Infection Flashcards
CAP ep
6th leading cause of death
42% hospitalisation
40% MO identified
Risk factors CAP
Aspiration
Etoh
Smoking
ISS nursing home
CURB 65
Confusion amts less than 8
Urea above 7
Rr above 30
BP less than 90/60
Over 65
3% Low risk 0-1 po Amos or Clark/doxy for 5-7
9% Moderate 2 po Amos and Clari/doxi for 5-7
15% Severe 3 iv aug and Clari for 7-10
ICU referral CAP
Pao2 less than 8 on max medical care
Raised paco2
Low GCS
Hypotension despite 3L
Metabolic acidosis max medical tx
6 week cxr not indicated
Less than 50 and no cxr change and no rf like smoking
CAP MO
Strep pneumonia
Commonest cause
CX meningitis sbe rhinosinusitis
Amox Clari cef
Viral flu rsv covid rhinovirus
Legionella
Older men, smoker, iss, work with water or air con, med
Cough fever myalgia diarrhoea confusion
Low na high ck deranged lft
Pontiac no Resp just fever
Doxi Levof Clari
NOTIFIABLE
HiB
Cap epiglottis
Amox augmentin cef
Mycoplasma
Younger lobar pneumonia
COUGH DIARRHOEA RASH
Haemolytic anaemia siadh hepatitis EN
Tree in bud ct
Clari or Doxi
Staph aureus
Post flu
Fluclox rif
MRsa vanc linezolid tied
Chlamydia pstacci GN
Birds
Rash haemAn Pneumonia endocarditis hepatitis neurocx renal failure
Serology
Doxi or Clari
Klebsiella
Cavitatory pneumonia esp etoh
Low plt and WCC
Coxiella
Goats or sheep
Cough fever headache
Doxy Clari
GN bacilli -cef levoflox mero
Pseud - ceftaz and gent, cipro and gent
Asp coamox
HAP
LRTI symptoms and cxr change after 48hrs admission
Strep or HiB intubated
Staph intubated neuro
Pseud longer tubed Copd
Actinobacter ventilated prev Abx
Anaerobic surgery
Abx 7-14d
20-50% mortality
VAP
Pneumonia with or without cxr change 48hrs post intubation
Fever / more secretions/ rising inflam / new cxr change
SS inc bronch send fungal culture and serology
Causative MO
MRSA
Pseud
Actinobacter
Steponom.
Mx
Early ertapenem ceft moxi levoflox
After 5d High risk GNB or MRSA so taz and amik and vanc
Duration at least 7d
No evidence trend pct
Reduce risk
Sedation hold
Elevate head
Oral hygiene
Lung abscess
Bacteria reaches lung parenchyma causes inflammation then necrosis
Communication bronchus so air enters
Air fluid level
RF eg dental disease etoh/ ISS /DM /cancer /reduced GCS /septic embolism sbe
Rep and constitutional symptoms
Lemieux fever cough neck pain and effusion
MO
peptosp
Bacteroides
Proteiella
Fuscibacteria lemier
Staph or strep
Kleb
HiB
Nocardia
Fungi
MTB or NTM
6 weeks Abx
Chest PT
Drainage not validated causes spread
CX haemorrhage /Abx res / recurrence
Surgical resection over 6cm or resistant MO or haemorrhage or recurrent disease
Aspiration pneumonia
Chemical pneumonitis
Failure glottis reflex acid to lung so chemical injury then secondary bacterial
Reduced gcs or reflux or ugi disease
Bacterial infection
Resp sx and fever
Cxr changes and rising inflam
Peptosp or fuscibacterium or bacteroides
Co Amox or clinda or mero
Mechanical Obstruction
Leptospirosis
Zoonic infection through skin abrasion
Flu like
Meningitis
Weils - fever /rash /jaundice /renal failure / coagulopathy w reduced plt
Lrti to ARDS
Serology ELISA
