Lower Respiratory Infections Flashcards
PE RSP signs for LRTI
Inspection /Palpation Percussion / Auscultation
No nasal flaring, no retractions. CTAB, no W/R/R.
Bacterial etiology more suspect when ?
symptoms prolonged - duration w/ worsening symptoms
causes of acute bronchitis
- Bacterial or viral respiratory infection of the respiratory tract
- heavy smoking
- Allergy due to dust, pollen, mold, etc.
what pathogenic cause accounts for 90-95% of cases in healthy adults
viruses
(Rhino, Adeno, Flu A/B, RSV, Coronavirus, Echovirus, Coxsackie A/B, and Parainfluenza)
bacterial acute bronchitis MC affects who?
unhealthy/compromised
(M. pneumo, Strep pneumo, H. flu, M. catarrhalis, and B. pertussis)
pathophys of acute bronchitis
- Infection in conducting airway
- Inflammation of airway
- Exudate production
- Bronchospasm
Two sequential phases of acute bronchitis
- Direct inoculation of tracheobronchial epithelium
- Responsible for typical symptomatology
- Lasts 1-5 days - Hypersensitivity of the airway receptors
- Responsible for persistent symptomatology
- Lasts 1-3 weeks (peak 7-14 day)
- Sloughed epithelium = ↑ sputum production
- Air passages clogged by debris and irritation
the cause of kennel cough in dogs
B bronchiseptica
sx of acute bronchitis
cough - Nonproductive / mucopurulent
Substernal Pain
Wheezing
Fever - 38.3 - 38.9 C
Fatigue
Malaise
Chest Tightness
SOB
Dyspnea / PND
Cyanosis
PE findings of acute bronchitis
during PE you find
Most generally cough with or without bronchospasm
Wheezing variable (worse in smokers and asthmatics)
Rhonchi (clears with cough)
Sputum variable
Low grade Fever (rare, depending on causative factor)
Chest wall tenderness
Findings more suggestive of URTI
Nasal congestion, rhinorrhea, erythematous throat, injected sclera
Lymphadenopathy
stridor is indicative of
Obstruction in tracheobronchial tree
Heaves are indicative of
RVH secondary to Chronic Bronchitis
clubbing is indicative of
Chronic Bronchitis or CF
Bullous is indicative of
M. pneumo
Conjunctivitis, adenopathy, and rhinorrhea in acute bronchitis is indicative of?
adenovirus
when does acute bronchitis become emergent
Pneumonia: (fever, tachypnea, tachycardia)
PE: (dyspnea, tachypnea, thoracic pain, tachycardia)
Pulmonary edema: (tachypnea, dyspnea, rales)
Status asthmaticus: (expiratory rhonchi, prolonged expiration, wheezing, beware: silent chest)
Pneumothorax: (stabbing thoracic pain, asymmetric thoracic motion, unilateral attenuation of breath sounds, hypersonic percussion sound)
Foreign Body Aspiration: (dyspnea, inspiratory stridor)
CHF
diagnostic labs ordered for acute bronchitis
- NP swab / viral panel - Influenza, COVID
- CBC w/ diff
- Procalcitonin (to distinguish bacterial vs. nonbacterial)
- > 0.25 mcg/L (non-ICU)
- > 0.5 mcg/L (ICU) - Blood CX (if bacterial suspected)
- Sputum cytology, gram stain, culture (if cough persistent, ill appearing and diagnosis unclear)
- Bronchoscopy (to exclude foreign body aspiration, TB, tumors, and other chronic diseases)
tx for acute bronchitis
Reassurance & Education
Symptomatic Treatment
- Rest, Hydration
- Cough meds - Antitussives, Expectorants
- Antihistamines (diphenhydramine)
- Decongestants (phenylephrine)
- B2 Agonists (albuterol) - if wheezing
HR >100, RR >24, oral temp >38℃, and abnormal lung exam is indicative for what condition
pneumonia
CXR of acute bronchitis vs pneumonia
bronchitis - clear
pneumonia - consolidation
does sputum color in acute bronchitis mean anything?
naur
is bronchitis contagious?
yes
The surface proteins ____ and _____ are critical for virulence of influenza
hemagglutinin
neuraminidase
what type of influenza is the most pathogenic
A
pathophys time line of influenza
incubation period 1 - 4 days
Transmission 1 day before onset of sx
Viral shedding lasts for approx 5 - 10 d
Most virulent in the first 3 days of sx
flu seasons in tropics and northern hemisphere
tropical - throughout the year
northern - starts in early fall, peaks in mid-February, and ends in the late spring of the following year
sx of influenza
F, HA, fatigue
sore throat, rhinorrhea, nasal congestion
cough, dyspnea
N/V/D
myalgia, joint pain, body aches
The criterion standard for confirming influenza virus infection is ?
reverse transcription-polymerase chain reaction (RT-PCR)
viral cx of nasopharyngeal or throat secretions
other work up for influenza
- CXR r/p penumonia
- Early radiographic findings include no or minimal bilateral symmetrical interstitial infiltrates.
- Later, bilateral symmetrical patch infiltrates become visible - Focal infiltrates indicate superimposed bacterial pneumonia
- CBC may show leukopenia and lymphocytopenia
- Ask about exposures, day care, school, work environment, etc.
management of influenza
- Supportive care
- Rest and hydration
- Supplemental oxygen - Hospitalization if evidence of hypoxia or in high-risk groups (infants, elderly, immunocompromised)
- NSAIDs or acetaminophen for fever and myalgias
- Isolation and good hygiene to prevent spread
antivirals for influenza
- Oseltamivir (Tamiflu) 75 mg bid X 5 days (adolescent/adult)
- Zanamivir (Relenza)
- Rapivab (Peramivir) (IV only) (FDA approved in 2014)
- Baloxavir marboxil (Xofluza) (FDA approved in fall of 2018) - indicated for high-risk
which influenza antivirals are neuraminidase inhibitors
oseltamivir
zanamivir
which influenza antivirals have activity aginst A and B including H1N1
oseltamivir and zanamivir
polymerase acidic (PA) endonuclease inhibitors
influenza antivirals must be administered when in order to be effective as tx
within 48 hours of symptom onset
which influenza antiviral is wt based dosing
tamiflu
prevention for influenza
