Lower Respiratory Tract Infection Flashcards
What are the possible lower respiratory tract infections?
Acute bronchitis Exacerbation of COPD Pneumonia Empyema Lung abscess Bronchiectasis
What are the symptoms of pneumonia?
Malaise Fever Chest pain (pleuritic) Cough Purulent sputum Dyspnoea
What is rusty sputum usually associated with?
Pneumococcal pneumonia
What are the signs of pneumonia?
Pyrexia Tachpnoea Central cyanosis Dullness of percussion of affected lobes Bronchial breath sounds Inspiratory crepitations Increased vocal resonance
What are the relevant investigations for patients with pneumonia?
Serum biochemistry and full blood count Chest X-Ray Blood cultures Throat swabs Urinary legionella antigen Sputum microscopy and culture
What are the most likely causes of pneumonia?
Strep pneumoniae H.Influenzae Legionella Staph Aureus Mycoplasma pneumoniae - Chlamydia psittaci All viruses
What is the scoring method for pneumonia?
CURB65
How does the CURB 65 score work?
Confusion Blood urea above 7 Respiratory rate above 30 Diastolic blood pressure less than 60 Age older than 65
A score of:
0 - indicates low risk
1/2 - Hospitalization
3/5 - High risk of death and need for ITU
How do you treat CURB 0-1?
Amoxycillin or clarithromycin / doxycycline
How do you treat CURB 2?
Amoxycillin and clarithromycin or levoflaxin
How do you treat CURB 3-5?
Co-amoxiclav and clarithromycin or levoflaxin (if penicillin allergic)
What other treatment besides antibiotics is advisable?
Oxygen
i.v. fluids
Continuous positive airway pressure
Intubation and ventilation
What are the complications associated with pneumonia?
Septicaemia (typically develop shock) Acute kidney injury Empyema Lung abscess Haemolytic anaemia ARDS
What might pneumonia get confused with?
TB Lung cancer Pulmonary embolism Cardiac failure Pulmonary Vasculitis (Wegners granulomatosis)
Where does TB infect the lung?
Upper lobes because TB is aerophilic and the upper lobes tend to have more air
Why can pulmonary embolism look like pneumonia on a scan?
Because of the pulmonary infarcts they cause
What are the most common causes of empyema?
Streptococcus
Staph aureus
Anaerobes
What are the signs/symptoms of empyema?
Chest pain
Absence of cough
High fever
How do you investigate empyema?
CT and ultrasound
How do you diagnose empyema?
pH is less than 7.2 after pleural aspiration
What is the treatment of empyema?
Chest drain and intravenous antibiotics (prolonged - 6 weeks)
Intrapleural tissue plasminogen activator and DNase sometimes required (these break down adhesions in pleural space and allow tissue to flow out)
Surgery for patients who do not improve with the above management
What can lung abscesses follow from?
Pneumonia
What are the symptoms of a lung abscess?
Non-specific
Lethargy
Weight loss
High Swinging fever
What are the relevant investigations for lung abscess?
CT thorax
Sputum culture
TB microscopy and culture as TB can be cavitating
Which bacteria are more likely to cause lung cavitation?
Staph. Aureus, pseudomonas
What is treatment for lung abscess?
Prolonged antibiotics
Drainage via the bronchial tree or pericutaneous
What is bronchiectasis defined as?
Abnormal widening of the bronchi or their branches, causing a risk of infection
What are the causes of bronchiectasis?
Idiopathic Immotile cilia syndrome Cystic fibrosis Childhood infection (measles) Hypogammaglobulinaemia Allergic bronchopulmonary Aspergillosis
What is hypogammaglobulinaemia?
(body does not produce immunoglobulin G)
What is allergic bronchopulmonary aspergillosis?
Presents like asthma (wheezing and cough)
Allergy to aspergillus
What are the symptoms of bronchiectasis?
Chronic cough Daily sputum production Sometimes - Dyspnoea Tiredness Flitting chest pains Haemoptysis
How do you describe the flitting chest pains in bronchiectasis?
Short lived, vary between the left and the right hand side
What are the signs for bronchiectasis?
Finger clubbing (in severe cases) Course inspiratory crepitations
What are the relevant investigations for bronchiectasis?
HRCT thorax
Sputum culture - will typically include haemophilus influenzae which can be resistant to amoxicillin
Serum immunoglobulins (searching for Hypogammaglobulinaemia)
Total IgE aspergillus precipitations
CF genotyping
What is the treatment of bronchiectasis?
Chest physiotherapy since massive sputum production High dose antibiotics Inhaled therapy (corticosteroids and beta 2 agonists)
