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Sem2: MDSA30160: Cardiorespiratory Disease > L11 Lower Respiratory Tract Infections > Flashcards

L11 Lower Respiratory Tract Infections Flashcards

1
Q

Pneumonia Pathogenesis?

A

Colonized by pathogen => inflammatory response => Fluid buildup in alveoli

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2
Q

Typical Causes of Community Acquired Pneumonia?

A

Streptococcus pneumoniae (Most Common)

  • Haemophilus influenzae*
  • Moraxella catarhalis*
  • Staphylococcus aureus*
  • Klebsiella pneumoniae*
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3
Q

Clinical Features of Typcial Community Acquired Pneumonia (CAP)

A

Clinical Features:

Acute onset

Fever

Rigors

Dyspnoea

Cough

Sputum

Pleuritic chest pain

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4
Q

Atypical causes of Community-Acquired Pneumonia (CAP)

A

Atypical Causes:

Nonzoonotic:

Legionella pneumophilia (Hotels/Gyms/Cruises)

Mycoplasma pneumoniae

Chlamydophilia pneumoniae

Zoonotic:

Chlamydophila psittaci

Coxiella burnetti (Q fever)

TB

Respiratory Viruses

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5
Q

Clinical Features of Atypical Community-Acquired Pneumonia (CAP)

A

Clinical Features:

Subacute onset

Fever

Dry cough

Extrapulmonary symptoms

Fatigue

Headache

Confusion

Nausea

Vomiting

Diarrhoea

Myalgia

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6
Q

Investigations for Pneumonia?

A

Investigations for Pneumonia?

Blood Tests:

Full blood count (FBC) - check for elevated WBC

Urea and electrolytes (U&E)

C-reactive protein (CRP) - increases in pneumonia

ABG - oxygenation of radial artery

Microbiology:

All patients w/ Pyrexia (fever) :

Blood culture (BEFORE antibiotics)

Sputum Culture** **Appearance: (Less effective for elderly w/ poor cough reflex)

Mucopurulent: bacterial pneumonia or bronchitis

Rusty: pneumococcal pneumonia

Scant or watery: mycoplasma or viral pathogens

Malodorous: aspiration

Pneumococcal/legionella Urinary Antigen

Pleural fluid culture

XRAY:

Lobar - bacterial

Diffuse Bilateral Infiltrates – viral, pneumocystis, atypical pathogen

Lower lobes are most commonly involved regardless of etiology

Radiology lags behind clinical improvement- Must repeat X-Ray 6 weeks after release

Invasive TestInvasive Test

Broncho-alveolar lavage (BAL): Only for those w/ severe Pneoumia and failure to respond to treatment

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7
Q

Sputum Culture Appearance for Pneumonia?

A

Sputum Culture** **Appearance for Pneumonia

Mucopurulent: bacterial pneumonia or bronchitis

Rusty: pneumococcal pneumonia

Scant or watery: mycoplasma or viral pathogens

Malodorous: aspiration

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8
Q

X RAY for Pneumonia:

Most Commonly Impacted?

When to Repeat scan?

A

XRAY for Pneumonia:

Lobar - bacterial

Diffuse Bilateral Infiltrates – viral, pneumocystis, atypical pathogen

Lower lobes are most commonly involved regardless of etiology

Radiology lags behind clinical improvement- Must repeat X-Ray 6 weeks after release

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9
Q

Blood Tests for Pneumonia?

A

Blood Tests:

Full blood count (FBC) - check for elevated WBC

Urea and electrolytes (U&E)

C-reactive protein (CRP) - increases in pneumonia

ABG - oxygenation of radial artery

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10
Q

Assessment of Pneumonia Severity?

A

CURB65 score: Determine Admission to hospital and Empiric Treatment

1 Point for each parameter

Confusion

Urea >7mmol/L

Respiratory rate >30/min

Blood pressure sBP<90mmHg and/ or dBP <60mmHg

Age >= 65years

+ Clinical judgment:

Hypoxia, hypercapnia, acidosis

Stability of underlying illness

Social circumstances

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11
Q

Empiric Treatment for Community-Acquired Pneumonia?

A

Typical: Typically treat with Co-Amoxiclav => Flucloxacillin if resistant

Atypical: Penicillin not effective, Clarithromycin/Doxycycline

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12
Q

Complications of Pneumonia?

A

Complications of Pneumonia:

Pleural effusion=> Empyema

Bacteremia (bloodstream infection)

Lung Abscess

Obstruction (Sputum plug => atelectasis)

Sepsis, severe sepsis, septic shock

Adult Respiratory Distress Syndrome (ARDS)

Renal Failure

Metastatic infection: Meningitis, septic arthritis, endocarditis

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13
Q

Prevention of Pneumonia?

