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Clinical pathology > Lower resp tract infections > Flashcards

Lower resp tract infections Flashcards

1
Q

Methods of acquiring Pneumonia

A

Community

Hospital (Pneumonia developing >48hrs after hospital admission)

Ventilator (Subgroup of HAP: Pneumonia developing >48hrs after ET intubation & ventilation)

Aspiration (Subgroup of HAP
Pneumonia resulting for the abnormal entry of fluids e.g. food, drinks, stomach contents, etc. into the lower respiratory tract, Patient usually has impaired swallow mechanism)

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2
Q

Predisposing factors to URTI

A

Loss or suppression of cough reflex / swallow

e.g. stroke, coma, ventilation

Ciliary defects e.g. PCD (primary ciliary dyskinesia)

Mucus disorders e.g. CF

Pulmonary oedema – fluid flooding alveoli

Immunodeficiency: congenital or acquired (Multiple examples!)

Macrophage function inhibition e.g. smoking

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3
Q

Acute Bronchitis

A

Inflammation & oedema of trachea and bronchi

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4
Q

Symptoms of bronchitis

A

Cough (typically dry)
Dyspnoea & tachypnoea
Cough may be associated with retrosternal pain

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5
Q

Cause of Acute Bronchitis

A

Most frequent in winter, in children

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6
Q

Diagnosis of acute bronchitis

A

Diagnostic tests not indicated in mild presentations

Look at vaccination history and previous exposures (influenza, B. pertussis )
If needed then get cultures from resp secretions

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7
Q

Treatment of Bronchitis

A

Supportive treatment for healthy patients

Those with severe disease or co-morbidities may require oxygen therapy or respiratory support

Antibiotics only if bacterial cause is suspected or found

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8
Q

What is Chronic Bronchitis

A

Cough productive of sputum on most days during at least 3 months of 2 successive years (which cannot be attributed to an alternative cause)

If airflow obstruction present on spirometry = COPD

Inflammation & oedema of airways is mediated by exogenous irritants (rather than infective agents)

Patients have acute exacerbations mediated by same infective pathogens as acute bronchitis

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9
Q

Bronchiolitis

A

Mostly kids

Affects bronchioles- inflammation and oedema

Most commonly caused by RSV (75% of cases)
- 80% children have evidence of previous RSV infection by 2yrs old
Also caused by parainfluenza, adenovirus, influenza

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10
Q

Symptoms of Bronchiolitis

A

Acute onset wheeze, cough, nasal discharge, respiratory distress (grunting, retractions, nasal flaring)

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11
Q

Diagnosis of Bronchiolitis

A

Chest X-ray
Full Blood count

Microbiological diagnosis: usually nasopharyngeal aspirate of respiratory secretions sent for viral PCR

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12
Q

Treatment for Bronchiolitis

A

Supportive: oxygen, feeding assistance

No clear evidence to support steroids, bronchodilators, ribavirin

Antibiotics only if complicated by bacterial infection

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13
Q

Pneumonia

A

Infection affecting the most distal airways and alveoli

Formation of inflammatory exudate

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14
Q

Two anatomical types of Pneumonia

A

1) Bronchopneumonia
Characteristic patchy distribution centred on inflamed bronchioles & bronchi then subsequent spread to surrounding alveoli

2) Lobar pneumonia
Affects a large part, or the entirety of a lobe
90% due to S.pneumoniae

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15
Q

What are atypical organisms

A

Described cases which failed to respond to penicillin or sulpha drugs and no organism could be identified

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16
Q

Typical Organisms examples

A 
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella  catarrhalis
Staphylococcus aureus
Klebsiella pneumoniae
17
Q

Atypical Organisms examples

A 
Mycoplasma pneumoniae
Legionella pneumophilia
Chlamydophila pneumoniae
Chlamydophila psittaci
Coxiella burnetii
18
Q

Clinical Presentation of Atypical Organisms

A

PRINT OUT SHEET!

19
Q

Clinical presentation of BACTERIAL CAP

A 
Symptoms:
Usually rapid onset
Fever / chills
Productive cough 
Mucopurulent sputum
Pleuritic chest pain
General malaise: fatigue, anorexia
Signs:
Tachypnoea, tachycardia, hypotension
Examination findings consistent with consolidation: 
-Dull to percuss
-Reduced air entry, bronchial breathing
20
Q

Clinical Presentation - Influenza (VIRAL)

A

Usually influenza produces uncomplicated disease:
Fever, headache, myalgia, dry cough, sore throat
Convalescence takes 2-3 weeks

Primary viral pneumonia occurs more commonly in patients with pre-existing cardiac & lung disorders
Cough, breathlessness, cyanosis
Secondary bacterial pneumonia then may develop after initial period of improvement:
S.pneumoniae, H.influenzae, S.aureus

Diagnosis: viral antigen detection in respiratory samples using PCR

21
Q

Non microbiological investigations

A

Routine observations: BP / pulse / oximetry

Bloods: including FBC / U&E / CRP / LFTs

Chest X-ray

22
Q

Microbiological investigations for inpatients: CAP

A

Recommended for all moderate-severe CAP based on CURB65 score >2

Sputum Gram stain & culture
Blood culture
Pneumococcal urinary antigen
Legionella urinary antigen
PCR or serology for:
-Viral pathogens e.g. influenza (PCR of respiratory samples)
-Mycoplasma pneumoniae (PCR of respiratory samples preferable, complement fixation: interpret with caution)
-Chlamydophila sp. (complement fixation test most widely available – on blood)

23
Q

Importance of Diagnosis

A

Optimise antibiotic selection
Limit the use of broad spectrum agents
Identify organisms of epidemiological significance
Identify antibiotic resistance and monitor trends
Identify new or emerging pathogens

24
Q

Assessment of disease severity: CAP

A 
CURB65
Confusion
Urea >7mmol/l
Resp rate >= 30
Blood pressure systolic >90 diastolic65
25
Q

Management of Septic CAP patient

A

A = Airway
ensure an open, patent and maintained airway

B = Breathing
Assess respiratory rate and saturations
Provide supplemental oxygen to reach prescribed target

C = Circulation
Assess blood pressure and heart rate
Gain IV access and give IV fluids if haemodynamically unstable
Urinary catheter to monitor urine output

Then prompt empirical antibiotic therapy

26
Q

Prevention of LRTI

A

Pneumococcal vaccination (S. pneumoniae)

  • Patients with chronic heart, lung and kidney disease
  • Patients with splenectomy
  • May repeat after 5 years in certain populations

Influenza vaccination for vulnerable groups (annually)

  • Over 65s
  • Chronic disease, multiple co-morbidities

Clinical pathology (5 decks)

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