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Resp > Lecture 17 - Lower respiratory tract infection > Flashcards

Lecture 17 - Lower respiratory tract infection Flashcards

1
Q

Pathogens that cause respiratory tract infections

A

Viridans streptococci
Fungi - candida

Less common:

  • strep pneumoniae
  • strep pyogenes
  • haemophilus influenzae
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2
Q

Why are lungs not sterile?

A

Normal alveolar microbiota
Aspiration
Blood stream spread
Direct spread

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3
Q

Defences of respiratory tract

A 
Mucous 
Muco-ciliary escalator
Cough and sneezing 
Nasal hairs  
Tonsils - lymphoid follicles
Secretory IgA and IgG 
Alveolar microbiota
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4
Q

Epithelial lining of the respiratory tract

A

Psuedostratified ciliated columnar cells

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5
Q

Typical infection pathophysiology

A
  1. Alveolar macrophages fail to stop pathogens from invading and multiplying
  2. Activated macrophages release cytokines that recruit more macrophages
  3. Inflammation and increased permeability as there is and increased blood supply
  4. Recruitment of immune cells like neutrophils and lymphocytes
  5. Damage to lung tissue
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6
Q

Typical infection effects systematically

A
  1. Inflammatory mediators like cytokines and chemokines are released into the systemic circulation
  2. Bone marrow releases neutrophils, increased heart rate and higher temperature causing pyrexia
  3. Dysregulation can cause tissue and organ injury
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7
Q

What causes dysregulation

A

Pathogen
Host factors
Drugs

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8
Q

Virulence factors of pathogens

A

Chlamydia pneumoniae - ciliotatic factor

Mycoplasma pneumoniae- shear off cilia

Strep pnuemoniae and neisseria meningitides - split IgA

Pneumoccocus - capsule inhibits phagocytosis

Mycobacterium/ Leigonella - resistant to phagocytosis

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9
Q

Host factors

A 
Age - older than 65
Smoking - abnormal ciliary function
Chronic lung disease 
Aspiration 
Immunocompromised - DM/HIV
Co-infection
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10
Q

Drugs that increase the risk of pneumonia

A

Antacids - PPI - increased risk of pnuemonia

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11
Q

Upper respiratory tract infection

A 
Laryngitis
Pharyngitis
Sinusitis 
Rhinitis 
Epiglottitis
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12
Q

Lower respiratort tract infections

A

Bronchitis
Pneumonia
Lung abscesses
Bronchiectasis

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13
Q

Acute bronchitis pathophysiology, symptoms, treatment, pathogen

A

Inflammation of small and medium sized airways

Mainly in smokers

Symptoms:

  • Cough
  • Fever
  • Sputum production
  • SOB

Organisms:

  • Strep pneumoniae
  • Haemophilus influenzae
  • Maroxella catarrhalis

Treatment:
Bronchodilation
Physiotherapy
+/- Antibiotics

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14
Q

Pneumonia

A

Acute inflammatory response to infection

Exudate released into lumen which can cause obstruction

Neutrophil and macrophage infiltration

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15
Q

Types of pneumoniae

A

Lobar pnuemoniae

  • involves whole lobe
  • consolidation of whole lobe

Bronchopneumonia

  • patchy and diffuse
  • affect the bronchioles and alveoli

Atypical/interstitial
- affects the interstitium outside the alveoli

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16
Q

Signs of pneumonia

A

Percussion: Dull resonance over affected area due to consolidation

Auscultation:

  • Crackles
  • tactile vocal fremitus - sound louder when saying phrases e.g. 99 as sounds travels faster through fluid
  • bronchial breathing

CXR: consolidation
- patchy

17
Q

Typical organisms that cause pneumniae

A 
Streptococcus pnuemoniae
Maroxella Catarrahalis
Haemophilus Influenzae
Klebsiella pnuemonia
Staph aureus
Group A Strep pyogenes

Fungi

  • cryptococcus
  • pneumocystis jiroveci - risk for immunocompromised individuals as opportunistic
18
Q

Atypical organism of pneumonia

A

Mycoplasma pneumoniae
Legionella pneumophila - contaminated water sources
Chlamydophila pneumoniae

19
Q

Symptoms of pneumonia

A 
Cough
Productive cough
Dyspnoea
Pluerisy - sharp chest pain 
fever
20
Q

CURB 65

A 
Confusion
Urea in blood over 7 mmol/L
Resp rate over 30
Blood pressure - systolic 
Over 65 yrs old
21
Q

Investigations for pneumoniae

A 
FBC
U+E
CRP
ABG
CXR
cytology of sputum
22
Q

Treatment

A

Antibiotics
Oral fluid intake
Analgesia

23
Q

Mild pneumonia antibiotics

A

Amoxacillin

or doxycycline/ erythromycin/ clarithromycin

24
Q

Moderate to sever antibiotics

A

Hospitalisation

Co-amoxiclav
Clarithromycin
Doxcycline

25
Q

Atypical pneumonia antibiotics

A

Macrolides
erythromycin
clarithromycin

26
Q

Complications of pneumonia

A

Lung abscesses
Empyema - pockets of pus inside pleural space
Bacteraemia

27
Q

First line hospital aquired pneumonia

A

Co-amoxiclav

28
Q

Aspiration pneumonia

A 
Aspiration of exogenous or endogenous secretions in the respiratory tract 
Decreased gag reflex due to:
- drug overdose
- epilepsy 
- dysphagia
- alcohol abuse
29
Q

Pathogens causing aspiration pneumoniae

A

Viridans streptococci

Anaerobes

30
Q

Presentation of atypical pneumonia

A

Cause vague symptoms like fatigue and regional

31
Q

Community acquired pneumonia

A

Person gets ill outside of a hospital of healthcare setting

32
Q

Hospital acquired pneumonia

A

Nosocomial
Patient is already sick in hospital
More serious as
- patient has a weakened immune system as already sick
- microbes in the hospital are more resistant to antibiotics e.g. MRSA

33
Q

Stages of lobar pneumonia

A
  1. Congestion (day 1 and 2)
    - blood vessels and alveoli fill with excess fluid
  2. Red hepatisation (day 3 and 4)
    - exudate (RBCs, Neutrophils and fibrin) fill air spaces making them more solid
    - liver like appearance
  3. Grey hepatisation (Day 3 to 7)
    - still firm
    - colour change as RBCs break down
  4. Resolution (Day 8 to 3 weeks)
    - exudate is digested by enzymes, ingested by macrophages or coughed up

Resp (22 decks)

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