Lower Respiratory Tract Infection

Question 1

what are the clinical signs of organ dysfunction?

Answer 1

brain = confusion

lungs = increased resp rate and hypoxia

heart = icreased heart rate and low BP

kidneys = oliguria and high creatinine

skin = prolonged central capillary refill

Question 2

what is the sepsis 6?

Answer 2

give 3 and take 3 - within the first hour of presentation

Give: oxygen, broad spec. antibiotics, fluids

take: blood cultures, FBC, urinary output

Question 3

what type of epithelium do we find in the lower resp. tract?

Answer 3

ciliated collumnar epithelium with mucous producing goblet cells

Question 4

what immune cells exist at the level of the alveoli?

Answer 4

alveolar macrophages

Question 5

what is the definition of pneumonia?

Answer 5

acute lower respiratory tract infection involving the lung parenchyma

Question 6

what categories do we seperate pneumonia into? Why is that relevant?

Answer 6

community acquired pneumonia

hospital acquired pneumonia

It’s important to distinguish as different causative organisims

Question 7

How do patients with pneumonia present?

Answer 7

systemic: fever, rigors, malaise, myalgia, anorexia
cough: often productive of purulent sputum

dyspnoea

tachypnoea

haemoptysis

pleuritic chest pain

Question 8

what sort of investigations should we order in a suspected case of penumonia?

Answer 8

• blood culture
• sputum
• FBC
• urinary antigen for legionella/pneumococcus
• nose/throat swab for influenza
• WCC/inflammatory markers
• CXR

Question 9

what is the difference between community acquired pneumonia and hospital acquired pneumonia?

Answer 9

community = pneumonia is acquired thorugh the community

hospital= pneumonia that occurs 48 hours or more after a hospital admition= “nosocomial” pneumonia

HAP is different to CAP b/c of additional patient risk factors, and different infectious diseases invovled so different antimicrobials are required

Question 10

is healthcare associated pneumonia the same thing as hospital acquired pneumonia?

Answer 10

No.

In fact, healthcare associated pneumonia is more similar to community acquired pneumonia than hospital acquired pneumonia

Question 11

what is the most common bacterial cause of community acquired pneumonia?

Answer 11

streptococcus pneumoniae - 60%

mycoplasma pneumoniae= 10-20%

Question 12

describe strep. pneumonia laboratory characteristics

Answer 12

gram - positive

optochin sensitivie

alpha haemolytic

catalase negative

Question 13

what should be your treatment to strep. pneumonia assuming no allergies?

Answer 13

Amoxicillin for oral switch

if there is a penicillin allergy = cefotaxime IV

Question 14

what does H. Influenzae cause?

Answer 14

it is a bacteria which causes pneumonia, NOT the flu- the flu is a result of the influenza virus

Question 15

what sort of atypical pnuemonias might we see?

Answer 15

• mycoplasma s
• legionella s
• chlamydias
• coxiellas

Question 16

what pneumonia do we see in people who are exposed to birds?

Answer 16

chlamydia psittaci

• contraction via inhalation of dried, infected bird droppings

Question 17

what pneumonia might we see with farmers, veterinarians, abattoir workers etc.

Answer 17

coxiella burnetii (Qfever)

• it is a zoonosis from sheep/cattle/goats

Question 18

what pneumonia is associated with an abscess formation - and is notable for it’s severe infection of previously healthy young people?

Answer 18

staph aureus

Question 19

what sort of viral causes of pneumonia might we see?

Answer 19

Influenza A&B

RSV

chickenpox in immunosuppressed

measles

CMV

Question 20

what sort of bugs do we see in hospital acquired pneumonia?

Answer 20

gram negative bacilli: E.coli, klebsiella spp, enterobactor spp, pseudomas spp,

Staph Aureus

Legionella Pneumophila

Viruses

Question 21

what pneumonias would we consider in immunocompromised patients?

Answer 21

fungi = aspergillus fumigatus and cryptococcus neoformans

viruses = herpes simplex, cytomegalovirus

mycobacteria= non-tuberculous mycobacteria and M tuberculosois

Question 22

why do CF patients get infections?

Answer 22

1. defects in microbial clearance
2. altered salt content in airway surface - liquid inactivates antimicrobial defensins and impairs neutrophila killing
3. receptor for P. aeruginosa
4. decreased NO antibacterial predisposes to lung infection
5. airways hyperinflammatory

Question 23

what pathogens are most likely to infect CF patents?

Answer 23

P. Aeruginosa

and S. Aureus