Penicillin or doxy
50% mortality
COVID
CT
Mosaicism
GGO
Organising pneumomia
CX
MOF aki liver failure ARDS
HLH and cytokines release syndrome
VTE
GBS
IHD myoc arrhythmia
O2 and cpap if fio2 over 40%
Dex 6mg for 10 days
Paxlovid vs remdez if less than 5d and on low flow o2
Tociluz if fio2 over 40% and crp over 75 — 2nd line barcitinib
No o2 req and ckd ritonavir
Remdez side effect haem cystitis or GI or lft or rash
SARS
Enveloped rna virus
Droplet inhaled alveolar damage then secondary bacterial,infection
2-10 day incubation
3-7d days sob cough then Resp failure
Cxr lung infiltrate to ARDS
CT ggo interlobular thickening Ptx
**PCR elisa dx **
Mx supportive
MERS
Zoonic RNA related to bat coronavirus
Saudi
Pneumonia to ARDS
Diarrhoea
Did
Pericarditis
Ix PCR
Mx supportive
Flu
Single stranded rna
Resp and systemic
CX bronchitis pneumonia OM myositis meningitis gbs myocarditis
Cxr consolidation
Dx elisa vs pcr vs poct NA amplification
Mx
isolate
Oseltamivir or IV zanamivir for less than 2d. Caution renal failure. Tx 5d and proph 10d
CMV
Enveloped dsDNA
Commonest virus in immunocompromised
Flu like with dry cough/ soboe/ fever/ marked hypoxia
Gord
Hepatitis
CT bilateral GGO or focal consolidation UL or bilateral nodularity opacity or effusion. Cavity rare
PCR quantitative then Ab active vs latent
BAL or Biopsy INCLUSION BODIES
TX IV GANCICLOVIR THEN FOSCARNET
proph valaciclovir in ISS with detectable cmv DNA
Adenovirus
Non enveloped dsDNA
Urti
CX myocarditis hepatitis nephritis meningitis DIC
Antigen PCR from throat swab or sputum or bal
Supportive
Human metapneumovirus
Single stranded rna
Seasonal
Urti 5 days
CX bronchitis pneumonia ARDS
Dx PCR or viral culture bal
Supportive
Ribavarin
Measles
Single stranded rna
Rash MP with koplich spot in mouth
Croup
Bronchitis and pneumonia
Leucooenia
Cxr reticulonodular shadowing w hilar lan, pleural effusion
Viral culture Dx
Mx supportive
Varicella pneumonia
Enveloped dsDNA
Pneumonia
Rash
Cxr nodules that calcify over months
Cytology or PCR on BAL
Iv aciclovir for 10 days
Parainfluenza
Single stranded rna
Risk factor asthma or Copd
Urti
Pneumonia
CX myocarditis meningitis GBS
PCR
Viral culture BAL
Supportive tx
RSV
Single stranded RNA
Urti /tracheobronchitis /pneumonia ISS
NPA or BAL
Supportive
Aerosolised ribavarin w steroids
Aspergillus
Fungus in mould or soil then inhaled forming hyphae
Spectrum of disease interplay host immune under or over activity + host lung disease
Colonise
Mycetoma
— airway nodule CPA
SAFS then ABPA
Invasive aspergilloma
IgG monitor immune response
ABPA
Ige and IgG reaction to aspergillus causes inflammatory damage to airways causing Bronchiectasis
Mucus plugging
Pulmonary raised IgE
ABPA S serological id 2/4 positive in asp prec or as IgG or skin test or Eo with normal CT
or ABPA B with BrE
Presentation
Poorly controlled asthma
Mucus plugging
Diagnosis
Obstructive lung disease and
Total IgE over 1000
Other serology aspergillus IgE over 0.5, raised Eo, some raised aspergillus IgG
Obs spiro
CT central Bronchiectasis with BRONCHOCELE, nodules, Mosaicism, mucus plugging
