Infections of the Respiratory System Flashcards
What is the definition of community acquired pneumonia?
Lung infection with inflammation and associated consolidation or infiltrates acquired in the community or within 48 hours of hospital admissions
What are the most common causative organisms of community acquired pneumonia?
Streptococcus Pneumoniae
Haemophilus influenzae,
Staph aureus
What is the most common cause of community acquired pneumonia and what are the classical symptoms you would associate with it?
S. Pneumoniae
Rust coloured sputum, acute onset, high temperature and classical lobular pattern
What IS Hx associated with Haemophilus influenzae?
Hx of COPD
What is the typical presentation and Hx with Legionella infections?
Hx of recent travel
Hyponatraemia and deranged LFTS
Neurological symptoms
Younger patient
What is the typical presentation and Hx associated with Mycoplasma infection?
Extrapulmonary features - Haemoloysis, Skin and joint involvement, erythema multiforme
Younger patient
Dry cough - often referred to as the walking pneumonia
Patchy or diffuse X ray NOT LOBAR
What is unique about blood results in a mycoplasma infection?
No raise in Neutrophils
What causative organism is associated with pneumonia in immunocomprimised patients?
pneumocystis jiroveci
Which causative organism is associated with pneumonia in patients who have a hx of bird contact and what are typical features of presentation?
Chlamydophila psittaci
Photophobia, long duration, headache and cough
What are risk factors for the development of community acquired pneumonia?
SMOKING
Immunocomprimise
Aspiration
Alcoholism
Which causative organism is associated with patients with a Hx of alcoholism and diabetes - what is typical sign?
Klebsiella
Red current sputum
What is the scoring system used for pneumonia, what are the figures and how is it interpreted?
CURB 65
Confusion, Urea >7, RR >30, BP <90/60 and age >65
Score >1 consider referral
Score of 3 or more associated with high mortality
What are investigations carried out and when are they indicated?
Bloods indicated in hospital only
Blood cultures all patients with moderate to severe CAP
Sputum - if producing high volumes of purulent sputum
CXR - all patients admitted to hospital
U&E and LFTs (atypical pneumonia)
When would you consider urine test for community acquired pneumonia and what are you looking for?
All patients with severe and moderate CAP
Streptococcal urine antigen and legionella antigen (severe only)
What is empirical antibiotic for non severe community acquired pneumonia?
Oral Amoxicillin for 7 days
+ Doxy for atypical cover
What is empirical antibiotic for severe community acquired pneumonia?
Pipilleracilin + Tazobactam = Tazocin IV
WITH c
What is the Abx of choice for a confirmed S pneumoniae infection?
IV benpen
What is the Abx of choice for a confirmed Staph aureus (methicillin sensitive) infection?
IV fluclox
What is the Abx of choice for a confirmed legionella infection?
Clarithromycin + Rifampicin
What is the Abx of choice for a confirmed PCP infection?
Co- Trimoxazole IV
What are the most common causative organisms for HAP?
Staph aureus
Pseudomonas
E coli
What is the management of non-severe community acquired pneumonia?
Amox + doxy
What is the management of non-severe aspiration pneumonia?
Amoxicillin + metronidazole
What is the management of severe HAP or Aspiration pneumonia?
IV tazocin with
+ clarithromycin if legionella suspected
What are risk factors for the development of a lung abscess?
DM
CF
Chronic alcoholism
COPD
What is the presentation of a lung abscess?
Insidious onset Swinging fevers Productive purulent cough +/- haemoptysis Night sweat SOB
What are Ix of choice for lung abscess?
Blood and sputum cultures
CXR and CT if needed
What is the management of lung abscess?
Antibiotics - long course
2 weeks IV and 2-6 weeks oral
Co-amox or clindamycin + metronidazole
What is the definition of TB?
Granulomatous disease caused by M. turberculosis
What is the pathophysiology of TB?
Respiratory droplet transmission
Myobacteria engulfed and replicate within the alveolar macrophage . Released Mycolic acid prevents degradation of the resulting in granuloma formation to prevent further spread
What is the presentation of pulmonary TB?
Productive cough +/- haemoptysis
Fever
Malaise
Weight loss
What are extra-pulmonary presentations of TB?
Clubbing Erythema nodosum Meningitis Arthritis Potts Spine
What are the imaging techniques that should be used to identify TB?
CXR - effecting apical and upper lobes predominantly
What samples are collected and what is done with them in the diagnosis of TB?
At least 3 sputum samples with one being an early morning
Ziehl-Neelson stain to identify acid fast baccili
Cultures are done but take 4-8 weeks to grow
What blood tests should be done in TB and why?
FBC
LFT and U&E lots of the anti-TB drugs are hepato and nephro toxic
What test would be done if a patient presented with no active TB?
Mantoux test to identify latent TB
What is the management on TB?
1st Rifampicin. Isoniazid, Pyrazinamide and ethambutanol for 2 months
FURTHER 4 months of Rifampicin and isoniazid
What are the side effects of Rifampicin?
Red- orange secretions
Heptatitis
What are the side effects of Ethambutanol?
Optic neuritis
Renal impairment
What are the side effects of Isonized?
Peripheral neuropathy
Hepatitis
Agranulocytosis
What are the side effects of pyrazinamide?
High uric acid leading to gout
Myalgia
Hepatitis
What is the antibiotic class of choice for patients with
Carbapenems
