differentiates Chronic bronchial sepsis from Bronchiectasis?

Answer 11

All the hallmarks of bronchiectasis but 
no bronchiectasis on the HRCT


Question 12

What is the treatment for Chronic bronchial sepsis?

Answer 12

Stop smoking 
‘Flu vaccine 
Pneumococcal vaccine 
Reactive antibiotics  – Give antibiotics appropriate to most recent positive culture 
When colonised with persistent bacteria 
- Prophylactic antibiotics

- Nebulised gentamicin, colomycin 
Low dose macrolide antibiotics have been shown to reduce exacerbation rates in bronchiectasis 
– Clarithromycin 250 mg OD 
– Azithromycin 250mg Three Times a Week