Specific IgE and total
To asl fum and other species
Monitor IgG to aspergillus
Mx
Pred
2nd line itraconazole as steroid sparing
Asthma fungal sensitisation
Aspergillus in airway causes inflammation and bronchospasm
Risk factor
Thunderstorm
Chronic pulmonary aspergillosis
Pg
Low grade invasion aspergillus hyphae to airway walls
Th2 reacts to antigen
Middle aged immune compromised w chronic lung disease
Fever malaise WL Resp symptoms inc haem
Ix
Cavitatory
Thin walled cavity slow progress in UZ. Dry no air fluid level
Serology IgG to aspergillus always raised cavitatory
Azole boric
Good prognosis mycetoma
Fibrosing
CT fibrosis with pleural thickening
Necrotising
CT focal lump w micronodular change ** with progression **
CT Bx gold standard
IgG sometimes positive
Azole NEVER GIVE PRED
Pg good mycetoma
Mx sx in CPA
Focal UL and good FEV1/TLCO post op
Otherwise Azole and then amphotericin
Mortality 30% mortality in 2 years
50% in 5 y
Mycetoma is aspergilloma
CT
Thin walled cavity
Air crescent sign
Cavity STABLE
Culture aspergillus, IgG may be positive
Bdg and galactomanan may be positive
Risk factor TB pre existing cavity
CX
Haemoptysis - txa then IR then sx
CPA
Mx stable disease
Azole VORICONAZOLE then second posicomazole/amphotericin
vs surgery
Aspergillus nodules
Less than 3cm
Asymptomatic
CT nodules
Bx vs resection is
Ddx cancer
Invasive aspergillosis
Macrophages absorb aspergillus fail to neutralise so vessel infarction due to fungul protease damage
Risk factor neutropenia and pred
BMT /AIDS /COPD /failure ITU /chronic gran
BAL aspergillus
Serology galactomanan 70% sensitive but not specific , raised IgG serology or IgE both sensitisation, sputum aspergillus or PCR
CT diffuse nodules and reverse halo , pleural bases area, non specific necrosis
Resp better than serology expect bdg
Galactomanan worse outcome non neut
Mx
IV voriconazole for 6-12m then amphotericin 2nd line
Airway aspergillus
Bronchitis
CT thick walled bronchi, tree in bud
Negative serology
Aspergillus tracheobronchitis
Ulcer and plaque
Dx bronch with positive aspergillus culture
Candida
Normal flora immune competent but immune suppressed spread and infiltrate lung
CT
Nodule
Infiltrates
RF ISS or central line or GI surgery or Lung or liver Tx
Sample and culture
Tx fluconazole
2nd line amlhotericin
Candidaemia iv caspofungin
PJP
Fungus airborne transmission
RF HIV or BMT or chemo or pred more than 26mg for 8w
Other non adherence prophylaxis or candidiasis or ohl or weight loss or bacterial pneumonia or pcp or high viral load
Exertional sob
Cough sob chest tightness
Malaise
CX Ptx or Resp failure
Ix bal and silver stain then use GROCOTT STAIN 100% spec and 90% sensitive OR lung bx if not improving
2nd line induced sputum and IF 90% specific or bc 98% sensitive but Bx risk
Cxr can be normal
CT infiltrates w proximal cysts / pneumatoceles and spare cpa
CX Ptx and Resp failure
Mx
Iv Sept rain 120mg per kg then reduce after 3d for total 21 days
Pao2 less than 9.3 or Sats less than 93% then pred 40mg BD for 5 days — then OD for 5 days then 20mg for 10d
