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Respiratory > Infection > Flashcards

Infection Flashcards

1
Q

Definition of pneumonia

A

An inflammation of the substance of the lungs/parenchyma in which the air sacs fill with pus and may become solid

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2
Q

What is protection against pathogenic bacteria provided by?

A

Colonisation
- commensal flora and colonisation resistance

Swallowing
- enruological + anatomical factors

Lung anatomy

  • mucociliary escalator
  • cough reflex

Immunity (innate and adaptive)

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3
Q

Symptoms of pneumonia

A

pyrexia (fever)

Resp symptoms:
cough
sputum
chest pain (pleurisy)
dyspnoea
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4
Q

Precipitating factors for pneumonia

A 
infants + elderly
underlying lung disease
immunocompromised
impaired swallow
congestive HF
alcoholics + drug users
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5
Q

Epidemiology of legionella pneumophila (a cause of CAP)

A

summer, water tanks, travel related (50%)

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6
Q

Epidemiology of chlamydophila pneumoniae

A

often older adults, sometimes closed outbreaks, longer duration of symptoms

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7
Q

If someone had contact with sick birds, what would you suspect?

A

chlamydophila psittaci

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8
Q

If someone had had contact with farm animals, esp sheep, what would you predict

A

Coxiella burnetti

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9
Q

Pathogenesis of pneumonia

A

Bacteria ‘translocate’ to the normally sterile distal airway

‘overwhelm’ resident host defence

‘develop and inflammatory response’

‘resolution phase’ when bacteria cleared

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10
Q

When would severe disease occur? (pathogenesis of pneumonia)

A

excessive inflammation
lung injury
and/or failure to resolve without lung damage

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11
Q

What does rusty sputum suggest?

A

S. pneumoniae

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12
Q

Pneumonia signs

A

Abnormal vital signs
Signs of lung consolidation on percussion + auscultation

+/- hypoxia + signs of resp failure

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13
Q

Investigations for pneumonia

A

WCC - aids Dx and is a marker for severity

CXR

Sputum - Gram stain, culture + sensitivity tests

Serology - for viruses + atypical organisms

Pulse oximetry (severity) +/- ABG (define RF)

CRP

Urinary antigen - legionella +pneumococcal antigens

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14
Q

What would CXR with upper lobe cavity suggest?

A

K. pneumoniae

but must exclude TB

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15
Q

What would a CXR with multilobal consolidated area suggest?

A

S. pneumoniae,
S. aureus
Legionella sp.

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16
Q

Assessment of severity in pneumonia

A

CURB65
Predicts mortality

confusion, urea, resp rate, BP, age

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17
Q

Tx for mild severity pneumonia in community

A

amoxicillin

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18
Q

Tx for moderate severity pneumonia

A

amoxicillin + clarithromycin

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19
Q

Antibiotic Tx severe pneumonia

A

co-amoxiclav + clarithromycin
or
cefuroxime + clarithromycin

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20
Q

Whats the duration to classify as severe pneumonia?

A

7-10 days

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21
Q

Specific Tx for severe legionella sp pneumonia?

A

Ensure fluoroquinolone in regimen either alone or with clarithromycin

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22
Q

Prevention of pneumonia

A

Polysaccharide pneumococcal vaccine

Influenza vaccine to those >65 yrs, Immunocompromised or with co-morbidities

Smoking cessation

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23
Q

Complications of pneumonia

A

lung abscess

empyema (presence of pus in the pleural cavity)

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24
Q

What can cause pus in the pleural cavity? and whats the presentation?

A
  1. rupture of lung access
  2. bacterial spread of severe pneumonia

Px: very ill, high fever and neutrophil leucocytosis

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25
Q

What’s a lung abscess?

A

From localised suppuration of the lung with cavity formation, often with a fluid level on CXR

26
Q

What causes a lung abscess?

A

Complicating pneumonia
Secondary to bronchial obstruction
From septic emboli from a focus elsewhere
Secondary to infarction

27
Q

What needs to happen promptly to an empyema?

A

Drainage by catheter insertion or chest tube placement

28
Q

Antibiotics for empyema?

A

co-amoxicalv

29
Q

Who are lung abscesses seen in and whats the Tx?

