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Clinical Pathology - > CP18 - Lower Respiratory Tract Infections > Flashcards

CP18 - Lower Respiratory Tract Infections Flashcards

1
Q

what factors would predispose a patient to LRTIs?

A
  1. loss or suppression of cough reflex/ swallowing - risk of aspirating food, drinks etc.
  2. ciliary defects - increased risk of infections
  3. mucous disorders - increased risk of infections, CF
  4. pulmonary oedema
  5. immunodeficiency
  6. macrophage function reduction, eg. due to smoking
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2
Q

which bacteria cause LRTIs?

A 
strep pneumoniae
h influenzae
staph aureus
Klebsiella pneumonia
mycoplasma pneumoniae
chlamydophilla pneumoniae
legiononella pneumophila
mycobacterium tuberculosis
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3
Q

which viruses cause LRTIs?

A

influenza
parainfluenza
RSV
adenovirus

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4
Q

which fungi cause LRTIs?

A

aspergillus
candida
pneumocystitis jiroveci

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5
Q

define LRTIs

A

anything affecting the respiratory system below the larynx

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6
Q

what is bronchitis?

A

inflammation of the large airways (bronchi)

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7
Q

what is bronchiolitis?

A

inflammation of the bronchioles

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8
Q

what is acute bronchitis?

A

inflammation and oedema of the trachea and bronchi, generally a mild illness

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9
Q

what is the presentation of acute bronchitis?

A

dry cough, dyspnoea and tachypnoea, cough may be associated with retrosternal pain
most frequent in winter, and children under the age of 5

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10
Q

which organisms are responsible for acute bronchitis?

A 
most commonly rhinovirus, coronavirus, adenovirus, influenza
bacteria less common
H. influenza
Mycoplasma pneumoniae
B. pertussis
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11
Q

what investigations are needed to confirm the diagnosis of acute bronchitis?

A

none in mild presentations, vaccination and past medical history may exclude some organisms.
resp cultures may be useful to single out a cause, but this is uncommon

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12
Q

how is acute bronchitis managed?

A

supportive treatment in healthy patients
oxygen therapy or respiratory support in patients with severe disease or co-morbidities
antibiotics if bacterial cause is suspected/found

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13
Q

what is chronic bronchitis?

A

cough, productive of sputum on most days during at least 3 months of 2 successive years, which cannot be attributed to an alternative cause

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14
Q

what are the risk factors for chronic bronchitis?

A

men, over 40s, smoking, pollution, allergens

mediate inflammation and oedema, but acute exacerbations are mediated by same infective pathogens as acute

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15
Q

how does bronchiolitis present?

A

primarily in paeds, 2-10 months
acute onset wheeze, cough, nasal discharge, respiratory distress
peaks in winter and early spring

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16
Q

what are the symptoms of respiratory distress?

A

grunting, retractions, nasal flaring

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17
Q

what are the causes of bronchiolitis?

A

RSV most common

others - parainfluenza, adenovirus, influenza

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18
Q

how is bronchiolitis diagnosed?

A

chest xray
FBC
nasopharyngeal aspirate of respiratory secretions sent for viral PCR

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19
Q

how is bronchiolitis treated?

A

supportive treatment - oxygen, feeding assistance.
antibiotics only given if complicated by a bacterial infection
no evidence for use of steroids, bronchodilators, ribavirin

20
Q

what is pneumonia?

A

formation of inflammatory exudate in the most distal airways and alveoli

21
Q

what is the presentation of community acquired pneumonia?

A

very common
usually rapid onset symptoms - fever/chills, productive cough, mucopurulent sputum, pleuritic chest pain, general malaise, fatigue, anorexia

22
Q

what are the signs of CAP?

A

tachypnoea, tachycardia, hypotension, dull to percuss, reduced air entry and bronchial breathing

23
Q

what is mucopurulent sputum?

A

sputum containing pus with WBCs, cellular debris, dead tissue, serous fluid and viscous liquid

24
Q

what organisms are responsible for a typical CAP?

A 
s. pneumoniae
H. influenza 
M. catarrhalis
S. aureus
Klebsiella pneumoniae
25
Q

what non microbiological investigations need to be undertaken to diagnose pneumonia?

A

BP, pulse, oximetry, bloods - FBC, U&E, CRP, LFT; CXR to locate consolidation and differentiate which type of pneumonia it is

26
Q

what microbiological investigations need to be done if CAP is suspected and when?

