INFECTIOUS DISEASE: Lung and heart infections Flashcards
Name atypical bacteria that cause atypical pneumonia
Legions of Psittaci MCQs
Legionella pneumophila
Chlamydia psittacosis
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Q fever - coxiella burneti
Common bacteria that cause chest infections/pneumonia ( spell them too!)
Streptococcus pneumoniae
Haemophilus influenzae
Less common/opportunistic bacteria that cause chest infections/pneumonia and when?
- Moraxella catarrhalis- in immunocompromised patients and those with chronic pulmonary disease
- Pseudomonas aeruginosa- patients with CF or bronchiectasis
- Staphylococcus aureus- In patients with CF
Chest infection presentation?
Cough
Sputum production
Fever
Lethargy
Crackles on the chest
Common bacteria that cause chest infections ( spell them too!)
Streptococcus pneumoniae
Haemophilus influenzae
Antibiotic for chest infection in community?
Amoxicillin or erythromycin or doxycycline
Exam patient with Chlamydophila pneumoniae?
School aged child with mild- moderate chronic pneumoniae and wheeze
Q fever exam patient?
Farmer with flu like symptoms
Q-fever linked to animal exposure and their bodily fluids
Chlamydia psittaci exam pt?
Parrot owner- contracted from infected birds
Presentation of infective endocarditis?
Main symptom and sign = fever and murmer (aortic valve regurgitation)
Symptoms: Headache, myalgia, weight loss, abdominal pain, night sweats, pleuritic chest pain, cough
Signs: Janeway lesions, osler nodes, non-blanching petechiae. murmer.
Investigations for suspected infective endocarditis?
ECG
FBC, U+Es, LFTs, CRP
3 blood culture samples (from different sites) - check have not missed infection
1st line imaging = transthoracic echo
Most sensitve imaging modality = transoesophageal echo
CXR
RF for infective endocarditis?
Valvular damage
- prosthetic valve
- age related valvular damage
- previous rheumatic heart disease
IV drug use
Male
Age 60 +
Poor dentition
Previous endocarditis
Initial management of endocarditis (called Blind therapy)?
Benzylpenicillin and gentamicin
Management of native valve (i.e. not prosthetic valve) infective endocarditis caused by Staphylococcus aureus?
- Flucloxacillin 4 weeks
- Penicillin allergy = Vancomycin + rifampicin 4 weeks
Management of prosthetic valve infective endocarditis caused by Staphylococcus aureus?
Flucloxacillin + gentamicin + rifampicin for 4-6 weeks
Management of infective endocarditis caused by Steptococci sp?
Benzylpenicillin 4-6 weeks
Complications of infective endocarditis?
Heart failure - from acute valvular insufficiency
Stroke, haemorrhages
Renal failure
Osteomyelitis
Septic arthritis
Common valve affected in IV drug users with infective endocarditis?
Tricuspid valve on R side of the heart
Entry mechanism of Strep viridans causing infective endocarditis?
Poor dental hygiene
Entry mechanism for Staph epidermidis which causes infective endocarditis?
Indwelling devices - cannulas.
Major clinical criteria of Modified Dukes criteria for infective endocarditis?
- Blood culture positive
- Echo positive or PET CT +ve or CardioCT +ve
Minor clinical criteria of Modified Dukes criteria for infective endocarditis?
- Predisposition present - IVDU, Heart condition
- Fever of 38C<
- Vascular phenomena present - arterial emboli, infarcts, conjunctival haemorrages
- Immunological phenomena present - glomerulonephritis, osler nodes, Rheumatoid factor
- Serology evidence of infective endocarditis
How is definitive infective endocarditis calculated using Dukes Modified criteria?
pathological criteria positive, or
2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria
Xray features of Mycoplasma pneumoniae?
Bilateral consolidation
CXR findings for pneumonia ?
Consolidation
Investigations for pneumonia and corresponding findings ?
CXR - consolidation
FBC - neutrophillia I.e. high WCC
U+Es - dehydration - urea in CURB6
CRP - raised as response to infection
ABG - indicated if O2 sats are low
Sputum culture - find sensitivity for abx
Classic organism causing pneumonia in alcoholics?
Klebsiella pneumoniae
