Infection (new facts) Flashcards
Gram + alpha haemolytic strep colonising URT?
Strep pneumoniae
Gram + beta haemolytic strep colonising URT?
Strep pyogenes
What is a non-strep gram + bacteria which also colonises the URT?
Staph aureus
What are gram - organisms which colonise the URT?
Haemophilius influenzae, Moraxella catarrhalis
What are complications of the common cold?
Acute sinusitis or bronchitis
What are organisms causing the common cold?
Adenovirus, rhinovirus, RSV
What URTI shows a pseudo-membrane?
Diphtheria
What causes epiglottitis and what kind of organism is this?
Haemophilius influenzae type B- gram + cocco bacillus
How do you test for epiglottitis?
Blood culture
What is the treatment for epiglottitis?
Intubation and ceftriaxone
What is a generally big risk factor for most LRTIs?
Intubation
What will acute bronchitis show on chest exam and CXR?
Normal
As well as cold like symptoms and coughing, what is another common symptom of whooping cough?
Vomiting
What causes whooping cough and what type of organism is this?
Bortedella pertussis- gram - coccobacillus
When should you give antibiotics for whooping cough?
Cough < 21 days
What antibiotics can be given for whooping cough and under what conditions?
< 1 month- clarithromycin
> 1 month- clarithromycin or azithromycin
Pregnancy- erythromycin
How is a diagnosis of bronchiolitis made?
PCR
How is bronchiolitis treated?
Supportive
What does chlamydophila pneumoniae cause?
Mostly mild respiratory tract infections
Primary influenza pneumonia after flu is most common in who?
During pandemics- young adults
Secondary bacterial pneumonia after flu is most common in who?
Infants, elderly, pre-existing disease or pregnancy
What is Influenza A 5HN1?
Highly pathogenic avian flu
Who are the only people to receive a live attenuated flu vaccine?
Children
What further antibiotic cover does hospital acquired require?
Gram -
What further antibiotic cover does aspiration require?
Anaerobic
What is the treatment for mild-moderate CAP (0-2 CURB65)?
amoxicillin 1g tds IV/PO (doxycycline if penicillin allergic)
What is the treatment for severe CAP (3-5 CURB65)?
co-amoxiclav 1.2g tds IV + clarithromycin 500mg bd IV (levofloxacin if penicillin allergic)
What are organisms which can cause lobar pneumonia?
Strep pneumonia, Klebsiella or Legionella
Who normally gets lobar pneumonia?
CAP- previously healthy young adults
Where does broncho pneumonia start and spread to?
Starts in airways and spreads to adjacent alveolar lung
Who is broncho-pneumonia more common in?
Those with a pre-existing disease or aspiration
What antibiotic treatment does mycoplasma, coxiella burnetti and chlamydia psittaci respond to?
Tetracycline and macrolides e.g. clarithromycin
Apart from pneumonia, what else can coxiella burnetti cause?
Q fever
Where does coxiella burnetti come from?
Sheep and goats
What is a complication of coxiella burnetti?
Culture negative endocarditis
What does chlamydia thrachomatis cause?
Infantile pneumonia
Is legionella gram - or +?
-
Where does legionella invade?
Alveolar macrophages and then replicates
How is legionella diagnosed mainly?
Urinary antigen
How do you treat legionella?
Clarithromycin, erythromycin or quinolones e.g. levofloxacin
How do you treat PCP?
Co-trimoxazole and maybe prophylaxis
how do you diagnose aspergillus or PCP?
Bronchioalveolar lavage
What type of organism is mycobacterium TB?
Acid alcohol fast bacilli
What can latent TB cause?
Immune alterations or reactivation later on
Where is the pathogen taken in primary TB?
To hilar lymph nodes
Where is secondary TB found?
Usually localised to the upper zones but may spread via bloodstream or airways
What type of TB will show a Ghon Focus in the midzone and enlarged pulmonary hilar lymph nodes?
Primary
What will secondary TB show on CXR?
Fibrosing and cavitating apical lesion
What type of TB is a miliary disease?
Secondary
What test uses the carbol-fuschin dye and what colour does this stain?
Zeihl-Neelson, stains mycobacteria red
What should you always check for in patients with chronic pulmonary infection?
Underlying immunodeficiency
What is usually the cause of a lung abscess?
Aspiration
What organisms can cause an abscess?
Bacteria or fungi
What can cause a right sided endocarditis from a DVT?
Septic emboli
Who are septic emboli common in?
IV drug users
What shows an uncomplicated effusion?
Clear fluid, ph > 7.2, LDH < 1000, glucose > 2.2
What type of organisms mainly cause empyema?
aerobes
When do anaerobic organisms cause empyema?
After severe pneumonia or if there is poor dental hygiene
What would give clinical suspicion of empyema?
Slow to resolve pneumonia
What will show a D sign on CXR?
Empyema
What is the preferred test for empyema?
US
What initial broad spectrum antibiotics are used for empyema?
Amoxicillin and metronidazole
What is used to diagnose bronchiectasis?
HRCT
What shows hallmarks of bronchiectasis but there is no evidence of this on CXR?
Chronic bronchial sepsis
Who are the two groups of people most likely to get chronic bronchial sepsis?
Young women involved in healthcare
Older people with COPD
What have been shown to reduce exacerbations of chronic bronchial sepsis?
Low dose macrolides
