Lower respiratory tract infection - adults Flashcards
What is acute bronchitis?
Inflammation of the bronchi
Is temporary so lasts less than 3 weeks
Usually viral
Symptoms - cough and sputum
What is the treatment for acute bronchitis?
Supportive management - drinking lots of fluid and taking paracetamol
What is chronic bronchitis defined as?
Cough lasting 3 months of the year for at least 2 years in a row
When would you go see the GP with bronchitis?
Cough lasts more than 3 weeks, high temp. for more than 3 days, sputum is streaked with blood, have underlying heart or lung condition, if becoming more breathless and have had repeated episodes of bronchitis
What are the symptoms of a COPD exacerbation?
Change in colour and amount of sputum
Fever
Increased breathless
Wheeze
Cough
What are common bacterial and virial causes of COPD exacerbations?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Many viral causes
What is the treatment for COPD exacerbations?
Steroids to reduce inflammation
Antibiotics for infection - amoxicillin, doxycycline, co-trimoxazole and clarithromycin
Maybe nebulisers if severe
What is pneumonia?
Inflammation of lung parenchyma - comprises of thin walled alveoli
What is bronchopneumonia?
It is the acute inflammation of the bronchi, accompanied by inflamed patches in the nearby lobules of the lungs
Is patchy and usually only one lung affected
What is lobar pneumonia?
Lobar pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung
What is interstitial pneumonia?
Is an inflammatory process and is usually viral
What are some of the risk factors for pneumonia?
Smoking and alcohol excess
Extremes of age
Preceding viral illness, Pre-existing lung diseases, chronic illness, immunocompromised, hospitalisation and IV drug abusers
What are the symptoms of pneumonia?
Fever, rigors and myalgia - pain in muscles
Cough and sputum
Chest pain that is increased on deep inspiration
Dyspnoea - SOB
What are some clinical signs of pneumonia?
Tachypnoea, tachycardia, reduced expansion, dull percussion, bronchial breathing, crepitations and vocal resonance as lung is more solid
What does rusty brown sputum in a patient show?
They have strep. pneumoniae
What community investigations would be made in pneumonia?
Maybe non
CXR if diagnosis in doubt or not improving
What investigations could be made in the hospital for pneumonia?
Bloods - serum biochemistry, FBC and CRP
Blood cultures
CXR
Sputum culture, viral throat swab
Legionella urinary antigen
What are differential diagnosis to a patient with pneumonia symptoms?
Tuberculosis, Lung cancer, Pulmonary embolism, Pulmonary oedema, Pulmonary vasculitis
What typical bacteria causes community acquired pneumonia?
Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
What atypical bacteria causes community acquired pneumonia?
Legionella pneumophilia
Chlamydia pneumoniae
Chlamydia psittaci
Coxiella burnetti
Moraxella catarrhalis
Viruses - influenza, RSV, SARS..
What the bacteria found in hospital acquired pneumonia?
Enterobacteria
Staphylococcus aureus
Pseudomonas aeruginosa
Klebsiella pneumoniae
Describe CURB65 and pneumonia severity
C - confusion
U - blood urea > 7 mmol/L
R - respiratory rate > 30/min
B - systolic BP < 90 mmHg, diastolic blood pressure < 60 mmHg
65 - age > 65
What is the score system for CURB 65?
0-1 low risk - treat in community
2 moderate risk - hospital treatment required
3-5 high risk of death and need for intensive care
What things do you need to consider in the CURB65 severity scale?
People who are hypoxic, young people and multi-lobar consolidations
What is the treatment for low risk pneumonia?
Amoxicillin
Clarithromycin or doxycycline if penicillin allergy
Duration is 5 days
What is treatment for moderate risk pneumonia?
Amoxicillin and clarithromycin
Levofloxacin if penicillin allergy
Duration is 5-7 days
What treatment is for high risk pneumonia?
Co-amoxiclav and clarithromycin
Levofloxacin or co-trimoxazole if penicillin allergy
Duration is 7-10 days
When would patients with pneumonia take antibiotics with IV?
If signs of sepsis
What supportive management is needed for pneumonia?
O2, fluids, antipyretics, NSAIDs
Intubation and ventilation
Explain aspiration pneumonia?
Inhalational acute lung injury that occurs after aspiration of sterile gastric contents
Happens in patients who have had a stroke, MS, myasthenia, sedation, oesophageal disease
Anaerobes likely - amoxicillin and metronidazole
What is used to treat MRSA?
Vancomycin
What are some complications of pneumonia?
Sepsis, acute kidney injury, adult respiratory distress syndrome, parapneumonic effusion, empyema, lung abscess and disseminated infection
What are signs of complicated pneumonia?
Swinging fever
Sweats
Persistently high WCC/ CRP
Weight loss
Failure to improve
What is empyema?
The collection of pus in a cavity in the body, especially in the pleural cavity
What is parapneumonic effusion
Parapneumonic effusion (PPE) is a type of pleural effusion - Pleural effusion is a build up of fluid in the pleural cavity. Having too much fluid in the pleural space can prevent your lungs from fully expanding and make it hard to breathe
What is the treatment for empyema/ parapneumonic effusion?
May need to drain and prolonged antibiotics
Surgery may be needed and drugs through chest drains
What is a lung abcess?
Also called a pulmonary abscess, is a pus-filled cavity in the lungs caused by an infection
More likely staph aureus, pseudomonas, anaerobes…
Purulent sputum and haemoptisis
What is the treatment for a lung abscess?
Screen for TB
CT scan and maybe bronchoscopy
Prolonged antibiotics
What is the recovery for pneumonia?
Takes weeks
Repeat CXR 6 weeks if over 50 years and smoker
Smocking cessation should be encouraged and helped
What could recurrent pneumonia suggest?
Person may be immunocompromised, have underlying structural lung disease, cancer or aspiration
What is bronchiectasis?
Bronchiectasis is a long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection
What are some causes of bronchiectasis?
Idiopathic
Childhood infection, CF, Ciliary dyskinesia, hypogammaglobulinemia, allergic Broncho-pulmonary aspergillosis
What are the symptoms and clinical examination signs for bronchiectasis?
Symptoms - chronic productive cough, breathlessness, recurrent LRTI and haemoptysis
Examination - finger clubbing, crepitations, wheeze and obstructive spirometry
What bacteria can cause infective exacerbations of bronchiectasis?
Staph. aureus
Haemophilus influenza
Pseudomonas aerigunosa
What treatment would be given to patients with infective exacerbations of bronchiectasis?
Mucolytic, prolonged antibiotic course and vaccines
Consider prophylactic antibiotics if frequent