A

aspiration, alcoholics and those with poor dentition

prolonged antibiotics for up to 6 wks

may need surgical drainage

30
Q

What would you suspect an elderly in patient with new fever, purulent secretions, radiological infiltrates, leukocytosis and increasing O2 requirements to have?

A

HAP

(acquired at least 2 days after admission)

could be Staph. aureus including methicillin resistant

31
Q

What’s the m. tuberculosis complex?

A

m. tuberculosis and m. bovis

aerobic, non-spore forming non-motile bacteria with high content of high MW lipids in its cell wall

32
Q

what is post-primary Tb?

A

all forms of tb that develop after the 1st few weeks of the primary infection when immunity to the mycobacterium has developed

33
Q

What is in the primary focus in TB characterised by?

A

exudation + infiltration with neutrophil granulocytes

34
Q

What’s a Gohn complex in TB?

A

In primary infection

The gohn focus (typical granulotamous lesions formed by macrophages), as well as caseous lesions in regional lymph nodes

35
Q

what is maxillary tb as a result of?

A

acute dissemination of tubercle bacilli via the bloodstream

36
Q

how is tb spread?

A

in aerosol from infected individual’s lung to another lung

or via spitting or sneezing on plates or hands

37
Q

Whats the natural history for most cases of TB?

A

the immune response enables the primary complex to encapsulate + contain the organism forever

lesions become fibrosic + calcify but may continue to house viable but dormant organisms for decades

38
Q

What factors would favour Tb disease (not infection) to develop?

A

age
immunosuppression
malnutrition
intensity of exposure

reinfection/new exposure

39
Q

Post-primary TB - whats this due to?

A

usually endogenous reactivation but also reinfection

40
Q

Where do secondary TB lesions develop?

A

in the regional lymph nodes

41
Q

What forms the primary complex?

A

granuloma (formed by macrophages) + lymphatics + lymph nodes

42
Q

If primary disease isn’t contained, what happens (TB)?

A

there is haematogenous dissemination, often leads to serious pulmonary disease

43
Q

what is post primary disease?

A

reactivation after a dormant phase

44
Q

systemic features of active TB

A 
weight loss*
low grade fever
anorexia
night sweats*
malaise
45
Q

Symptoms of pulmonary TB

A

chest pain, dyspnoea
upper lobe consolidation: dull apex with bronchial breathing
compression by LN: collapse, cough etc.

46
Q

Ix TB

A

CXR: patchy or nodular shadows in the upper zones

Sputum/bronchoscopy with washings

LP: to examine CSF for evidence of infection in all cases of military TB

47
Q

contact tracing for tb?

A

report all cases to the local Public Health Authority

48
Q

Drug treatment for TB

A

DOT (directly observed therapy)

rifampicin
isoniazid
pyrazinamide
ethambutol

49
Q

what tb drug has a possible side effect of optic neuritis?

A

ethambutol

50
Q

what drug stains body secretions and urine pink (TB)

A

rifampicin

51
Q

whats the BCG vaccine?

A

a bovine strain of M. tuberculosis which has lost its virulence after growth in the lab for many years

immunisation produces cellular immunity and a positive mantoux test

52
Q

rifampicin mechanism of action

A

inhibits bacterial DNA-dependent RNA synthesis by inhibiting bacterial DNA-dependent RNA polymerase.

53
Q

Pharyngitis aetiology

A

viral: rhinovirus, adenovirus

glandular fever EBV

Acute HIV infection

streptococcus pyogenes,

54
Q

what viruses cause croup?

A

parainfluenza viruses

55
Q

what is sinusitis usually caused by?

A

viral infection

56
Q

what do rhinoviruses cause?

A

rhinoviruses: common cold, bronchitis, sinusitis

57
Q

what do coronaviruses cause?

A

colds but occasionally severe respiratory illnesses

58
Q

what do adenoviruses cause?

A

URT infection, pharyngitis, bronchitis, occasional pneumonia

59
Q

emerging respiratory virus infections

A

SARS
Middle East Respiratory Syndrome novel Coronavirus
Avian influenze

60
Q

What URT infection does haemophilus influenza type B (Hib) cause?

A

acute epiglottitis

61
Q

Whats another name for acute laryngo-treacheobronchitis?

A

croup!

mainly due to parainfluenza viruses

62
Q

what does respiratory syncytial virus cause?

A

bronchiolitis

Respiratory (16 decks)

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