Lower respiratory tract infection in adults Flashcards
What are the possible lower respiratory tract infections ?
Acute bronchitis Exacerbation of COPD Pneumonia Empyema Lung abscess Bronchiectasis
What is acute bronchitis ?
Temporary inflammation of the bronchi
How long does acute bronchitis last for ?
<3 weeks
What are the signs of acute bronchitis ?
Cough
Sputum
What is usually the cause of acute bronchitis ?
Viral
What is COPD exacerbation ?
Worsening of symptoms
Change in colour of sputum
Increased SOB, wheeze, cough
What is a likely caustitive agent of AECOPD ?
Strep pneumoniae
H.Influenzae
Moraxella catarrhalis
Viral
What is the treatment of COPD exacerbation ?
Steroids
Antibiotics
- amoxycillin
- doxycycline
- co-trimoxazole
- clarithromycinWhat is pneumonia ?
Inflammation of the lung parenchyma
How many cases of acute bronchitis develop into pneumonia ?
1 in 10
What is consolidation ?
Solidification due to cellular exudate in alveoli leads to impaired gas exchange
What are risk factors for pneumonia ?
Smoking, alcohol Extremes of age Preceding viral illness Pre-existing lung disease Chronic illness Immunocompromised Hospitalisation IDVU
What are the symptoms of pneumonia ?
Malaise Fever Chest pain (pleuritic) Cough Purulent sputum Dyspnoea Haemoptysis
What is rusty sputum usually associated with ?
Strep pneumoniae
Pneumococcal pneumonia
What are the signs of pneumonia ?
Pyrexia Tachycardia Tachypnoea Central cyanosis Dullness of percussion of affected lobes Bronchial breath sounds Inspiratory crepitations Increased vocal resonance
What are the investigations for pneumonia in community ?
Maybe none
CXR if in doubt
What are the investigations of pneumonia in hospital ?
Bloods- serum biochemistry, FBC, CRP Blood cultures CXR Sputum culture Viral throat swab Legionella urinary antigen
What are the most likely causes of pneumonia ?
Strep pneumonia
H.Influenzae
Legionella Staph aureus Moraxella catarrhalis Mycoplasma pneumoniae Chlamydophilia pneumoniae Chlamydophilia psittaci Coxiella burnetti All viruses
What are the differential diagnosis of pneumonia ?
TB Lung cancer Pulmonary embolism Pulmonary oedema Pulmonary vasculitis (wegners granulomatosis)
What are typical community acquired microorganisms ?
Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
What are atypical community acquired microorganisms ?
Legionella pneumophilia Chlamydia pneumoniae Chlamydia psittaci Coxiella burnetti Moraxella catarrhalis Viruses
What is nosocomial infection ?
healthcare-associated infections (HAI)
Infections acquired during the process of receiving health care that was not present during the time of admission
When does nosocomial (HAI) occur ?
> 48hrs after admission
What are nosocomial microorganisms ?
Enterobacteria
Staphylococcus aureus
Pseudomonas aeruginosa
Klebsiella pneumoniae
How is the severity of pneumoia scored ?
CURB65
What does CURB65 mean ?
C- confusion U- blood urea >7mmol/L R- RR >/= 30/min B- systolic BP <90mmHg, diastolic BP <60mmHG 65- age >/= 65
What does a CURB score of 0-1 mean ?
Low risk- could be treated in community
What does a CURB score of 2 mean ?
Moderate risk- hospital treatment usually required
What does a CURB score of 3-5 mean ?
High risk of death and need for ITU
What is the treatment for a CURB score of 0-1 ?
Amoxycillin
Clarithromycin/ doxycycline (if penicillin allergy)
for 5 days
What is the treatment for a CURB score of 2 ?
Amoxycillin + clarithromycin
Levofloxacin (if penicillin allergy)
5-7 days
What is the treatment for a CURB score of 3-5 ?
Co-amoxiclav + clarithromycin
Levofloxacin or co-trimoxazole (if penicillin allergy)
7-10 days
What other treatment besides antibiotics is advisable ?
Oxygen
IV fluids
Continuous positive airway pressure
Intubation and ventilation
What are the complications of pneumonia ?
Sepsis Acute kidney injury Adult resp distress syndrome Parapneumonic effusion Empyema Lung abscess Disseminated infection
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 percutaneous
What are the risk factors for recurrent pneumonia ?
Immunocompromised
Underlying structural lung disease
Aspiration
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 Childhood infection CF Ciliary dyskinesia Hypogammaglobulinemia Allergic bronchi-pulmonary aspergillosis (ABPA)
What is hypogammaglobulinemia ?
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 productive cough Daily sputum production Breathlessness Recurrent LRTI Haemoptysis
What are the signs of bronchiectasis ?
Finger clubbing
Coarse creps
Wheeze
Obstructive spirometry
How do you describe the flitting chest pains in bronchiectasis ?
Short lived, vary between the left and the right hand side
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 Hypogammaglobulinemia)
Total IgE aspergillus precipitations
CF genotyping
What is the treatment of bronchiectasis ?
Chest physiotherapy since massive sputum production
High dose antibiotics
Mucolytics
Inhaled therapy (corticosteroids and beta 2 agonists)
Vaccinations