A

moderate-severe CAP based on score>2 on CURB65

sputum gram stain and culture, blood culture, PCR or serology for viral antigens, m. pneumonia, Chlamoydophila sp.

27
Q

how is CAP treated?

A

low severity - amoxicillin
moderate - amoxicillin and clarythromycin
high - co-amoxiclav and clarithromycin asap
choice of antibiotic depends on the CURB65 score

28
Q

what are the 2 anatomical patterns of pneumonia?

A
  1. bronchopneumonia - characteristic patch distribution centred on inflamed bronchioles and bronchi then subsequent spread to surrounding alveoli
  2. lobar pneumonia - affects a large part or the entirety of a lobe, clear line of demarcation seen on CXR. almost always S. pneumoniae
29
Q

why is it important to know where the pneumonia was acquired from?

A

it informs the course of treatment

30
Q

what are the various types of pneumonia?

A

CAP
hospital acquired pneumonia
ventilator acquired pneumonia
aspiration pneumonia

31
Q

when does hospital acquired pneumonia develop?

A

> 48 hours post hospital admission, divided into early onset (2-5 days) and late onset (5+ days)
late onset causative organisms - enterobacteriae and pseudomonas

32
Q

what is ventilator acquired pneumonia?

A

a subgroup of HAP, develops >48h post ET intubation and ventilation
ET = endotracheal

33
Q

what is aspiration pneumonia?

A

pneumonia that is caused by the abnormal entry of fluids - food, drinks, stomach contents into the LRT
usually due to an underlying impairment in the swallowing mechanism

34
Q

what are the atypical organisms causing CAP?

A 
dont respond to penicillin or sulpha drug treatment 
mycoplasma pneumoniae
Legionella pneumophila
chlamoydophila pneumoniae
chlamoydophila psitacchi
coxiella burnetti
35
Q

how does M. pneumoniae present?

A

commonest in children and young adults
main symptom - cough
diagnosis through serology
complications - pericaridits, arthritis, guillain barre, peripheral neuropathy, all rare

36
Q

legionella pneumophila

A

colonises water piping systems, outbreaks associated with showers, AC units, humidifiers.
high fevers, cough dry initially productive later, riggers, dyspnoea, D&V, confusion
bloods - deranged LFTs, SIADH

37
Q

chlamoydophila pneumoniae

A

mild pneumonia or bronchitis in adolescence and young adults. incidence highest in the elderly. they may experience more severe disease

38
Q

chlamoydophila psittaci

A

associated with exposure to birds, consider splenomegaly and history of bird exposure in patients with pneumonia. may also have a rash, hepatitis, haemolytic anaemia, reactive arthritis

39
Q

influenza

A

usually produces uncomplicated disease - fever, headache, myalgia, dry cough, sore throat.
primary viral pneumonia occurs more commonly in patients with pre-existing cardiac and lung disorders or are immunocompromised
observe cough, breathlessness and cyanosis in these patients
secondary bacterial pneumonia may develop after initial improvement.
diagnosis - viral antigen detection in resp samples using PCR

40
Q

why is it important to establish a diagnosis in pneumonia?

A

optimise antibiotic selection
limit the use of broad spectrum agents
identify organisms of epidemiological significance
identify antibiotic resistance and monitor trends
identify new or emerging pathogens

41
Q

what is Guillain-Barre syndrome?

A

acute disorder of the peripheral nerves, often preceded by a respiratory infection, causing weakness and often paralysis of the limbs

42
Q

what is peripheral neuropathy?

A

damage of peripheral nerves

43
Q

what are rigors?

A

a sudden feeling of cold with shivering accompanied by a rise in temperature, often with copious sweating

44
Q

what is SIADH?

A

syndrome of inappropriate antidiuretic hormone secretion - too much ADH

45
Q

CURB65 scoring

A

1 point each for

  1. confusion
  2. urea >7mmol/L
  3. resp rate >=30
  4. BP =65
46
Q

how is CURB65 scoring used?

A

0-1 - low
2 - moderate
3-5 - high severity

47
Q

how can LRTIs be prevented?

A
  1. pneumococcal vaccination for patients with a chronic heart, lung and kidney disease, and those with splenectomy
  2. annual influenza vaccination for those over 65 and those with chronic diseases or co-morbidities

Clinical Pathology - (15 decks)

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