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Respiratory Anatomy & Disease Mechanisms > Chronic Pulmonary Infection (DISEASE MECHANISMS) > Flashcards

Chronic Pulmonary Infection (DISEASE MECHANISMS) Flashcards

1
Q

What are the risk factors for developing chronic pulmonary infections?

A

Abnormal host response / innate host defence

Repeated insult

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2
Q

In which ways can innate host defects be abnormal increasing risk for developing chronic pulmonary infections?

A

Damaged bronchial mucosa
Abnormal cilia
Abnormal secretions

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3
Q

What are the two types of immunodeficiency?

A

Congenital

Acquired

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4
Q

What are the origins of immunosuppression?

A

Drugs

Malignancy

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5
Q

What are examples of repeated insult that can increase risk for chronic pulmonary infections?

A

Aspiration

Indwelling material

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6
Q

What are the four types of immunodeficiency?

A

Antibody deficiencies
Hypo-Splenism
Immune paresis
HIV

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7
Q

What does a deficiency in IgA cause? Is it common/rare?

A

Common

Increased risk of acute (rarely chronic) infections

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8
Q

What does hypogammaglobulinaemia cause? Is it common?

A

Rare

Increase risk of acute & chronic infections

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9
Q

What does CVID cause? is it common?

A

Most common cause of immunodeficiency

Causes recurrent infections

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10
Q

What is specific polysaccharide deficiency?

A

Inability to make antibodies against polysaccharides

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11
Q

Without a spleen you can’t produce ____ so you need _______________

A

antibodies

lifelong prophylactic penicillin therapy

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12
Q

What is immune paresis?

A

Can only produce 1 type of antibody that is typically non-functional and stops secretions of other antibodies

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13
Q

Which therapies cause immunosuppression?

A 
Steroids
Azathioprine 
Methotrexate
Cyclophosphamide
Monoclonal antibodies 
Chemotherapy
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14
Q

What can damage the bronchial mucosa`

A

Smoking
Recent pneumonia
Viral infection
Malignancy

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15
Q

What cause cause abnormal cilia (congenital)?

A

Kartenager’s syndrome

Young’s Syndrome

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16
Q

What can cause abnormal secretions?

A

Cystic fibrosis

Channelopathies

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17
Q

What can cause recurrent aspiration?

A

NG feeding
Poor swallow
Pharyngeal pouch

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18
Q

What can cause indwelling material?

A

NG tube in the wrong place
Chest drain
Inhaled foreign body

19
Q

What are the forms of chronic infection?

A 
Intrapulmonary abscess
Empyema
Chronic bronchial sepsis
Bronchiectasis
CF 
Others
20
Q

How does a patient with an intrapulmonary abscess present?

A

Indolent
Weight loss commonLethargy, tiredness, weakness
Cough +/- sputum
High mortality if untreated (death by sepsis)
Usually preceding illness

21
Q

Which illnesses precede intrapulmonary abscesses?

A

Pneumonia
Aspiration pneumonia
Poor host immune response (Hypogammaglobulinaemia)

22
Q

What is the course of treatment if an abscess is too large for antibiotics to reach it?

A

‘Pop’ the abscess then give antibiotics

23
Q

Which pathogens cause intrapulmonary abscesses?

A

Bacteria (streptococcus / staphylococcus)
E-coli
Gram negs
Fungi (Aspergillus)

24
Q

How are multiple abscesses formed?

A

Bacteria enter blood > lungs act as filter > filter out clots & bacteria -causes-> seeding of bacteria throughout lung

25
Q

What is empyema?

A

Pus in the pleural space

26
Q

Patients with empyema have a ___ mortality

A

high

27
Q

How does a simple parapneumonic effusion progress to empyema?

A

pH and glucose decrease below 2.2 and LDH rises above LDH to form complicated parapneumonic effusion and then empyema

28
Q

Most of the bacteria that cause empyema are _____

A

aerobes

29
Q

Which aerobic gram positive bacteria cause empyema?

A

Staph Milleri

Staph Aureus

30
Q

Which aerobic gram negative bacteria cause empyema?

A

E-coli
Pseudomonas
Haemophilus Influenza
Kelbsiellae

31
Q

Anaerobic bacteria caused empyema is usually only seen in ____ _______ or _____ _____ ______

A

severe pneumonia

poor dental hygiene

32
Q

How is an empyema diagnosed?

A

Clinical suspicion (slow-resolving pneumonia / lateral chest film)
CXR - persisting effusion, loculations?
USS - targeted sampling
CT - differentiate empyema & abscess

33
Q

How is an empyema treated?

A

USS or CT guided drain

IV (amoxicillin or metronidazole initially) oral antibiotics

34
Q

What is bronchiectasis?

A

Localised irreversible dilation of the bronchial tree

35
Q

What happens in bronchiectasis?

A

Involved bronchi are dilated, inflamed and easily collapsible causing airflow obstruction and impaired clearance of secretions

36
Q

How does bronchiectasis present?

A

Recurrent chest infections
No or short-lived response to antibiotics
Persistent sputum production

37
Q

What is meant by a signet ring? (referring to radiology)

A

Large bronchiole with a small artery

38
Q

How do you diagnose bronchiectasis?

A

Clinical - cough + sputum
Chest pain
Recurrent LRTs
Radiological - HRCT - bronchioles > 1 cm wide

39
Q

What is the pathophysiology of bronchiectasis?

A 
Bronchial obstruction
Cystic fibrosis
Young's syndrome
kartaneger's syndrome 
ABPA
Immunodeficiency
RA
Bronchopulmonary sequestration
Mounier-Khun syndrome 
Yellow nail syndrome 
Traction bronchiectasis associated with pulmonary fibrosis 
Alpha-1 antitrypsin deficiency 
> 50% IDIOPATHIC
40
Q

How does chronic bronchial sepsis present?

A

All bronchiectasis hallmarks / no bronchiectasis on HRCT / confirmed pos. sputum results / often young (mainly female) patients often involved in child care / others older usually with COPD or airways disease

41
Q

How can chronic bronchial sepsis be treated ?

A

Stop smoking
Flu vaccine
Pneumococcal vaccine
Reactive antibiotic - most appropriate to most recent sputum sample

42
Q

How can chronic bronchial sepsis be treated when colonised with persistent bacteria?

A

Prophylactic antibiotic
Nebuliser gentamicin/colomycin
Pulse iv abs
Alternating oral antibiotic

43
Q

What anti-inflammatory treatment is there for chronic bronchial sepsis?

A

Low dose-macrolide reduce exacerbation rates in bronchiectasis
Clarithromycin
Erythromycin

Respiratory Anatomy & Disease Mechanisms (13 decks)

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