Early HAART
2nd line clinda w primaquine OR pentamidine
G6PD def then pentamidine OR atorvaquone
Prophylaxis septrin or dapsone
Cd4 less than 200
Long term iss
Prognosis
90% survival
Early cpap good
Inv avoid
Cryptococcus
Bird droppings then inhale encapsulated yeasts propagate in alveoli
Cough
Pleuritic chest pain
Fever
Meningitis
CT
Nodule
GGI or Consolidation or cavity
Diffuse infiltrates in immunosuppressed
LAN
Pleural inflammation with effusion or Ptx
Bronch
Also LP
Diagnosis fluid bronch/ pleural GIEMSA stain or LP India ink stain
Serology CRAG 100% sensitivity or 98% specific
Mx
Iv amphotericin
Second line flucytosine
—> step down to fluconazole
Isolated Resp with no hypoxia and CSF negative
Then fluconazole 400mg OD for 10w
Mild itra
Histoplasmosis
Endemic mycosis
Bat or bird droppings inhaled to lymphatics cause granuloma
OHIO
Asymptomatic
Resp symptoms
Arthritis
CX rash systemic endocarditis meningitis
CT
Infiltrates
UL nodules
LAN
Cavitatory disease
Bronchiolitis
Mediastinal fibrosis
Dx bmb or culture or histology
Antibody false negative
Mx itraconazole
Iv amphotericin severe
Blastomycosis
Inhaled spores from soil
Mississippi
Lrti
Severe ARDS
B symptoms
Disseminated disease in skin bone cm
Dx bal with minimal lidocaine
PCR fast but false negative
Sputum mcs weeks
CT consolidation or diffuse nodular
Mx
Itraconazole
Severe amphotericin
Coccidomycosis
Resp sx
Raised Eo
CT consolidation cavity pleural
Mx fluconazole
Severe amphotericin
Azole
Side effect
Drug interaction
Long qtc
Deranged lft
NV
Peripheral neuropathy
Pulmonary oedema
Adrenal insufficiency
Alooecia
Checks
Drug interaction
Lft and ecg baseline then 2w then 3m
TB risk factors
Homeless poverty overcrowding
Etoh ivdu
Born endemic
Low bmi
Biomass exposure
Tb Hx or exposure
Silicosis or fibrocavitatory disease
HIV or aids
DM /CKD /Ca /steroids/ tnfa blocker/ISS
TB pathophysiology and is
Airborne droplets inhaled then mtb taken up mc
Via lymph to LN cell mediated IR ghon focus then granuloma limits spread
90% IC so rids or contain latent
10% mostly ISS active infection
Ix
PCR MTB species and if rif mutation 2 h
Smear days positive more infectious
Culture 6 weeks less infectious
Other samples no formalin
Pleural and ascetic fluid ADA
Mantoux and igra latent
TB symptoms
Resp
inc Haemoptysis
CX Bronchiectasis pleural cavity pneumothorax LN enlargement
LAN
Clubbing
CNS SOL meningitis
Pericarditis or effusion
Spinal disease Potts
Epidydimitis or orchitis
Military
Mx MTB
Aim
Take sample
Then tx
4ab
Sensitive TB
RHZE for 2m then RH for 4m
CNS 12m so 4 for 2m then RI for 10m
Spinal TB for 6m
LP low glucose/ high protein and lymphocytes/ high pressure
Steroids CNS and pericarditis
Latent TB
No clinical signs
Cxr clear
Test indication new UK no BCG or healthcare worker no BCG
Positive
Mantoux more than 5mm
IGRA more than 0.35
Testing sensitisation
Caveats
BCG - FP affects Mantoux more than IGRA
Mantoux FP BCG or NTM or incorrect . FN steroid or sarcoid
IGRA is cytokine released TC when exposed MTB - stays positive after tb treatment - no BCG or NTM
