Lecture 18- Chronic Disease And Infections

Question 1

Chronic illnesses that are particularly vulnerable to infection?

Answer 1

COPD
Diabetes
Cystic fibrosis

Question 2

Why do chronic diseases make infection easier?

Answer 2

Change to tissue structure or function and altered presence of microorganisms

Question 3

Cystic fibrosis?

Answer 3

Autosomal recessive. Defect in CFTR gene affects the coding of chloride channels. Reduced secretion of chloride means that more water reabsorbed giving sticky mucus

Question 4

CF complications?

Answer 4

Lung- colonisation and infection
Pancrease- inflammation 
Intestine- blockages for small babies 
Infertility 
Sinus infections 
Cirrhosis of liver

Question 5

Why do CF patients get infection?

Answer 5

Thick sticky mucus and reduced ciliary action

Question 6

Common infective organisms for CF?

Answer 6

H influenzae
Staph aureus
Pseudomonas aeruginosa

Question 7

Pseudomonas aeruginosa?

Answer 7

Gram negative bacilli
Affects immunocompromised individuals and is opportunistic
Break in first line defences to cause infection eg IV lines etc
Can be found in environment and in healthy people

Damaged epithelium gives chance to form biofilms which are often antibiotic resistant and have multiple virulence factors

Take sputum sample

Question 8

Preventing respiratory infections in CF?

Answer 8

Encourage mucus clearance through chest physiotherapy, nebulisers, bronchodilators etc. Use steroids to reduce inflammation. Prophylactic antibiotics and avoid mixing with other CF patients as well as good nutrition and hand hygiene

Question 9

How to treat pseudomonas aeruginosa?

Answer 9

Combination of antibiotics

Ciprofloxacin

Gentamycin

Question 10

Why do diabetics get infections?

Answer 10

Hyperglycaemia reduces humoral immunity and neutrophils and lymphocytes

Poor vasculature males healing slower etc

Neuropathy makes skin breaches harder to detect

Question 11

Common diabetic infections?

Answer 11

Cellulitis
UTI’s
Malignant otitis externa
Respiratory infections

Question 12

Cellulitis cause and organism?

Answer 12

Hyperglycaemia, reduced perfusion, impaired sensitivity

Staph aureus

Question 13

What to do with diabetic foot ulcer?

Answer 13

Take swab and culture 
Take FBC etc to rule out sepsis 
Check kidney function
Debridement if necessary 
Check HbA1c

Reduce other cardiovascular risk factors and do regular foot checks

Question 14

Why UTI’s in diabetes?

Answer 14

Neuropathy causes defect in bladder control- stasis and infection

Glycosuria provides food for bacteria

Caused by pseudomonas aeruginosa and e.coli

Question 15

DKA and infection?

Answer 15

Infection increases risk of DKA as glucose required to fight inf3ction

Question 16

Respiratory infections?

Answer 16

Reduced perfusion and hyperglycaemia impairing neutrophils

Streptococcus pneumoniae
Haemophilia influenza
Staph aureus

Question 17

COPD?

Answer 17

Chronic inflammatory response in response to irritants inhaled such as cigarette smoke and leads to increased neutrophils and macrophages

Get emphysema and chronic bronchitis

Increased mucus production but cilia impaired so colonisation occurs

Haemophilus influenza and pseudomonas aeruginosa