lower respiratory tract infection Flashcards

1
Q

what part of the airway is the lower airway?

A

from trachea downwards

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2
Q

name common LRTIs?

A

bronchitis, bronchiolitis, pneumonia, influenza

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3
Q

what pathogen commonly causes LRTIs?

A

bacteria or virus

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4
Q

in what % of acute bronchitis is the cause identified?

A

> 30% of cases

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5
Q

what % of cases of acute bronchitis are viral and bacterial?

A

90% of cases = viral, 10% = bacterial

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6
Q

how long is acute bronchitis symptomatic for?

A

up to 2 weeks

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7
Q

what viruses can cause acute bronchitis?

A

adenoviruses, coronavirus, parainfluenza, influenza and rhinovirus

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8
Q

what bacteria cause acute bronchitis?

A

Bordetella pertussis & Mycoplasma pneumonia

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9
Q

what causes severe bronchiolitis?

A

Respiratory Syncytial Virus

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10
Q

what are symptoms of acute bronchitis?

A

sore throat, fatigue, stuff or runny nose, fever, body aches, vomiting, diarrhoea

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11
Q

what is the pathophysiology of acute bronchitis?

A
  • RSV infects host cells – activates innate and adaptive response
  • Viral RNA is recognised by TLRs and RIG-I-like receptors
  • Triggers release of early inflammatory mediators e.g. IFNs , TNF-a and chemokines (CXCL8 and CXCL11)
  • NK cells, PMNs, macrophages release cytokines
  • Dendritic cells present to T cells  B cells  antibodies
  • T cells also activate eosinophils which release cytokines
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12
Q

what do IFNs do?

A

upregulate pro-apoptotic factors in epithelial cells)

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13
Q

what does TNF-a and chemokines do?

A

recruit NK cells and polymorphonuclear leukocytes (PMNs) -kill infected cells and limit viral replication

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14
Q

how can you prevent acute bronchitis?

A
  • Avoid contact with viral particles
  • Wash hands frequently
  • Avoid touching your eyes with contaminated hands
  • Use disposable tissues
  • Use hand sanitisers to stop spread of germs
  • Avoid touching your nose
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15
Q

how do you manage acute bronchitis?

A
  • encourage increased fluid intake, humidity

- recommend antipyretics, analgesics and antitussives for symptom relief

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16
Q

define pneumonia?

A

inflammation of the alveoli in either one or both lungs

become inflamed and fill up with fluid

17
Q

what’s the most common causative agent to cause pneumonia?

A

Strep. Pneumoniae

18
Q

which groups of people are most at risk of pneumonia?

A

elderly and the very young

19
Q

what % of S. pneumoniae are resistant to penicillin and macrolides?

A

Penicillin (10%) & Macrolides (15%)

20
Q

how long does it usually take pneumonia symptoms to resolve without complications?

21
Q

what can complicate the duration for which pneumonia symptoms take to resolve?

A

Primary influenza pneumonia/secondary bacterial pneumonia can complicate this

22
Q

what are the symptoms of pneumonia?

A

headache, fever, weakness, dry cough, nasal congestion, chills, sore throat, sweating, muscle aches

23
Q

how long do pneumonia symptoms last?

A

3-4 weeks

Daily activities impaired for a further 3 weeks

24
Q

what is the pathophysiology of pneumonia?

A
  • Pneumonia (direct injury) → Inflammation → Innate immunity →Alveolar injury/dysfunction
  • Invasion & overgrowth of a pathogenic microorganism in the lung parenchyma → intra-alveolar exudates → Pneumonia
25
what diagnosis methods are used for pneumonia?
* Physical exam * Complete blood count * Sputum culture * Urine test * PCR * CT scan * Chest x-ray – right lower lobe consolidation with mid-zone changes
26
how is CAP diagnosed in secondary care?
clinical symptoms + signs of a LRTI + CXR (consolidation
27
how is CAP diagnosed in primary care?
Symptoms + New focal chest signs on examination + At least one systemic feature (fevers, sweats, rigors and/or a temperature of ≥38oC) o CXR not usually available in a primary care setting
28
what is the criteria of the CRB65 severity score?
o Confusion o Respiratory Rate > 30/min o Blood pressure (SBP <90 or DBP <60) o Age > 65 years
29
what treatment should be given for each range of scores of the CRB severity score?
* 0 – low severity. Likely suitable for home treatment. Give antibiotics as per the table. * 1-2 – moderate severity. Consider hospital referral * 3-4 – high severity. Urgent hospital admission. Empirical antibiotics if life-threatening
30
what are the main causes of early treatment failure in pneumonia?
• Sepsis and cardiovascular complications
31
how can you prevent pneumonia?
* Routine immunisations, including pertussis, measles and Hib * Pneumococcal vaccinations * Exclusive breastfeeding for the first 6 months * Safe drinking water, good sanitation and frequent hand washing with soap * Good nutrition esp for children over 6 months of age * Improve indoor air quality * Recognising danger signs of pneumonia and seek care quickly
32
what are the clinical parameters for severe pneumonia in a baby less than 2 months of age?
RR >60/min and/or lower chest wall in-drawing
33
what are the clinical parameters for very severe pneumonia in a baby less than 2 months of age?
any of the below; - central cyanosis - not able to drink - head nodding
34
what are the clinical parameters for pneumonia in children 2-60 months?
RR >50/min for 2-11 months | RR > 40/min for 12-60 months
35
what are the clinical parameters for severe pneumonia in children 2-60 months?
lower chest wall in-drawing
36
what are the clinical parameters for very severe pneumonia in children 2-60 months?
central cyanosis unable to drink head nodding