False positive prednisolone
Ix in HIV need IGRA
Mx indication less than 65 or 35-65 no hepatotox
RH 3m for less than 35 and risk hepatotox
H for 6m for rif interaction risk
Rif 4m
Pyridoxine
To prevent B6 deficiency in Isoniazid
ISO resistance
2 RZE then 7RE
HIV
REP w levoflox for 6m
Start HAART asap
TB tx interruption or MDRTB
2HRZES
1HRZE
5HRE
MDR TB
Rif and iso resistant
8 months
Bdq w lzd w lfx
Plus
Cfz or cs
Plus
Injectable
All oral for 6m
6 bdq w lfx w cfz w z w e w th w eto
5 lfx w cfz w z w e
TB medication side effect
Rif
Bacteriocidal
Inducer red urine hepatitis GI
Isoniazid
Bacteriocidal
Hepatitis periN b6 def
Peripheral neuropathy risk increased: renal failure/ etoh/ HIV/ diabetes
Ethambutol
Bacteriostatic
ON Renal
Pyrz
Bacteriocidal
GI hepatitis gout
Streptomycin
Bactericidal
Ototoxic se
TB med combo
Rifater :: R ISO Pz
Rifinah :: RI
Voracativ :: RIFE
TB isolation
Smear positive then 2 weeks
MDR negative pressure side room and isolate longer
Longer
Tolerance adherence
No cough with improvement
No IC people at home
Smear grade low
No extensive cavitation
No laryngeal
TB end of treatment
Cxr
FU
Normal or single drug 2m
MDR follow up 12m
Relapse restart same
MDR TB
4% cases
Not more infectious
RF
prev tb reduced compliance
Contact MDR
HIV
From high prevalent area
Treat 18m
BCG vaccine
Live attenuated M Bovis so low risk TB in humans
Indication
- New to uk
- Previously unvaccinated
- less than 16 or 16-35 from high prevalence eg SSaharan
- HCP or prison or police
- contacts with pulmonary and laryngeal tb who are not vaccinated and under 35 or over 35HCW
70% efficacy in children
TB pregnancy
RIE for 6m
Less than 2 weeks tx sputum positive mums then pre delivery treat iso and skin test 6w
6 week bab6 skin test negative then BCG
Breast feeding
Ok all meds
pyridoxine with iso + monitor iso toxicity (convulsion and neuropathy)
Outcomes
Dx trim 1 same
2-3 4x increase mortality
TB and comorbidities
Liver
Stop all when 5x above upper Then Restart 2x (and bili normal and symptoms resolved) one at a time. Restart ethambutol and strep
2x continue but repeat weekly
Renal
Pyraz and ethambutol reduce dose. Ensure pyridox with iso
Drugs after dialysis
HIV
HAART start TB meds 2w if cd4 less than 50 otherwise 2m
IRIS pred
DM risk TB. SU interacts rif
Skin
Risk drug related lupus reaction
Stop and restart lower risk drugs Ethambutol/streptomycin
Nocardia
Soil and water
GP aerobic filamentous rod
AFB on ZNS
Lobar pneumonia cavity
Rib erosion
CNS brain lesion
Skin abscess
Pericarditis
Mediastinitis
SVCO
Mx
Septrin 6m or amik or 3rd gen cephalosporin or mero
90% cure
Anthrax
Gram positive spore forming bacillus
Spores soil then skin vs Resp
4-6 days incubation
Resp worse outcome cutaneous
Flu like symptoms
Pleural effusion haemorrhagic
Cutaneous oedema with necrosis
Meningitis
CT
Pleural effusion
Mx
Cipro clinda linezolid mero
And antitoxin and IVIG
Actinomycosis
Gram positive anaerobic filamentous bacilli
Clinical presentation
Consolidation /sinus rib erosion /effusion
Dental disease
Head and neck soft tissue infection with sinus
