CP10 respiratory infections Flashcards
What are 4 common illnesses that cause an acute sore throat?
Pharyngitis
Tonsillitis
Infectious mononucleosis (EBV)
Suspect epiglottitis
What in the history helps you diagnose what is causing an acute sore throat?
Speed of onset
Difficulty breathing/speaking
Ability to swallow/eat/drink
Associated neck swelling +/- pain
Symptoms of systemic infection e.g. fever, chills, malaise
Travel history
What is the most common infectious cause of a sore throat?
Viruses
What are 2 common types of pathogens that cause acute sore throats?
Virus
Bacteria
What 2 criteria help identify patients with a sore throat that need antibiotics?
FeverPAIN criteria and centor criteria
What is included in the FeverPAIN criteria?
Fever in previous 24 hrs
Purulence (pus on tonsils)
What is included in the centor criteria?
Is there a presence of:
Fever
Tonsillar exudate
Tender lymphadenopathy
Cough
What a clinical history of an acute sore throat…
…What is the aetiology?
…What is the diagnosis?
…What are appropriate investigations and treatment?
Bacterial or viral infection
Pharyngitis, tonsillitis, mono/glandular fever
Monospot if suspect EBV, can do throat swab, blood cultures (if septic) full blood count, urea, electrolytes and liver function tests - treat with antibiotics
What is the clinical history of mono/glandular fever?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Often asymptomatic but can cause fever, tonsillitis, pharyngitis and cervical lymphadenopathy.
EBV
Glandular fever
AVOID amothocilin
What is the clinical history of epiglottis?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Sore throat, fever, muffled voice, drooling, stridor, children sit leaning forward
Caused by hemophillus influenza (vaccine reduced incidence), strep pneuomoniae and group A strep
Epiglottis
Don’t examine throat as can close airway. Do blood cultures and epiglottis swaps once airway is supported. Oxygenate, IV antibiotics and analgesia.
What is a common cause of chronic/persistent sore throat?
Gastro-oesophageal reflux
What is the clinical history of otitis externa?
What is the aetiology?
What is the diagnosis?
What investigations are done and what is the management/ treatment?
Acute = Otalgia, pruritus, non-mucoid discharge.
Chronic= pruritis, discomfort,
Acute = usually bacterial (can be fungal)
Chronic = bacteria - usually pseudomonas aeruginosa or staph aureus
If persisted longer than 3 weeks, chronic OE, less than three weeks acute OE
Investigated with otoscopic exam, history, ear swab. If necrotising also with a CT temporal bone and bone biopsy, blood cultures of systemically unwell. Treat with ear drops (can be antibiotic, corticosteroid, antifungal or acidic)
What is the clinical history of malignant/necrotising otitis externus?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Severe pain, otorrhoea, granulation tissue in canal floor, potentially cranial nerve palsies
Bacterial infection spread
It is an infection - not a cancer
6 week course of IV antibiotics e.g. fluroquinolone +/- a penicillin, topical antibiotic/corticosteroids, rarely surgical debridement
What is the clinical history of otitis media (OM)?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Uncomplicated acute= mild pain that lasts <72 hours with no ear discharge nor fever about 39 Celsius or any other severe systemic symptoms
Complicated acute= severe ear pain + perforated eardrum +/- purulent discharge. Bilateral infection with associated mastoiditis.
Viruses and bacteria (e.g. strep pneumoniae, haemophilus influenza & moraxella catarrhalis) - very common in children
Uncomplicated acute, complicated acute or chronic OM (chronic if symptom duration = >6 weeks)
Swab for any pus. If no systemic illness only treat symptoms e.g. with analgesia. If unwell then treat with amoxicillin or clarithromycin
What is the clinical history of mastoiditis ?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Fever, pain posterior to ear +/- local erythema over the mastoid bone, oedema of the pinna (aka the auricle) +/- a posterior and downward displacement.
Complication of acute otitis media
Mastoiditis - requires CT head
Treatment = analgesia, IV antibiotics +/- mastoidectomy
What is the clinical history of pinna cellulitis?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Pain, erythema and swelling of auricle + hot to touch
Trauma e.g. a piercing, surgery, burns or bacteria (pseudomonas aeruginosa +/- staphylococcus aureus)
Pinna cellulitis or Perichondritis if only affects upper part of outer ear
Antibiotics e.g. Ciprofloxacin + Flucloxacillin/vancomycin
What is the clinical history of bacterial pneumonia?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Symptoms = Productive cough, SoB, mucopurulent sputum, pleuritic chest pain, fatigue, fever/chills
Signs= tachypnoea tachycardia, hypotension, dull lungs on percussion with reduced air entry and bronchial breathing (not always crackles)
Caused by typical (have cell wall and easily culturable in lab) or atypical (no/atypical cell wall and often non-culturable) bacteria - usually s.pneumoniae or haemophilus influenzae (both typical)
Bronchopneumonia or lobar pneumonia. Community acquired pneumonia (CAP) or hospital acquires pneumonia (HAP), ventilation acquired pneumonia (VAP), aspiration pneumonia
CAP = Sputum culture, blood cultures, check for urinary antigens, PCR or serology for viral pathogens, mycoplasma pneumoniae or chlamydia species, HIV test (especially for recurrent CAP), manage using ABC (airway, breathing, circulation)
What are common atypical bacteria causing bacterial pneumonia?
Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella pneumophila
How is severity of pneumonia measure/monitored?
With CURB score
(C= confusion, U= urea >7mmol/l, R = RR > 30 breaths per min, B = BP where systolic = <90 or diastolic = <60 mmHg)
What are some viruses causing pneumonia in healthy people?
In immunocompromised people?
Influenza A and B
Adenovirus
VZV
+ RSV and parainfluenza in children
+ measles, HSV, CMV and HHV-6 in immunocompromised
What is the clinical history of influenza?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Fever, headache, myalgia, dry cough, sore throat
Influenza A and B
Flu - can progress to primary viral pneumonia or secondary bacterial pneumonia
Treated with hydration, analgesics, antivirals like tamiflu for some.
What is the clinical history of VSV pneumonia?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Rash, progressive tachypnoea, dyspnoea and dry cough
Complication of VZV infection
VZV pneumonia
Investigated with chest X-ray and treated with breathing support and IV acyclovir
What is the clinical history of rhinovirus?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Symptoms of common cold
Rhinovirus
Common cold which can cause LTRI or trigger asthma exacerbations
Supportive
What is the clinical history of CMV?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Usually asymptomatic but on initial infection can have cold like symptoms including high temp, myalgia, fatigue, sore throat and swollen glands
CMV
Cytomegalovirus
Usually no treatment unless have congenital CMV, immunocompromised or have had a stem cell or organ transplant then given antivirals
What is the clinical history of LRTI with bronchiactasis?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Chronic cough, mucopurulent sputum production and recurrent infection
S.aureus, H.influenza, P.aeruginosa or viruses
LRTI
Antibiotics, effective clearance of respiratory secretions, nutritional support, annual flu vaccine
What is the clinical history of LRTI with CF?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
General LRTI symptoms
S.aureus, P.aeruginosa, Burkholderia cepacia, non-TB mycobacteria, fungi
LRTI with acute exacerbation of CF
Prolonged antibiotics, postural drainage, deep breathing, coughing, exercise, aerosolised DNAase, influenza and pneumococcal vaccination - in serious cases with lung transplant
What is the clinical history of allergic bronchopulmonary aspergillosis?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Worsening asthma and lung function in individuals with a PMHx of atopy, asthma or CF
An allergic reaction to exposure to aspergillus causing high IgE levels specific to aspergillus
ABPA
Corticosteroids and antifungal therapy
What is the clinical history of aspergilloma?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Cough, haemoptysis, weight loss, wheeze, nail clubbing- sometimes can be asymptomatic
Aspergillus colonises/ forms a mobile mass in pre-existing lung cavity left by previous TB or sarcoidosis
Aspergilloma
Chest x-ray or CT, test for aspergillus IgG antibody +/- aspergillus antigen and sputum culture used for diagnosis
Can resolve spontaneously but also treated with surgical resection +/- antifungals
What is the clinical history of pneumocystis jirovecii pneumonia (PCP)?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Pneumonia with gradual onset of fever, dyspnoea, non-productive cough and reduced exercise tolerance and exercise induced hypoxia
Fungus, which lacks ergosterol wall thus not susceptible to anti fungals, transmitted via airborne particles
Pneumocystis jiroveci pneumonia
Investigations include PCR, bronchi-alveolar lavage and blood test for beta-D-glucan
Treated with antimicrobials e.g. co-trimoxaxolem steroids and supportive care and primary prophylaxis in risk groups e.g. those with HIV whose CD4 is <200
What is the clinical history of nocardia asteroides?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Variable clinical presentations so hard to diagnose
Nocardia bacteria inhaled and can cause lung abscesses
Nocardia asteroides
Supportive (ABC) and long term antibiotics (several months) - usually co-trimoxazole
What is the clinical history of mycobacterium tuberculosis?
What is the aetiology?
What is the diagnosis?
What is the management/ treatment?
Chronic productive cough, haemoptysis, weight loss, fever, night sweats - 90% of primary infections are asymptomatic and can reactive in later life and become symptomatic
Inhalation of respiratory droplets of mycobacterium tuberculosis causes formation of ghon focus in alveoli
TB or miliary TB if disseminated
Diagnosed with clinical features + supportive radiology + sputum sample which is positive for acid fast bacilli or M. Tuberculosis culture. IGRA and tuberculin skin tests can also be used,
Treated with combined chemotherapy and BCG vaccine given to children and infants in high risk areas
