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RESP > Lecture 13: LRTI and Pneumonia > Flashcards

Lecture 13: LRTI and Pneumonia Flashcards

1
Q

What majority age group dies from acute LRTI?

A

Elderly (65+ years)

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2
Q

What is the microbiota of the respiratory tract?

A

Common: viridans streptococci, neisseria, candida
Less common: strep.pneumoniae, strep.pyogenes, haemophilis influenzae
(lungs are not sterile)

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3
Q

What are the defences of the respiratory tract?

A
  • muco-ciliary clearance mechanisms, nasal hairs, ciliated columnar epithelium
  • cough and sneeze reflex
  • respiratory mucosal immune system: lymphoid follicles of the pharynx and tonsils, alveolar macrophages, secretary IgA and IgG
  • alveolar microbiota
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4
Q

What is the course of a typical respiratory tract infection?

A

In lungs:
-alveolar macrophage fails to stop pathogen
-cytokines are produced which recruit more macrophages, and causes an inflammatory response
-inflammation= increases blood supply and permeability so more WBC’s/proteins (neutrophils, lymphocytes, antibodies) leak out
-leads to damage of the lung tissue
Outsie the lungs:
-inflammatory mediators (cytokines/chemokines) into systemic circulation: activates bone marrow to produce more neutrophils, increased CO, raised body temp

If infection gets out of control: dysregulation- signs of tissue/organ injury

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5
Q

What causes dysregulation?

A
  • pathogen
  • host factors
  • drugs (antacids/PPIs/inhaled corticosteroids)
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6
Q

Name some pathogen factors:

A

Chlamydia pneumonia: ciliostatic factor
Mycoplasma pneumoniae: shear off cilia
Influenza virus: reduced mucus viscosity
Strep pneum/neisseria meningitidies: split IgA
Pneumococcus: capsule inhibits phagocytosis

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7
Q

Name some host factors that contribute to disregulation:

A
  • age >65
  • lifestyle (smoking/alcohol/drugs)
  • chronic lung diseases
  • immunocompromised
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8
Q

What is an upper respiratory tract infection and give examples?

A 
Infection in the trachea or above 
-rhinitis (common cold)
-pharyngitis 
-sinusitis
Commonly caused by viruses
Can cause secondary infection by bacteria: bacterial super infection is common with sinusitis and otitis media= lead to meningitis, mastoiditis, brain abcess
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9
Q

What are some examples of lower respiratory tract infections?

A
  • bronchitis (acute/chronic, chronic is not caused by infection)
  • pneumonia
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10
Q

What is acute bronchitis?

A

-inflammation of medium sized airways
-infective process
-mainly in smokers
Causes: cough, fever, sputum, SOB
CXR NORMAL
Organisms:
-viruses
-S. pneumoniae
-H. influenzae

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11
Q

What is chronic bronchitis?

A
  • inflammatory process (not primarily infective)

- exacerbations may be associated with many organisms

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12
Q

How do you treat acute bronchitis?

A

-bronchodilation
-physiotherapy (remove secretions)
+/- antibiotics

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13
Q

What are the different types of pneumonia (inflammation of lung alveoli)?

A

CAP (community acquired pneumonia): outside a healthcare setting
HAP (hospital acquired pneumonia): 48 hours post-admission
VAP (ventilation acquired pneumonia): 48 hours post-intubation

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14
Q

What occurs in pneumonia?

A
  • inflammation of the lung alveoli
  • leads to acute inflammatory response, causing exudate:fibrin rich, and neutrophil/macrophage infiltration
  • ‘stony’ dull sound of chest percussion, fluid in the lungs appears opaque
  • patient becomes SOB as poor ventilation due to fluid, starts to cough, blood gas= hypoxic
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15
Q

What is the difference between lobar pneumonia and bronchopneunonia?

A
  • lobar is widespread and affects the whole lobe

- bronchopneumonia is patchy

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16
Q

What causes CAP?

A

Typical/atypical organisms

Typical: (85%)

  • Strep.pneumoniae (commonest)
  • H.influenzae
  • Staph.aureus

Atypical: (15%) (don’t behave as typical bacteria)

  • mycoplasma: no cell wall (commonest)
  • legionella (contaminated water sources)
  • coxiella burnetti (Q fever): farm animals, can manifest hepatitis
17
Q

What are the clinical symtpoms of CAP?

A

-cough (dry/wet)
-dyspnoea
-pleurisy (lining of lungs become inflammed: pleuritic chest pain)
-crackles
-bronchial breathing
Systemic:
-fever
-tachycardia
-organ dysfunction

Imaging: consolidations/infiltrates/cavitations (cna’t have a normal CXR with pneumonia)

18
Q

What is CURB-65?

A

Assess severity of pneumonia

Confusion 
Urea >7 mmol/l
Respiratory Rate >30
Blood pressure <90 systolic <60 diastolic
>65 years

Score <2: mild pneumonia, managed in community, no investigations done, so we don’t really understand the prevalence of the pneumonia
Score 2: ?admit
Score 2-5: manage as severe

19
Q

What investigations do you do for pneumonia?

A

-FBC
-U and E
-CRP
-ABG
-CXR
Microbiological investigations: sputum, blood culture, broncho alveolar lavage fluid if no sputum, nose a throat swabs, urine, serum antibody test

20
Q

What are the differential diagnosis of CAP?

A
  • heart failure & pulmonary oedema
  • PE
  • atelectasis (collapse of lung)
  • lung cancer
21
Q

How do you treat CAP?

A

Antibiotic treatment
5-7 days for mild CAP (amoxicillin, give doxycycline if allergic)
7-10 days for severe CAP (co-amoxiclav AND clarithromycin)

Atypical: treat with clarithromycin as not suscpetible to penicillin

22
Q

What are the complications of pneumonia?

A

Initial infection progression: empyema/lung abcess/bacteraemia
Non-resolving CAP: incorrect initial diagnosis

23
Q

What causes hospital acquired pneumonia?

A
  • staph aureus
  • MRSA
  • E coli
  • fungi (candida)
24
Q

How do you treat HAP?

A

First line: Co-amoxiclav

Second line/ITU: broad spectrum: piperacillin/meropenem

25
Q

What is aspiration pneumonia?

A

Aspiration of exogenous material or endogenous secretions into the respiratory tract
-common in patients with neurological dysphagia: epilepsy, alcoholics, drowning

=likely to have mixed infection as it is aspirated

26
Q

What can cause pneumonia in immunosuppressed organisms?

A

HIV patients: TB, atypical mycobacteria, pneumocystis jirovecci
Neutropenia: fungi
Bone marrow transplant: cytomegalo virus
Splenectomy: encapsulated organsisms (malaria/H.influenzae/S.pneumonia)

27
Q

How do we prevent pneumonia?

A

Immunisation: flu vaccine every year, pneumococcal vaccine every 5 years
Chemoprophylaxis
Smoking advice

RESP (18 decks)

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