Brain abscess meningitis
Vaginal discharge vs epididymitis
Risk factors dental disease vs ICC vs Copd
Microscopy yellow sulphur granules
Mx 6m penicillin
Taz mero clinda EM
Immune deficiency
Non mycobacterium TB
Found in soil and water. Less virulent than MTB
Risk factors
ISS
Chronic lung disease
Gord. Pectus excavatum. Kyphoscoliosis
Cough fever
Weight loss
Disseminated infection
Dx
Symptoms and
CT thin walled upper lobe cavity, pleural involvement, nodules, tree in bud, cylindrical Bronchiectasis, bilateral ground glass, Mosaicism AND
Sputum afb x2 or 1 bronch or tbb (granuloma and positive NTM)
Treat
12 months after negative expect MAb longer
MAC
Elderly male smokers
Risk factor HIV
Fever
Night sweats
Fatigue
Anorexia
Diarrhoea
LAN HSM ulcer septicA OM pericarditis
CT
Upper lobe fibrocavitatory disease
Mx
REC +- amik or strep for 12m
M Kansasi
Risk factor HIV
Fever and cough
CT
UL fibrocavitatory disease
Mx
REI C
M Malmoensae
Risk factor
Cavitatory disease eg. COPD
Mx
REC severe add gent or amik
M Xenopi
CT
Upper lobe cavitatory disease
Mx
RECH and if severe aminog
M abscessus
Non smoking women
Risk factor CF or BE
Mx
4 weeks IV amik and iv tigecycline and iv imipenem and po Clari
Maintenance
neb amik with Clari with clofazamine or linez or minecycline or doxy
HIV treatment and TB
Start within 4 weeks of TB Dx
CD4 less than 50 then in 2w
CNS TB 8w
MDR TB start tx asap
Mx
Efavrinz w tenofivir w emtrictibine
Change rif to rifabutin due to interaction protease inhx
TB meningitis add steroids and taper
IRIS steroid and taper
Latent 6m iso and cxr on completion
HIV
REP w levoflox for 6m
Start HAART asap
TB and BPF
Sealant or fibrin glue
Pseudomonas non cf bre
Neb colistin then proph aza
Eradicate iv taz or oral cipro
Babeiosis
Tick bite
Splenomegaly
Pulm oedema
ARDS
Ix tetras ring RBc
Mx atorv and Clari or clinda and quinine
Ritux
Hypogamma
Risk cap
SAFS
Ige 500-100
Ige raised
No IgG
Mucormycosis
Risk factor Covid
Iv amphotericin
Moraxiella
Tx
Co Amox
Clari or cipro or doxy
Melliodosis
South east Asia
Water soil mo
Inhalation
GN bacillus
Cavity empyema nodular consolidation
Tx 3m
Iv cef and metro or mero or imipenim
Methaglobinaemia
Fe2+ oxidised to fe3+
Left shift o2 dissociation curve
Cellular hypoxia
Sob headache NV collapse
Met acidosis
Collapse arrhythmia seizure coma
Rf dapsone sm NF lidocaine poppers
Mx methylene blue
TB epidemiology
1.1 M new cases per year
400,000 rif must or MDR
1.25 M total deaths
TB Ix
Cxr then ct
Induced sputum vs bronch if no sputum
GeneXpert 45 mins mtb complex and if rif mutation. More sensitive than smear but not culture
Smear stains red in 2d - sensitivity 50%
Culture 6w
Back pain mri spine as 25% have multi focal disease
Any fluid Ada afb geneXpert
Bloods
Normal
HIV hep bnc
Monoresistant TB
One drug
XDR
Pre xdr
ISO rif fluoroquine resistant
XDR MDR definition MDR plus resistance to fluroquinolones
Rif iso fluoroquine linez and bedequilline
Immune deficiency
Agammaglobunaemia
X linked AR
No IgM or IgG or IgA or B cells
Recurrent severe bacterial infection
CVID get pcp MHominis MAI adenovirus.