A

Prevention of Community:

  • Pneumococcal vaccination
  • Influenza vaccination
  • Smoking cessation

Prevention of HAP:

  • Good infection prevention and control practice
  • Yearly staff Influenza vaccination
  • Maintain upright position and mobility
  • Avoid sedatives if possible
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14
Q

Most common Nossicomal Disease contributing to death?

A

Hospital-Acquired Pneumonia (HAP)

Pneumonia develops >48 hours post-admission

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15
Q

Transmission of Hosptial Acquired Pneumonia

A

Aspiration of contaminated oropharyngeal secretions

Inhalation of contaminated respiratory droplets (influenza) or Aersol (TB)

Contaminated Water => Legionella spp.

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16
Q

Risk Factors for Hosptial Acquired Pneumonia

A
17
Q

4 common Causes of Hospital-Acquired Pneumonia?

A

Gram Negative and Resistant Bacilli more common, often multidrug resistant

E. coli

Klebsiella pneumoniae

Enterobacter spp.

Pseudomonas aeruginosa

18
Q

Treatment for hospital acquired pneumonia

A

Agent with activity against Gram negative bacilli (Piperacillin/Tazobactam)

19
Q

__________________: Fluid or food aspirated into the lung => secondary inflammation

4 Potential Outcomes?

Patients at risk?

Microbiology?

A

Aspiration Pneumonia: Fluid or food aspirated into the lung => secondary inflammation

Outcomes of aspiration:

  1. Chemical pneumonitis (gastric acid)
  2. Obstruction of airway secondary to particulate matter (food)
  3. (Bacterial) aspiration pneumonia
  4. Lipid Pneumonia (From inhaled mineral oil => lipid-laden macrophages fill alveoli)

Patients at risk:

Elderly

Neurological impairment: stroke, dysphagia, cerebral palsy, motor-neuron disease, cranial nerve palsy, dementia

Impaired conscious level: Sedative medication, post seizure

Gastric disorders eg. GORD

Microbiology

Anaerobic bacteria

Staphylococcus aureus

Streptococci

Enterobacteriaceae

20
Q

Pneumonia in the Immunocompromised?

A

Pneumonia in the Immunocompromised

  1. Regular pathogens in community / hospital setting
  2. Reactivation of latent / dormant infections (TB)
  3. Opportunistic infections (Fungi => Concerning if pyrexia after a few days )
21
Q

Pleural Effusion vs. Empyema

A

Pleural Effusion= Buildup of fluid in Pleural Space, Lungless able to expand

Empyema = Pus in the pleural space

22
Q

Epidemiology/Risk Factors for Pleural Effusion

A

Epidemiology:

Mostly pediatric or elderly

57% of patients w/ pneumonia develop pleural effusion => risk of development to empyema w/ inappropriate therapy

Risk Factors

Extremes of age

Diabetes mellitus

Alcohol misuse

Immunosuppression

Corticosteroids

Gastroesophageal reflux disease

23
Q

Clinical Features and Diagnosis of Pleural Effusion

A

Clinical Features

Pneumonia with unresolving features of infection persistent

Pyrexia

Dyspnea

Raised inflammatory markers WCC, CRP

Pleuritic chest pain

Diagnosis

Clinical suspicion

Chest XR: Pleural effusion

Pleural Fluid Aspiration: Appearance of fluid: clear/purulent

24
Q

Most common Lower Respiratory Tract Infection during first year of life?

A

Bronchiolitis

25
Q

Pathogenesis of Bronchiolitis?

A

VIRAL: Respiratory Syncytial Virus (RSV) 75%

Respiratory virus infects airway epithelium

Necrosis and cilial damage → promote an inflammatory response → Edema

Accumulation of mucus and cellular debris in airways → airway obstruction

26
Q

Clinical Features / Severe Signs of Bronchiolitis?

A

Clinical Features

Cough

Tachypnoea (rapid breathing)

Airway secretions

Difficulty feeding

Apnea (suspense of breathing)

Dehydration

Severe Signs:

Lethargy

Severe respiratory distress - nasal flaring/grunting

Oxygen saturations <95%

27
Q

Diagnosis/Management of Bronchiolitis

A

Diagnosis

Typical history

Nasal discharge

Fever

Wheezy cough

Examination findings

Inspiratory crackles

Expiratory wheeze

Nasopharengial Aspirate: PCR Test

Management:

Supportive care

Anti-viral drugs (Unclear benefit, not in routine use)

Humanized monoclonal antibody against F protein of RSV

Containment of viral infection on hospital ward

Sem2: MDSA30160: Cardiorespiratory Disease (24 decks)

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