Lower Respiratory Tract Infection - ADULTS Flashcards
Acute bronchitis
- Inflammation of bronchi
- Temporary <3 weeks
- Cough and sputum
- Usually viral
- Supportive management
COPD exacerbation
- Change in colour of sputum
- Fevers
- Increased breathlessness
- Wheeze
- Cough
Treatment for COPD exacerbation
- Steroids
- Antibiotics:
~ amoxicillin
~ doxycycline
~ co-trimoxazole
~ clarithromycin - +/- nebulisers
Pneumonia
- Inflammation of lung parenchyma
- 1 in 20 acute bronchitis -> pneumonia
Risk factors for pneumonia
- Smoking, alcohol XS
- Extremes of age
- Preceding viral illness
- Pre-existing lung disease
- Chronic illness
- Immunocompromised
- Hospitalisation
- IVD
Symptoms of pneumonia
- Fever, rigors, myalgia
- Cough and sputum
- Chest pain (pleuritic)
- Dyspnoea
- Haemoptysis
Signs of pneumonia
- Tachypnoea
- Tachycardia
- Reduced expansion
- Dull percussion
- Bronchial breathing
- Crepitations
- Vocal resonance
Investigations of pneumonia
- Community: Maybe none!
CXR if diagnosis in doubt, not improving, ?ca - Hospital:
Bloods – serum biochemistry, FBC, CRP
Blood cultures
CXR
Sputum culture, viral throat swab
Legionella urinary antigen
Microbiology
- Strep Pneumoniae 39%
- H. Influenzae 5.2%
- Legionella 3.6%
- Staph aureus 1.9%
- Moxarella catarrhalis 1.9%
- Mycoplasma pneumoniae 10.8%
- Chlamydophila pneumoniae 13.1%
- Chlamydophyla psittaci 2.6%
- Coxiella burnetii 1.2%
- All viruses 13.1%
CLASSIFICATION
SEE NOTES
Pneumonia - severity scoring
CURBS
C = confusion
U = blood urea > 7mmol/L
R = respiratory rate >/= 30/min
B = systolic BP < 90 mmHg, diastolic blood pressure < 60mmHg
65 = age >/= 65
A SCORE OF
0-1 low risk - could be treated in community
2 moderate risk - hospital treatment usually required
3-5 high risk of death and need for ITU
Pneumonia - treatment
SEE NOTES TABLE
Lung abscess
- More likely with Staph aureus, pseudomonas, anaerobes…
- Purulent sputum, haemoptysis
- Screen for TB
- CT scan +/- bronchoscopy
- Prolonged abx
Recovery of lung abscess
- Takes weeks!
- Repeat CXR 6 weeks if >50yrs, smokers
- Smoking cessation
What questions may arrise from recurrent pneumonia?
- Immunocompromised?
- Underlying structural lung disease?
- Aspiration?
What causes bronchiectasis?
- Idiopathic
- Childhood infection
- CF
- Ciliary dyskinesia
- Hypogammaglobulinaemia
- Allergic Broncho-Pulmonary Aspergillosis (ABPA)
Symptoms of bronchiectasis
- Chronic productive cough
- Breathlessness
- Recurrent LRTI
- Haemoptysis
- Finger clubbing
- Crepitations (coarse)
- Wheeze
- Obstructive spirometry
INFECTIVE EXACERBATIONS
SEE NOTES
What are the complications of pneumonia
- Sepsis
- Acute Kidney Injury
- Adult Respiratory Distress Syndrome
- Parapneumonic effusion
- Empyema
- Lung Abscess
- Disseminated infection