IgG / IgA / Bcell /T cell
Bacterial infection w autoIS w malignancy
IgA deficiency less than 7mg per dl
Atopy autoimmune GIT defect
Innate neutrophils and macrophages
Steroid organtx AML BMT neutropenia
Mtb aspergillus nocardia viraemia
B cell or low ig
Complement def or CVID or ritux or myeloma or splenectomy
Bacterial or Resp or bre
T cell
Solid organ tx or T cell lymphoma or chemo or HIV
PJP or cryptococcus or mtb or toxo or viraemia
Ix
Bloods
Viral screen and fungal markers and parasite and endemic mycosis
Crag HIV
Blood culture inc mtb
Urine atypical
Throat swab
Sputum mcs afb fungal
BAL
CT
CT ISS
MTB or HIB
Nodules
tree in bud
TB or CPA or bacterial
Cavity
Aspergillus or mtb or nocardia
Larger nodule
PJP or viral or atypical bacterial
GGO
Non infectious risk HIV
Lung cancer 2x
Copd 50%
Primary PH
Smoking related lung disease faster decline lung function
IRIS
Paradoxical deterioration after starting HAART
Days to weeks
Lower cd4 higher risk
Mx supportive and pred reduces morbidity
Mo
Copd ex
HiB
Moraxiella
M catarrhalis
Loefflers
Post parasite ascaris strongyloides or schisto
Af or Asia or central South America
Ix
Eo blood normal
Peri hilar infiltrates resolve after a month
Bal more than 25% Eo and hyphae
Mx Azoles
Severe pred
Pg resolve
Endemic mycosis
T cell depletion
AIDS lymphoma steroid
Histo
Coccidio
Blasto
Mucomycosis
IC
Black lesions mouth
Fever sob cough chest pain
Consolidation cavity nodule
Tx amphotericin
Paracoce
S America
Fever and HSM
Cytopenia Diffuse nodules
Culture sputum or BAL
Itra and severe amphotericin
Chronic granulomatous disease
AR
Defect phagocyte function
Bacterial and fungal infection eg aspergillus
Pleural infection
Community strep
Hx proteus and staph aureus
CF MO
Baby staph and HiB
Teenage pseud
Adult burkholdeira and strenotroph
Parasite
Echinoccocus commonest parasite in lung
Dogs and sheep vectors
Cough Haemoptysis fever HM
Cxr notch sign
CT cyst that calcify, pleural and pericardial cyst
Mx Azole
Lemier
Post oropharyngeal infection to bacteraemia
IJV thrombus
Lung abscess
To brain joints and liver also
Fuscibacterium
Staph
Strep
Anaerobes
Tx betalactamase res Abx eg mero or taz
Paradoxical
LN or cerebral disease
Less than 6w start HAART
Ddx
Treatment fail
Drug resistance
Malabsorption
DOTS
Hx non adherence
Previous TB**
Hx homeless ivdu etoh
Prison
Psych or memory issues
Denial re TB
Too ill
Pt request
PHA section 37 and 38
Bone marrow tx
Less than 30d
DAH or engrafment ( in a week, fever rash ARDS mods, mx steroids)
Bacterial ecoli strep pseud (GP or GN); candida or aspergillus or hsv or viral
30-100d
Cellular immunity
GvHD
Staph strep asperg candida PCP CMV or IA
Over 100d
Humoral immunity
BO in chronic GVHD or PTLD or COP
Encapsulated bacteria aspergillus CMV or nocardia
Other
Cop
Pulmonary VO disease cause G1 PAH. Ct pulmonary oedema
PVL SA
Severe staph aureus pneumonia
Cavitation
Mx Rif linez or clinda
Extend Abx cap
Fever 1d
Hr over 100
Rr over 24
Bp less than 90
Sats less than 90
ABC side effect
Cipro tendon rupture and long qt
Doxy bone deposition baby
High risk MDR VAP
High rates on unit
Prior Abx
Recent prolonged Hx more than 5d
Colonisation pathogen
VAP cutoff
1000
Bal 10.000
Tularaemia
Fever dry cough
Tender ulcer
Regional lan
Rural farmer or hunter
Gram negative
Cipro strep gent
Pregnancy and covid
Prone up to 28w
Toci if crp over 75
Remdez only if worsening
Pred 40mg if not preterm
if preterm dex 12mg in 24h then pred
Fungal infection tx
Aspergillosis most common
Tracheobronchitis disease bronch ulcer
Prophylaxis inhaled amphotericin or oral vori
Risk factors
Induction alemtuzumab
Single lung
CMV
Hypogamma
Rejection use mAB GvHD
Neutropenia more than 2w
Sarcoid + Haemoptysis
CPA
Voriconazole
Photosensitisation
Can become cancerous
Primary AB def
OM sinusitis pneumonia
Strep HiB Mycoplasma pseud staph MCatarrhalis
Mycoplasma susceptible due to ureaplasma urealyticum
Strongest predictor pulmonary complications HSCT
Low Karnofsky
Cancer
HSCT infection risk
Allogrnic due to prolonged iss
Esp ritux and purine analogue impair BT
Commonest virus RSV higher mortality
PERDS
Higher autologous
96 hours
Rash fever pulm infiltrates liver dysfunction aki encephalopathy
Steroids
Good prognosis
DAH
Equal auto and allo
Early
Bloodier bal from sub segments
Haemosiderin laden macrophages
No infection
Moderate response steroids
MOF and death
BO in HSCT
Allogenic
1 year
Wheeze cough sob
Ct hyper inflated /air trapping / Mosaicism
Obstructive Normal TLCO
Bal no infection.
Hx fibrotic plugs obliterate bronchoceles with if and scar
Steroids and iss
Poor pg - older or non related or total body irradiation or over 12Gy or acute GvHD
PTLPD
Rare
Proliferation EBV infected lymphocytes
6m later
LAN
HSM
Anti B cell mAB
M Bovis Tx
REI for 2 months
Rifampicin and ISO for 7m
Risk latent TB transformation
HIV
Younger than 5
Alcohol excess ivdu
Tx haem ca chemo
Dm CKD silicosis
Anti tnf drugs
CNS TB steroids
Gcs 15 without focal then 20mg pred
Gcs 11-14 or 15 with focal neurology then 30mg pred
Gcs less than 11 with or without focal neurology 4 weeks IV steroids
Pericardial TB
60mg pred weaning over 2-3 weeks
Pyrazinamide resistance
2 months REI
7 months RI
Ethambutol Resistance
2 months RIP
7 months RI
Rifampicin resistance
Gene rPoB
Bedaquiline
Levoflox
Linezolid
Contact tracing
Flight
Less than 3 months on flights over 8h
Teacher
Class in the last 3m
Ant TNF
3.5 x increase risk TB
All need cxr and IGRA
IGRA less sensitive in those taking pred and aza
Chemoprophylaxis
Treat 2 months prior to starting
BCGosis
Live attenuated BCG immunotherapy for superficial bladder cancer
Breaks in epithelium risk of infection
High fever and sepsis
Mx RI
Risk TB in HIV
31x
HIV and ISO resistant TB
Rif
Pyrazinamide
Ethambutol
Levoflox in
HIV and pneumonia
Mostly strep and HiB
S aureus increasing
Low cd4 pseud
Hospital gram negative
Stains aspergillus
KOH sputum
GROCOTT gomori
Flu HIV
No increased risk of developing but more severe
Oseltamivir or alternative zanamivir IV if flu in less than 48hrs
Also Co Amox and Clari for 7d OR doxy
Prophylaxis indication cd4 less than 200/ no vaccination and exposed less than 48h
Cavitatory pneumonia
Klebsiella
Staph aureus
Legionella
TB or NTM
Nocardia
Actinomycosis
Pneumonia MO by group
Etoh strep or GN or legionella
Copd HiB or catarrhalis
DM strep
Elderly strep or mycoplasma or legionella
Neb colistin or tobra or AG challenge
Stop if FEV1 drops 10%
